Incisional Hernia Repair of Medium- and Large-Sized Defects: Laparoscopic IPOM Versus Open SUBLAY Technique.

Background: Small incisional hernias can be repaired laparoscopically with low morbidity and reasonable recurrence rates. The aim of this study was to compare laparoscopic with open technique in medium- and large-sized defects regarding postoperative complications and recurrence rates. Methods: Between 2012 and 2016, 102 patients with medium- or large-sized defects according to EHS classification underwent incisional hernia repair. Patients' characteristics, hernia size and postoperative complications were prospectively recorded. In October 2016, eligible patients were assessed for recurrence. Results: About 31 patients underwent laparoscopic IPOM and 71 patients open SUBLAY repair. Morbidity rate was significantly lower in IPOM group than in SUBLAY group (19% versus 41%; p = .028). Postoperative complications according to Clavien-Dindo classification were significantly lower in the IPOM group (p = .021). Duration of surgery (88 versus 114 min; p = .009) and length of hospital stay (five versus eight days; p < .001) were significantly shorter for IPOM than for SUBLAY. 71 patients were available for follow-up. Recurrence rates showed no significant difference between study groups (13% versus 7%, p = .508). Conclusions: Laparoscopic repair in medium- and large-sized defects is a feasible and safe approach. IPOM compared to SUBLAY significantly reduces postoperative complications and hospital stay; recurrence rates are comparable.

Impact of obesity on postoperative complications after laparoscopic and open incisional hernia repair - A prospective cohort study.

BACKGROUND: Obese patients are often required to lose weight prior to incisional hernia repair as obesity is thought to increase postoperative complications and recurrence rates. The aim of this study was to determine the impact of BMI on the outcome after laparoscopic and open incisional hernia repair. MATERIALS AND METHODS: In a cohort study from May 2012 to August 2016, 178 patients underwent incisional hernia repair: 90 patients open SUBLAY and 88 patients laparoscopic intraperitoneal onlay mesh (IPOM). Patients' characteristics, hernia size and postoperative complications were prospectively recorded. Patients were divided into two groups according to their weight: non-obese (BMI < 30 kg/m2) and obese (BMI ≥ 30 kg/m2). In October 2016, eligible patients were assessed for recurrence. RESULTS: 109 patients (61%) were non-obese; 69 patients (39%) were obese. Morbidity rate was higher among obese patients without reaching statistical significance (35% versus 22%; p = 0.083). BMI had no impact on length of hospital stay. The mean duration of surgery was significantly longer for patients with a BMI ≥30 kg/m2 (82 min versus 98 min; p = 0.026). Duration of surgery in particular was significantly longer for obese patients that underwent open SUBLAY repair (p = 0.001). 119 patients (67%) were available for follow-up. Recurrence rates also showed no significant difference between both groups (7% versus 8%, p = 0.856). CONCLUSION: Morbidity rate following incisional hernia repair is not significantly higher in obese than in non-obese patients. BMI has no significant impact on the recurrence rate. Laparoscopic IPOM could be beneficial for obese patients with regard to duration of surgery.