[Is vTAPP for small ventral hernias a potential «gold standard¼ for less than 24 hours hospitalization?] / Operatsiya vTAPP pri nebol'shikh ventral'nykh gryzhakh ­ potentsial'nyi «zolotoi standart¼ dlya dosutochnoi gospitalizatsii?

OBJECTIVE: To evaluate clinical efficacy and cost-effectiveness of vTAPP for small/M3W1 hernias compared to IPOM. MATERIAL AND METHODS: We retrospectively analyzed a prospectively recruited group of patients. Study objects were patients undergoing ventral laparoscopic transabdominal preperitoneal hernia repair (vTAPP) for primary Midline/Lateral Small hernias up to 2 cm. The control group comprised patients after IPOM procedure. RESULTS: We analyzed 179 patients: vTAPP (n=132) and IPOM groups (n=47). The vTAPP group was characterized by significantly shorter hospitals-stay (Q1-Q3: 8-70 hours, p<0.001), fewer relapses (n=2, p=0.047) and slightly longer surgery (Q1-Q3: 40-80 min, p=0.037). Cost-effectiveness analysis revealed 3.39 times more profitable vTAPP compared to IPOM. CONCLUSION: Laparoscopic preperitoneal hernia repair is a safe and effective method not requiring special tools and consumables. This approach is applicable as an outpatient (or <24h hospital-stay) method.

Onlay mesh repair for treatment of small umbilical hernias ≤ 2 cm in adults: a single-centre investigation.

PURPOSE: Previous studies on the repair of small umbilical hernias have suggested a lower recurrence rate with mesh compared to suture repair. An important question is in what anatomical position the mesh should be placed. The purpose of this study was to investigate the outcome of using a standardized 4 × 4 cm onlay-mesh for umbilical hernias ≤ 2 cm. METHODS: A retrospective study was conducted at a single centre in Sweden on all umbilical hernia repairs during 2015-2019. The follow-up time was at least four months. Patients were identified using the hospital medical database. Repairs performed with suture or a sublay, ventral patch and laparoscopic mesh positioning were excluded. The patient's demographics, comorbidities, intra-and post-operative details were considered. The primary outcome was surgical site complications within 30 days. The secondary outcome was a recurrence. RESULTS: 80 patients were repaired with a small onlay-mesh for an umbilical hernia ≤ 2 cm. The median (range) follow-up time was 29.0 (4.3-50.1) months. The median age was 46 (26-76) years old. The median body mass index was 28 (19-38) kg/m2. The male to female ratio was 2:1. 4 patients were identified with a surgical site post-operative complication; three with seromas and one with a superficial wound infection. 3 of these were given antibiotics. 2 patients were treated with wound openings bedside. There were no registered cases of recurrence. CONCLUSIONS: Repairing small umbilical hernias with a small onlay-mesh was safe with a low surgical site complication rate. Randomized trials are needed to assess whether mesh can reduce recurrences in umbilical hernia repairs ≤ 2 cm.

SUMMER Trial: mesh versus suture repair in small umbilical hernias in adults-a study protocol for a prospective randomized double-blind multicenter clinical trial.

BACKGROUND: Small umbilical hernia repair is one of the most common surgical performances in general surgery. Yet, a gold standard procedure for the repair is still lacking today. There is an increasing evidence that mesh could be advantageous compared to suture repair in lowering recurrence rates. An additional important question remains with regard to the optimal anatomical positioning of the mesh. We hypothesize that the use of an onlay mesh in small umbilical hernia defects can reduce recurrence rates without increasing the complications compared to a simple suture repair. METHODS: A prospective, national, multicenter, randomized, double-blind clinical trial comparing a standardized 4 × 4 cm onlay mesh to a conventional suture repair will be conducted. A total of 288 patients with a primary elective umbilical hernia ≤ 2 cm from 7 participating Swedish surgical centers will be enrolled. Intraoperative randomization will take place using a centralized web-based system resulting in total allocation concealment. Stratification will be done by surgical site and by defect size. Trial participants and follow-up clinical surgeons will be blinded to the assigned allocation. The primary outcome assessed will be postoperative recurrence at 1 and 3 years. Secondary outcomes assessed will be postoperative complications at 30 days and pain 1 year after surgery. DISCUSSION: Currently, there has been no randomized clinical trial comparing the recurrence rates between an onlay mesh repair and a simple suture repair for small umbilical hernia defects. How to best repair a small umbilical hernia continues to be debated. This trial design should allow for a good assessment of the differences in recurrence rate due to the large sample size and the adequate follow-up. Surgeons' concerns surrounding optimal anatomical positioning and fear for larger required dissections are understandable. A small onlay mesh may become an easy and safe method of choice to reduce recurrence rates. Guidelines for small umbilical hernia repairs have stressed the need for reliable data to improve treatment recommendations. We can expect that this trial will have a direct implication on small umbilical hernia repair standards. TRIAL REGISTRATION: ClinicalTrials.gov NCT04231071. Registered on 31 January 2020. SUMMER Trial underwent external peer review as part of the funding process.