Surg Endosc (2015) 29:2463–2484 DOI 10.1007/s00464-015-4293-8
and Other Interventional Techniques
GUIDELINES
Laparoscopic ventral/incisional hernia repair: updated guidelines from the EAES and EHS endorsed Consensus Development Conference Gianfranco Silecchia1 • Fabio Cesare Campanile2 • Luis Sanchez3 • Graziano Ceccarelli4 • Armando Antinori5 • Luca Ansaloni6 • Stefano Olmi7 • Giovanni Carlo Ferrari8 • Diego Cuccurullo9 • Paolo Baccari10 • Ferdinando Agresta11 Nereo Vettoretto12 • Micaela Piccoli13
•
Received: 29 January 2015 / Accepted: 27 April 2015 / Published online: 3 July 2015 Springer Science+Business Media New York 2015
Abstract Background The Executive board of the Italian Society for Endoscopic Surgery (SICE) promoted an update of the first evidence-based Italian Consensus Conference Guidelines 2010 because a large amount of literature has been published in the last 4 years about the topics examined and new relevant issues. Methods The scientific committee selected the topics to be addressed: indications to surgical treatment including special conditions (obesity, cirrhosis, diastasis recti abdominis, acute presentation); safety and outcome of intraperitoneal meshes (synthetic and biologic); fixing devices (absorbable/non-absorbable); abdominal border
Gianfranco Silecchia and Fabio Cesare Campanile contributed equally to the preparation and writing of the article. & Fabio Cesare Campanile
[email protected] 1
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Division of General Surgery and Bariatric Centre of Excellence, Department of Medico-Surgical Sciences and Biotechnology, Sapienza University of Rome, Via Faggiana 1668, 04100 Latina, LT, Italy Division of General Surgery, Ospedale San Giovanni Decollato Andosilla, ASL VT, Via Ferretti 169, 01033 Civita Castellana, VT, Italy Division of Oncologic Surgery, Department of Oncology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy
and parastomal hernia; intraoperative and perioperative complications; and recurrent ventral/incisional hernia. All the recommendations are the result of a careful and complete literature review examined with autonomous judgment by the entire panel. The process was supervised by experts in methodology and epidemiology from the most qualified Italian institution. Two external reviewers were designed by the EAES and EHS to guarantee the most objective, transparent, and reliable work. The Oxford hierarchy (OCEBM Levels of Evidence Working Group*. ‘‘The Oxford 2011 Levels of Evidence’’) was used by the panel to grade clinical outcomes according to levels of evidence. The recommendations were based on the grading system suggested by the GRADE working group. Results and Conclusions The availability of recent level 1 evidence (a meta-analysis of 10 RCTs) allowed to 7
Division of General and Oncologic Surgery, Advanced Laparoscopy Center, Policlinico San Marco, Zingonia, BG, Italy
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Division of General, Oncologic and Mini-Invasive Surgery, A.O. Ospedale Niguarda Ca` Granda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
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Division of General, Laparoscopic and Robotic Surgery, AORN dei Colli Ospedale Monaldi, Naples, Italy
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Division of General Surgery, Santa Maria della Misericordia Hospital, P.zale Menghini 1, 06129 Perugia, Italy
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Department of General Surgery, ULSS19 del Veneto, Via Etruschi 9, 45011 Adria, RO, Italy
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Division of General Surgery, Ospedale di Spoleto, Via Loreto 3, 06049 Spoleto, PG, Italy
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Laparoscopic Surgical Unit, M.Mellini Hospital, Viale Giuseppe Mazzini 4, 25032 Chiari, BS, Italy
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Department of Surgery, Catholic University of Rome, Largo A. Gemelli 8, 00168 Rome, Italy
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Division of General Surgery I, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy
Department of Surgery, NOCSAE (Nuovo Ospedale Civile Sant’Agostino Estense), Via Giardini 1355, 41126 Baggiovara, Modena, Italy
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recommend that not only laparoscopic repair is an acceptable alternative to the open repair, but also it is advantageous in terms of shorter hospital stay and wound infection rate. This conclusion appears to be extremely relevant in a clinical setting. Indications about specific conditions could also be issued: laparoscopy is recommended for the treatment of recurrent ventral hernias and obese patients, while it is a potential option for compensated cirrhotic and childbearing-age female patients. Many relevant and controversial topics were thoroughly examined by this consensus conference for the first time. Among them are the issue of safety of the intraperitoneal mesh placement, traditionally considered a major drawback of the laparoscopic technique, the role for the biologic meshes, and various aspects of the laparoscopic approach for particular locations of the defect such as the abdominal border or parastomal hernias. Keywords Abdominal Bariatric Hernia Obesity Ultrasonography Clinical papers Clinical trials Clinical research Ventral hernias (primary or incisional) are common. Their operative repair is part of the daily routine of every general surgeon. It can be extremely invasive with a long and painful period of illness and even leading in some cases to a negative outcome. Surgery can be extremely complex, especially for incisional hernias, due to the size of the defect or sac content, the extent of intraabdominal adhesions, and the length of the operation. For a surgeon not trained in this particular area, it is increasingly difficult to determine the best treatment option. The goal of these guidelines is to support surgeons in the decision-making process. The fundamental precondition for a reliable guideline is the availability of quality published studies of high ranking in the classification of the EBM. PubMed search on this topic (‘‘ventral/incisional hernias’’) produced more than 11,000 papers, 30 % published in the last 4 years. In January 2010, the first evidence-based Italian Consensus Conference about laparoscopic ventral/incisional hernia repair was organized in Naples. The panel of that consensus focused on the indications for laparoscopic ventral hernia repair (LVHR), surgical technique, complications, their prevention and management, and recurrence after laparoscopic repair. The results were published on the 2013 issue of ‘‘Hernia’’ [1]. The Executive board of the Italian Society for Endoscopic Surgery (SICE) promoted an update of that guidelines because a large amount of literature has been published in the last 4 years about the topics examined then, and new relevant topics.
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Methods Organization of the Consensus Conference The Executive board of the Italian Society for Endoscopic Surgery (SICE) promoted the consensus, involved the Italian Chapter of EHS and the Italian Society of Anesthesiology (SIAARTI) in the Promoting Committee and designated a scientific committee made of five members, expert in the surgical treatment of ventral hernia, guideline methodology, and literature search (co-authors of this paper: FCC, GS, FA, NV, MP). Two of them had also been members of the 2010 Consensus Conference scientific committee (FA and MP). In the first stage, the scientific committee selected six experts as Topic Editors and the Italian chapter of EHS proposed two additional experts to complete a panel of eight Topic Editors (also co-authors of this paper: LS, GC, AA, LA, SO, GCF, DC, PB) plus a delegate of the Italian Society of Anesthesiology (SIAARTI). The eight Topic Editors and the delegate of the SIAARTI constitute the ‘‘panel’’ mentioned in the present paper. The selection criteria were: (a) (b) (c)
proven expertise in laparoscopic ventral hernia repair authorship in peer-reviewed journal on laparoscopic ventral hernia repair involvement in the society (SICE) registry of laparoscopic ventral hernia repair
Two epidemiologists, expert in methodology, were indicated, respectively, by Age.na.s. (Agenzia Nazionale per i Servizi Sanitari) and Istituto di Ricerche Farmacologiche Mario Negri to oversee the methodological aspects. In the second stage, the scientific committee selected the topics to be addressed by the panel and performed a first literature search. The Topic Editors were asked to review the available literature (after having completed and integrated it) on the topic, produce an evidence report, outlining key statements (and their literature support) to be discussed by the entire panel, and grade the supporting evidence according to the Oxford hierarchy of evidence 2011 [2].The identity of the panelists was not revealed, at this stage, to prevent the authority, personality, or reputation of some participants from dominating others in the process, according to the Delphi method. In the third stage, the society (SICE) set up a closed online forum on the Web site http://www.siceitalia.com to pursue a blind discussion on the evidence report produced by each Topic Editor. The panelists and the members of the scientific committee posted their comments during the
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following 2 months. The Topic Editors were encouraged to revise their earlier reports in light of the replies of other members of the panel. In the fourth stage (June 2013), the panel met in Rome, to discuss each topic, and produced key statements with a grade of recommendations (GoR) followed by a commentary to explain the rationale and the level of evidence behind the statement. Only at this stage the identity of the panelists was revealed. The recommendations were based on the grading system suggested by the GRADE working group [3]. Strong recommendation The panel is confident that the desirable effects of adherence to a recommendation outweigh the undesirable effects. Weak recommendation The panel concludes that the desirable effects of adherence to a recommendation probably outweigh the undesirable effects, but is not confident about it. All recommendation were issued as ‘‘for’’ (in favor) recommendation, no ‘‘recommendation against’’ was necessary. Next those statements and the evidence reports were updated and the ‘‘file’’ was submitted to the external reviewers. The statements were presented and discussed by the audience of the Annual Congress of the SICE in Naples (September 20, 2013). The external reviewers participated to the conference. The audience voted each statement acting as jury in the guideline development process. The panel modified the statements following the decisions of the Congress audience. The full revised evidence reports remained on the Web site http://www.siceitalia.org for 1 month. All the members of the society (SICE) were invited to send comments, suggestions, and questions to the scientific committee. A further appraisal by the external reviewers was obtained before submitting the paper for publication. Literature search and appraisal The results of the systematic literature review performed for 2010 Italian Consensus Conference on Laparoscopic Ventral Hernia Repair were entirely considered; the literature search strategy adopted has been detailed in that paper [1]. An additional literature search was done from 2010 through June 2013 with the following limits and filters: Humans, Clinical Trial, Meta-Analysis, Practice Guideline, Randomized Controlled Trial Review, English, All Adult: 19? years. The PICO (population, intervention, comparison, outcome) system was applied for the MeSH (Medical
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Subject Headings) search whenever possible. Analogous search has covered the Cochrane Collaboration database, Scopus, and the Google Scholar in order to gather all the remaining evidence, synopses, and guidelines on the topic. Database searches combined the key word laparoscopy (or laparosc*) with ventral/incisional hernia repair and with condition-specific keywords (e.g., complications). Limits regarding language, age, and study type were then removed, to identify observational, population-based outcomes studies, case series and case reports, and any other clinically relevant report. Duplicates, publications with no abstract and of low interest in the specific topics, and key questions were not taken into consideration. The literature search was extended back to 1990 for those topics not taken into consideration in the 2010 Consensus Conference, to include all relevant papers. The Oxford hierarchy (OCEBM Levels of Evidence Working Group*. ‘‘The Oxford 2011 Levels of Evidence’’. Oxford Centre for Evidence-Based Medicine. http://www. cebm.net/index.aspx?o=5653) was used by the panel to grade clinical outcomes according to levels of evidence (LE). Studies containing severe methodological flaws were highlighted and downgraded as necessary. For each intervention, the validity and homogeneity of study results, effect sizes, safety, and economic consequences were considered.
Results Topic 1: Indications to surgical treatment of ventral/ incisional hernias Luis Sanchez, Lapo Bencini The only presence of a ventral/incisional hernia does not represent an indication to surgery. The goals of ‘‘elective’’ repair are relief of symptoms (pain and discomfort) and prevention of complications (strangulation/incarceration) [4–7]. However, the data on the natural history of the disease are contradictory: a prospective long-term study and a more recent review reported that 60 % of patients are symptoms-free [8, 9], while a retrospective review of almost 1000 patients showed 78 % symptomatic hernias and 5 % with complications [10]. Indications for ventral/ incisional hernia repair have to take into account age, site, size, gender, obesity, concomitant medical illness, previous surgery, esthetic impairment, and limitations in normal activities. A recent meta-analysis of 10 randomized controlled trials comparing laparoscopic versus open ventral/incisional hernia repair, involving 880 patients, demonstrated
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the superiority of the laparoscopic approach in terms of shorter hospital stay and reduced wound infection rate [11] (LE1). Retrospective population-based studies reported conflicting results [12–18]. Excellent results, when dealing with primary ventral hernias, have been published [19–21]. STATEMENT Laparoscopic repair of ventral hernia is safe and effective with lower risk of wound infection and shorter hospital stay compared with open repair. STRONG RECOMMENDATION (Panel consensus 100 %) Laparoscopic approach could play a role in reducing perioperative morbidity and cardio-circulatory overload in elderly patients. Nevertheless, there are only few papers concerning the laparoscopic approach in aged patients, but the definition of ‘‘older’’ varies from age 65 to over 80. Five retrospective underpowered studies targeted advanced-age patients [22–26] (LE4). The morbidity and mortality rates of elderly patients were similar to those of younger age. Two studies reported longer length of stay and later return to normal activities [26, 27]. The aforementioned studies have weak statistical power and short follow-up. The Cochrane Review 2011 demonstrated a consistent reduced risk of infection among elderly [11]. STATEMENT Older age is not a contraindication for laparoscopic treatment of ventral/incisional hernia. STRONG RECOMMENDATION (Panel consensus 100 %) Ventral hernias occur more frequently in males than in females, although complications (i.e., strangulation and obstruction) affect similarly both sexes [28]. Scant data are reported in the literature about women in childbearing age. There have been some concerns about placing a prosthesis in childbearing-age female who will desire a pregnancy, but few studies targeted this specific topic. Two case reports are available on vaginal delivery after abdominal wall laparoscopic repair with PTFE [29, 30]. In none of the studies aimed at detecting risk factors, female sex was found to be significant for different perioperative results or recurrence [31–33]. No suggestion can be issued on the basis of the current literature. Laparoscopic repair of ventral/incisional hernias is currently accepted when the defect size is at least of 3 cm, because smaller defects can be safely treated with suture repair under local anesthesia [34, 35]. Small midline hernias are best treated by laparoscopy. On the other hand, large hernias are thought to be more challenging and can lead to more morbidity and recurrence rates [36, 37].
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However, the term ‘‘large hernia’’ is poorly defined. The upper limit of the hernia defect suitable for laparoscopic repair is not clearly defined. Moreover, when considering the dimension of the hernia defect, the whole surface of the patient’s abdomen should be taken into account such as the need for a wider prosthesis overlap. Several groups report a favorable outcome with laparoscopic ventral hernias repair larger than 15 cm in diameter [33, 38–41]. Furthermore, some authors consider large hernias to be the best indication for the laparoscopic approach in terms of perioperative results [42–44]. The systematic search provided only one prospective study [45] addressing this particular issue (defect size/outcome). The authors reported that the upper limit of 10 cm correlates with low recurrence rate. The panel confirms the recommendation of the previous consensus as far as defect size is concerned. STATEMENT Laparoscopic repair is accepted for hernia defect larger than 3 cm. There is no consensus on the suitable upper limit. STRONG RECOMMENDATION (Panel consensus 100 %) Although the cornerstone of ventral hernias diagnosis is represented by an accurate clinical evaluation, imaging should be utilized to rule out abdominal comorbidities and achieve a complete definition of the hernia defect and its content. Ultrasound or CT scan are recommended before a scheduled operation, especially in obese patients (BMI [ 30), in an emergency setting and in those suffering for large defects with loss of domain, posttraumatic hernias or recurrences. Recent literature shows that a dynamic ultrasound can reach the same accuracy of CT scan when performed by experienced radiologists [46, 47], while some authors emphasize the use of MRI for recurrences [48, 49]. The panel confirms the 2010 consensus recommendation about the use of imaging (US, CT, MRI) before LVHR only in selected cases. STATEMENT Preoperative assessment by imaging techniques is recommended in selected patients (obese, large defects, multiple previous surgery, border defect, complex cases, emergency surgery). STRONG RECOMMENDATION (Panel Consensus 100 %) The presence, the numbers, or the types of prior surgical incision, including a failed attempt of hernia correction, are not contraindications for laparoscopic ventral/incisional hernia repair. A prospective study showed that the number of previous operations and repairs neither affects the results
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in terms of recurrence nor increases the risk of complications [31] (LE3), while a previous study reached opposite conclusions about recurrence [50] (LE4). Therefore, recurrence should not be considered a contraindication to laparoscopy, even though complications [51], conversions [52], and additional recurrences [32, 53] may be more frequent. However, the short-/long-term data reported in the literature are largely not homogeneous [54, 55].
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concomitant hernia repair and bariatric procedure seems to be very low [67]. STATEMENT 2.1. Laparoscopic repair is recommended in obese patients with ventral/incisional hernia. STRONG RECOMMENDATIONS (Panel Consensus 100 %)
STATEMENT Previous surgeries (with or without the use of meshes) are not contraindications for further laparoscopic repair. STRONG RECOMMENDATION (Panel Consensus 100 %) Topic 2: Indications in special conditions Graziano Ceccarelli Obese patients Obesity is a risk factor for the occurrence of ventral/incisional hernia and leads to higher recurrence rates and perioperative related complications. The enhanced incidence of larger defects (especially [10 cm) in the obese population carries a further increase of recurrence rate [45]. The laparoscopic approach to ventral/incisional hernia repair in obese patients (BMI [ 30), achieves an infection rate lower than in open procedures [56]. Similar results are shown in other studies [54, 57–62]. A recent retrospective cohort analysis of 47,661 obese patients undergoing ventral hernia repair demonstrated an increased use of the laparoscopic approach, with better results in terms of complication rate, hospital stay, and overall cost of care [63]. A lower recurrence rate after the laparoscopic approach is also described in obese patients with umbilical hernias [58]. Laparoscopy allows identifying additional hernia defects that might have gone unrecognized, especially in obese patients. The timing of ventral hernia repair in patient candidate to bariatric surgery is controversial [64]. A two-stage approach (weight loss procedure followed by laparoscopic hernia repair) may decrease the recurrence rate and technical difficulties. Furthermore, the risk of mesh contamination at the time of bariatric surgery suggests deferring the hernia repair. In addition, resolution of metabolic comorbidities, (i.e., diabetes) could guarantee better outcomes [65]. However, symptomatic ventral hernias could be repaired before the bariatric procedure [66]. Nevertheless, a one-stage procedure is considered to have some advantages as the risk of mesh implantation in a potentially contaminated or clean-contaminated field in
Cirrhosis Umbilical and incisional hernias are more common in the cirrhotic patients than in the general population. Abdominal distension caused by ascites, consequent high intraabdominal pressure, and loss of muscle mass secondary to poor nutritional status are the main risk factors for ventral hernia formation and enlargement in patients affected by cirrhosis. Patients with both cirrhosis and ascites have about 20 % risk of developing umbilical hernia [68, 69]. Laparoscopic hernia repair in cirrhosis (Child A) is feasible and safe [70–72]. The high morbility rate of an emergency treatment in this group of patients suggests that elective treatment should not be deferred [73, 74]. The laparoscopic approach was described also in recurrent incarcerated umbilical hernia, Child’s class B, C, and refractory ascites patient [75, 76]. Ascites control is the mainstay of postoperative management. Good control of ascites allows similar outcomes as in patients without cirrhosis [77, 78]. Elective repair of an umbilical hernia should be avoided for those with adverse predictors, such as age older than 65 years, MELD score higher than 15, and albumin level less than 3.0 g/dL [79]. Laparoscopic incisional hernia repair is possible and safe after liver transplantation too [69, 72]. STATEMENT 2.3 Compensated Child A-B cirrhosis is not a contraindication to elective laparoscopic ventral/incisional hernia repair. WEAK 100 %)
RECOMMENDATION
(Panel
Consensus
Diastasis recti abdominis Surgical treatment of diastasis recti abdominis (suture of the linea alba with the use of a mesh) is indicated in symptomatic patients who present abdominal pain or discomfort. Laparoscopic repair was described as safe and effective in small case series [80, 81]. In 2011, a systematic
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review underlined the scarceness of literature on laparoscopic repair of diastasis recti, but the authors suggest a lower complication rate in the minimally invasive compared with the open approach. [82]. Preoperative imaging evaluation for determining the position of the recti abdominis muscles is recommended [83]. Ventral/incisional hernia associated with diastasis recti abdominis represents a challenge for the surgeon. No evidence from the literature was obtained. The panel considers the data of the literature too scanty to draw any recommendation. Acute presentation: emergency No relevant scientific data about the laparoscopic approach to incarcerated ventral/incisional hernias were published after the Consensus Conference of the European Association of Endoscopic Surgery (EAES) [84] and the 2010 Consensus Conference [1]. The open approach remains the standard treatment for incarcerated hernia, although laparoscopic surgery may be considered in selected patients [1]. The incidence of intra- and postoperative complications and recurrences in emergency cases was the same as in elective cases. Selection criteria are: • • •
Absence of marked bowel distension [85–87]. Absence of peritonitis [88] and high-septic-risk situations, such as entero-cutaneous fistulas [89]. Absence of hemodynamic instability and severe comorbid conditions, such as heart and lung diseases, which preclude the use of pneumoperitoneum [88].
The presence of non-viable intestine is not to be considered as a contraindication for prosthetic repair [90]. The immediate mesh repair is deferred only in the presence of abundant peritoneal contamination [87, 91–94]. The biologic meshes may provide a new prospect in a contaminated surgical field [95], also in laparoscopic emergency hernia repair, with good results in terms of recurrence and wound infection [96, 97]. Laparoscopy is useful both to confirm the diagnosis and to carry out therapeutic repair [98–100]. Single-port laparoscopic repair of incarcerated ventral hernia were described [101]. Incarcerated hernia, together with mesh size, patient age, and complex hernia are predicting factors about longer length of stay [27]. STATEMENT 2.4 Incisional hernia in emergency is not a contraindication to laparoscopic approach and may be performed in selected cases. WEAK 100 %)
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RECOMMENDATION
(Panel
Consensus
Topic 3: Safety and outcome of intraperitoneal meshes Armando Antinori Safety The indications for laparoscopic ventral hernia repair have been widely debated with increasing approval from the scientific community. Most of the abdominal hernia surgical procedures are mesh-based, and since the first description of a mesh use for abdominal wall repair, numerous prosthetic materials have become available for surgeons. The placement of a mesh into the abdominal cavity is the fundamental theoretic assumption of every laparoscopic ventral hernia repair. Many meshes have been specifically manufactured to avoid adhesion formation with the abdominal viscera, to be implanted intraperitoneally. Today, expanded polytetrafluorethylene (ePTFE), polypropylene (PP), polyethylene terephthalate/polyester (PET), adequately formed or composed with different adhesion barriers, are the main synthetic polymers used [102]. The safety of the intraperitoneal mesh implant is supported by the results of more than 20 years of laparoscopic surgery for the abdominal wall hernias. Several randomized controlled studies and meta-analysis of controlled trials published in the last decade have demonstrated that laparoscopic repair should be considered a safe technique, and there is a sufficient follow-up to state that most of the barrier mesh prostheses determine a very low risk when placed intraperitoneally [11, 36, 61, 103]. A recent Cochrane review showed heterogeneity among studies analyzed with respect to the type of the intraperitoneal mesh used, even within the same study. As a matter of fact, the purpose of the studies was generally to confirm the feasibility of laparoscopic repair and not to analyze the immediate and long-term results of different types of mesh. A few papers compare different types of mesh [104]. One retrospective study compared polyester composite versus PTFE mesh with no significant association between types of mesh used and postoperative complication rate [105]. In order to obtain a new mesh classification, 1000 samples of various meshes explanted for recurrence, pain, or infection after different abdominal wall hernia open repairs were analyzed. Although the aim of the study was not to define the risk of a particular kind of mesh, the number of intraperitoneal mesh sample explanted was very low [106].
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A further evidence of the safety of the intraperitoneal implant of barrier mesh prostheses could be indirectly deduced by some prospective and retrospective studies that reported the use of pure, un-coated polypropylene meshes during laparoscopic repair with an acceptable rate of complications [11, 107]. Even in challenging indication, such as parastomal hernia repair, where the mesh is necessarily wrapped around the bowel, the role of the laparoscopic approach has been positively confirmed [108]. Some case reports and a case series study suggest that laparoscopic ventral hernia repair be an acceptable and safe therapeutic option also in fertile woman who intend to have further pregnancies and that intraperitoneal implant of a mesh do not cause significant problems during pregnancy or delivery [30]. STATEMENT 3.1 The intraperitoneal placement of a prosthesis specifically produced for laparoscopic ventral hernia repair is safe. STRONG RECOMMENDATION (Panel Consensus 100 %) Outcome The perfect mesh for laparoscopic repair should have minimal adhesion formation, excellent tissue ingrowth, and minimal shrinkage: the ideal mesh is not yet available. Adhesions are relatively frequent after the intraperitoneal mesh placement; they may potentially cause some complications and make re-operations challenging. Some clinical studies have attempted to determine the adhesion characteristics and effectiveness of the available barrier mesh prostheses. Re-operative findings in patients with prior laparoscopic repair have been recently analyzed providing the most valuable information on these issues. Some authors reported null or minimal omental adhesions in 89 % of cases with polyester absorbable barrier mesh implant [109]. Other authors found null or minimal adhesions involving omentum in 82 % of cases with a ePTFE implant and observed that adhesions occurred mainly against exposed elements (tacks, edge of the mesh) [110]. Only one clinical study compared the most common barrier mesh prostheses, and the adhesion features found at the time of laparoscopic re-exploration performed in 69 cases. Adhesions to the permanent-barrier non-composite mesh (ePTFE) were less tenacious than in all other mesh groups, and the adhesiolysis-related complications were seen only with uncoated polypropylene mesh [111].
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Thus, most of the barrier mesh prostheses do not prevent adhesions completely and determine some degree of adhesion, but the cause of related complications seems to be multifactorial. The potential for shrinkage of intraperitoneal meshes remains a concern. The inflammatory reaction, stimulated by prosthetic materials, determines a certain level of shrinkage (from 5 to 57 % for all meshes) that might favor recurrences or pain [112]. This issue, analyzed in several experimental studies, has been recently investigated in human. Two retrospective studies reported 6.7 and 7 % shrinkage of ePTFE mesh measured by computed tomography [113, 114]. These results were markedly lower than those determined in animal studies. One prospective randomized clinical study on 40 patients treated with a polypropylene composite mesh showed that shrinkage was significantly influenced by mesh fixation, with a lower rate (0.1 %) in the transfascial suture group compared with the tack group (3.1 %) [115]. All data collected from the literature cannot allow to state that shrinkage depends on the mesh type, while it seems to be correlated with mesh fixation technique. A clear relationship between shrinkage and recurrence rate or chronic pain cannot be demonstrated. On the basis of the current literature, the panel cannot state any recommendation. STATEMENT Adhesions formation is relatively frequent after laparoscopic repair, and the cause of related complications seems to be multifactorial. Most mesh materials undergo some degree of shrinkage after the intraperitoneal positioning, similar to that observed after open hernia repair. No significant differences have been shown for adhesion and shrinkage with different mesh types specifically designed for intraperitoneal implant. Topic 4: Biologic mesh for incisional hernia Luca Ansaloni Question: which role could play biologic meshes for laparoscopic incisional hernia repair? Approximately one million prostheses are worldwide used each year for abdominal wall reconstruction [116–118]. Since the use of mesh for abdominal wall reconstruction was first described [119], plenty of new materials have been introduced, first synthetic and later biologic. The specific indications of the different materials (biologic in
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particular) are controversial. Many biological prostheses (BP) are currently available (Table 1). They are obtained from human (homografts) or mammalian tissues (xenografts) [120]. The latter derives from uniform animal population with similar age and life history; therefore, implants are more consistent than homografts [120]. BP are further classified into two main groups: cross-linked and non-cross-linked. The introduction of cross-linking between the collagen chains strengthens the prosthesis and reduces the effectiveness of bacterial or host collagenase enzymes. Therefore, the implant is less susceptible to degradation in vivo [121, 122]. On the basis of the presence or absence of the cross-linking, biological prostheses are categorized into two subgroups: partially or completely remodelable (over time). The former (crosslinked) prostheses come from porcine or human dermic and bovine pericardium collagen [120]. The completely remodelable (not cross-linked) ones derive mainly from swine intestinal submucosa, swine dermis, human dermis, fetal bovine dermis, and bovine pericardium. The differences in remodeling times should be considered in the selection of these materials for the abdominal wall repair [120]. Each type of prosthesis allows and promotes angiogenesis and cellular ingrowth, but different prostheses can offer different clinical characteristics. The presence of additional linkages grants increased resistance to mechanical stress and longer duration to the partially remodeling prostheses. Moreover, BP are credited with the lowest potential for adhesion formation among all prosthetic materials available for intraperitoneal use [123]. In groin
hernia repair, biological prostheses have been shown to reduce postoperative pain and discomfort [124]. Implants would act as a scaffold that guides the growth of the host tissue cells and fibroblasts. They also support the abdominal wall up to its recovery. The remodeling process ranges between a few months and few years [125], and it is related to the properties of the prosthesis and host tissues. BP management should be completely different from the standard synthetic meshes. The latter trigger a foreign body response leading to intense fibrous reaction. On the contrary, BP activate a remodeling process guiding the host to start a real tissue engineering process [126]. The correct use of different BP in abdominal wall surgery, and ventral/ incisional hernia in particular, remains unclear [120, 127]. Only few studies took into consideration the laparoscopic placement of a biological mesh. The LAPSIS study was a multicentre European RCT comparing open retromuscular (mesh augmentation technique) versus laparoscopic repair (mesh bridging technique) and the use of a non-cross-linked biological mesh (Surgisis) versus classical synthetic mesh for clean primary ventral/incisional hernia with a diameter of 4–10 cm, in a two-factorial design. On August 7, 2009, further inclusion of patients into the trial was stopped because of the low rate of patient recruitment, incompleteness of the study data, and a higher preliminary recurrence rate in the BP compared with the synthetic mesh groups. The analysis of 257 patients whose surgical approach and type of mesh could be assessed at the stopping time (median follow-up of 1 year) was carried out. The implantation of Surgisis
Table 1 Biological prosthesis currently on the market Name
Manufacturer
Tissue source
Material
X-linking
Alloderm
LifeCell Human
Acellular dermis
No
AlloMax
Bard
Human
Acellular dermis
Flex HD
Ethicon/MTF¥
Human
Acellular dermis
–
DermaMatrix
MTF¥
Human
Acellular dermis
No
Permacol
Covidien
Porcine
Acellular dermis
Yes
CollaMend
Davol/Bard
Porcine
Acellular dermis
Yes
Strattice XenMatrix
KCI/LifeCell Brennan Medical
Porcine Porcine
Acellular dermis Acellular dermis
No No
No
Surgisis
Cook
Porcine
Small intestine submucosa
No
Surgisis Gold
Cook
Porcine
Small intestine submucosa
No
Lyosis
Cook
Porcine
Lyophilized small intestine submucosa
No
FortaGen
Organogenesis
Porcine
Small intestine submucosa
Yes
SurgiMend
TEI bioscience
Bovine
Fetal dermis
No
Periguard
Synovis
Bovine
Pericardium
Yes
Veritas
Synovis
Bovine
Pericardium
No
Tutomesh
Tutogen
Bovine
Pericardium
No
Tutopatch
Tutogen
Bovine
Pericardium
No
MTF Musculoskeletal Transplant Foundation
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resulted in a higher early recurrence rate in each of the study arms: 19 % (10 of 53) versus 5 % (3 of 63) after laparoscopic repair, and 11 %(7 of 65) versus 3 % (2 of 76) after open repair. No differences between the study groups in the other study endpoints (infection or reoperation) have been identified [104]. In a prospective observational study, Franklin et al. [97] presented their 5-year experience with placement of Surgisis mesh in potentially or grossly contaminated fields. The study included 116 patients with 133 laparoscopic procedures for abdominal hernia. Two techniques were adopted: intraperitoneal onlay mesh (IPOM) and two-layered ‘‘sandwich’’ repair (laparoscopic and open exploration with reinforcement with Surgisis anteriorly and posteriorly by laparoscopy); the adequate fixation to the abdominal wall was obtained with transfascial sutures or staples, allowing uniform adherence to the closed defect. Among the 57 (42.8 %) procedures for incisional hernias, there were two recurrences (3.5 %). The mean follow-up was 52 ± 20.9 months. It has to be stressed, however, that the quality this single-center observational study has been questioned due to several methodological issues [128] In the prospective database of Italian Register of BP, analyzed by Coccolini et al. [129], in 2 years (January 2009–December 2010), 110 ventral/incisional hernia repaired with BP were included. Thirty-one of them (28 %) were repaired with laparoscopic underlay technique. Unfortunately no others details are available for this group of patients. Despite the lack of high-grade evidence (only LE 3–4 studies are available), BP are generally implanted in contaminated fields, where they allow for a one-stage repair with no or little subsequent mesh removal. BP may play a valuable role in ventral hernia repair in contaminated fields: in these situations, it is generally not accepted to implant a synthetic mesh, and the recurrence rate after BP implant, although high, seems to compare favorably to a direct repair. However, elective repair of non-complicated ventral/incisional hernia with BP continues to be afflicted by higher recurrence rate and wound complications. Furthermore, significant additional cost of BP should be thoughtfully considered when utilizing these materials. Although it has been shown to be feasible, very scarce data are related to the laparoscopic implant. It is imperative that the surgical community and funding agencies undertake prospective randomized trials to properly direct the use of these meshes and evaluate their ultimate value, especially in the laparoscopic field. STATEMENT Different biologic prosthesis are available, and further studies are necessary to determine the cost-effectiveness of their use. Nowadays, even if their laparoscopic
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implant is feasible, the use of biologic prosthesis should be restricted to contaminated field in open surgery. Their laparoscopic use is recommended in controlled trials. WEAK RECOMMENDATION (Panel Consensus 100 %)
Topic 5: Absorbable and non-absorbable fixing devices and positioning technique Stefano Olmi, Giovanni Cesana Non-absorbable fixing devices In a meta-analysis of more than 200 patients [130], the recurrence rate between tack and suture mesh fixations was comparable, but it is emphasized that the use of spiral tacks reduces the operative time and the postoperative pain. Other studies [14, 31, 131–133] report recurrences rate with the use of tacks, from 0.89 to 3.5 % [132] with a follow-up superior to 2 years. An important series of more than 1000 patients compares various fastening systems and concludes that there is not a significant difference in recurrence between spiral tacks alone or with sutures (3.9 vs 2.6 % respectively) [107]. Conflicting data emerge regarding a higher incidence of postoperative and chronic pain. A randomized clinical trial [110] compares three groups: spiral tacks alone, spiral tacks plus absorbable sutures, and spiral tacks plus non-absorbable sutures. There were no significant differences in terms of postoperative pain, return to work, and recurrences, with a follow-up limited to 3 months after surgery. The authors stressed the differences in operative time: the use of sutures appears to lengthen the operating time without any real improvement in outcome. Other studies confirmed the same findings [134, 135]. Postoperative pain and chronic pain are analyzed in four RCTs [110, 115, 131, 136]. Tacks are associated with an equivalent [110] or lesser [115, 131, 136] postoperative pain than sutures. The latest paper [136] demonstrates an equivalent recurrence rate at 24 months. One study [115] reports an increased risk of shrinkage in large hernia defects when tacks are used. A large case series [106] compares more than one thousand patients with four different fixation techniques (Protack, EndoAnchor, EMS, and transabdominal sutures ? Protack); chronic pain is found to exceed 10 % in all groups (with a peak of 16.4 % in transabdominal sutures ? Protack group), but the recurrence rate was lower in two Protack groups (2.6 % Protacks and sutures and 3.9 % Protacks alone), and was higher in the EMS group. No statistically significant difference was noted.
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STATEMENT
STATEMENT
Mesh fixation with non-absorbable spiral tacks should be considered the standard method of fixation in laparoscopic ventral/incisional hernia repair. The use of transparietal sutures seems to lengthen the operating time without difference either in postoperative pain, recurrence, or seroma formation.
The use of biological glues alone as fixing device is possible in small hernia when a macropore lightweight mesh is used.
STRONG RECOMMENDATION (Panel Consensus 100 %) Absorbable fixing devices At present, there are no adequate clinical researches about the use of absorbable devices, and the panel cannot make any recommendation. Studies on animals demonstrate the safety of the use of those fixing devices [137, 138]. Recently few cases series have been reported. A clinical series of 29 cases by I-clip (absorbable in 1 year) showed the absence of recurrence and chronic pain at 1-year follow-up [138]. New devices have been developed which achieve a sufficient tensile fixation strength compared with non-absorbable tack and transfascial suture [139, 140], but data on large series with long-term follow-up are not yet available. There is not enough evidence to make any recommendation in favor or against the use of the absorbable fixing devices. Further studies are encouraged. Glue Ericksen [141] compared the use of fibrin glue versus spiral tack in laboratory animals and in the clinical setting. The study detected less acute postoperative pain during rest (p = 0.025) and during activity (p = 0.014), less discomfort, and a shorter convalescence (after median 7 vs 18 days; p = 0.027), after 1 month, when glue was used. A recent systematic review [142] examines 36 studies with biological glue (Tisseel/Tissucol) for a total of almost 6000 patients, including both inguinal and ventral hernias. The papers related to laparoscopic repair of primary and incisional ventral hernias show less postoperative and chronic pain with glue than non-absorbable devices. The importance of the type of mesh used is emphasized, because its characteristics influence the ability of the glue to induce an appropriate adhesion to the abdominal wall [143]. Although it appears promising for small abdominal wall defects (up to 6 cm) provided that a proper mesh is used, further studies are necessary before recommending the use of the glue as only fixing methods [144].
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WEAK 100 %)
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(Panel
Consensus
Positioning technique There are not randomized control clinical trial comparing the different positioning of fixation devices (single vs double crown). Some case series confirm the variability in the positioning of fixation device but suggest the value of a double crown, at a distance ranging from 1.5 to 3 cm, with different recurrence rates up to 2.1 % at 38 months [89, 107, 132, 145, 146]. The panel confirms the results of the first Italian Consensus Conference [1]. Overlap There is no new evidence that suggests any modifications of the conclusion reached in the in 2010 Italian Consensus Conference [1]. All papers stress the importance of prosthesis overlap, with the mesh area adequately exceeding the margins of the hernia defect, even though there is no agreement on numeric values. The minimum recommended overlap is 3 cm along the entire circumference of the defect; however, the general trend is to extend it to 5 cm. It can be stated that a 3-cm overlap is enough for smaller defects (about 3–4 cm), while larger defects require a 5-cm overlap [1]. SILS Few studies were found about the use of the SILS technique in the repair of ventral hernias. In the studies examined [147–150], a total of 104 patients was reported. It is suggested that the single access decreases the possibility of future trocar hernia. No significant differences compared with the laparoscopic procedure in the perioperative course were observed. At present, it is not possible to make any recommendation. Topic 6: Laparoscopic treatment of parastomal and abdominal border hernia Giovanni Ferrari, Camillo Bertoglio Abdominal border incisional hernias are those defects arising close to bony structures delimiting the abdominal
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wall. Median (M1 and M5) and lateral defects (L1 and L4) according to EHS classification are described [151]. To date, the literature research found only one article with a retrospective evaluation of results of laparoscopic repair for all the aforementioned sites [142]. More frequently, the authors take into account single types of the abdominal border hernias, or postoperative results are analyzed together with those derived from more common incisional hernias. The previous consensus conference failed to find significant influences of the hernia site on postoperative course, and no contraindication was found whether adequate experience is available [1]. Lumbar incisional hernias Previous surgery usually produces abdominal wall musculature denervation causing disruption of normal anatomy and large bulging defects that occupy most of the lumbar region [152, 153]. The largest series of 35 laparoscopic repairs in 13 years showed significantly better results in terms of early postoperative course and less incidence of recurrence when compared to open repair. The procedure of choice should be laparoscopic except for large hernia because the recurrence rate is higher than in open repair [154]. Laparoscopic lumbar defect repair usually requires a combination of both transabdominal stitches and metallic tacks and is always described as technically challenging [153, 154]. Recurrence after a laparoscopic procedure seems to be significantly higher for subcostal than lumbar defects [45]. In some case of complex incisional hernia, the use of a double-mesh technique may be advisable [155]. The combined use of two running sutures with non-absorbable monofilament material could restore the normal anatomy, thereby improving muscular function of the area, at the cost of the repair not being ‘‘tension-free’’ [156]. Subxiphoid and subcostal incisional hernias Subxiphoid and subcostal incisional hernias published in the last 4 years report low morbidity and 5 % recurrence rate [157]. Few isolated cases of laparoscopic repair with suture alone for small defect size are also described [158]. A review of 113 patients treated for subxiphoid incisional hernia, published before 2009, remains the main source of data on this particular topic [159]. Three different authors have described twenty-one laparoscopic procedures with recurrence rates ranging from 10 to 33 % [160–162]. Those results are likely related to the learning curve of the technique [162]. Avoidance of both tacks and sutures in the most cephalad portion of the mesh is thought to contribute to the recurrence rate higher than in other hernia sites. An important technical point is the need to dissect the falciform ligament up to the hepatic veins providing a generous
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retroxiphoid overlap beyond the edge of the hernia defect [162]. Endoscopic tackers can be used around the edges to fix the prosthesis avoiding the area beyond the costal chondral margin [161, 164]. In other series, the placement of additional full-thickness or intraperitoneal abdominal wall stitches allow additional strength to mesh fixation [142, 162]. The laparoscopic repair seems to be as effective as the open approach although long-term comparative studies should be advocated. Parastomal incisional hernias The presence of a colostomy is frequently associated with the development of a parastomal hernia [163]. A systematic review compared 12 papers for a total of 338 laparoscopic repairs with meshes to 13 studies for 283 ‘‘open’’ prosthetic repair. The laparoscopic procedure had no significant advantage over the open repair in terms of morbidity, mortality, and recurrence rate [164]. Both the Sugarbaker [165, 166] and the keyhole [167, 168] techniques are currently used with a slight prevalence of the latter. The use of a mesh with a slit is related to significant higher mean recurrence rate (34.6 vs 11.6 %) [164, 168–171], while the risk of mesh infection and overall postoperative morbidity did not differ significantly between surgical techniques. A recent multicentric cohort study on 61 patients stated that a modified Sugarbaker procedure safe and feasible in experienced hands with overall morbidity of 19 % and recurrence rate of 6.6 % after a mean follow-up of 26 months [170]. In addition Sugarbaker’s repair has been found to be technically less demanding and associated with decreased surgical time in recent series [172]. One theoretical concern with this method would be that lateralizing the bowel could lead to severe bowel obstructing angulation even though there has not been a reported occurrence [163]. The combination of both techniques has been recently described as ‘‘sandwich repair’’ with lower recurrence rate (2 %) over a median follow-up of 20 months [173]. E-PTFE is the most frequently used prosthetic material for the laparoscopic approach in both techniques. Sporadic reports with the use, in a keyhole fashion, of composite meshes attached with intracorporeal sutures to the bowel serosa are also available [174]; rigorous long-term follow-up is expected to validate its use. An inert mesh material such as polyvinylidene fluoride (PVDF) was used in the sandwich technique in 47 patients with promising low incidence of postoperative mesh-related infections [172] when compared to 3.6 % prosthetic infection with the use of ePTFE patches [164]. Primary laparoscopic Sugarbaker mesh placement with transabdominal suture on either side of the lateralized bowel was found to be effective in reducing the recurrence rate [169]; it could be performed in selected small parastomal hernias or some large ones to ensure
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adequate approximation of the edges prior to mesh deployment [175]. Suprapubic incisional hernias Since the first report in 2001 [176], experience with laparoscopic treatment of such hernias is limited and longterm follow-up between 2.6 months [177] and 4.8 years [178] in the four largest series. Authors agree that laparoscopy allows complete assessment of both the hernia defect and prior scar with reduced chance of ‘‘missed’’ defects [177, 178]. No comparative studies with the open technique were found, and only one article was published on this specific topic since 2009; this retrospective study of 72 patients over a period of 10 years is the largest series of laparoscopic repair of suprapubic hernias to date [179]. All the authors underline the importance of preperitoneal surgical dissection by developing a peritoneal flap with direct visualization of the pubic bone, Cooper’s ligaments, and the inferior epigastric and iliac vessels to obtain sufficient mesh overlap in an area with limited space [177–180]. Most of the authors advocate the elevation of the peritoneum flap with the bladder at the end of the procedure to cover Cooper’s ligaments and the inferior mesh edge, repositioning the bladder to its normal anatomic position [176–179]. The meshes are most frequently fixated to the periosteum of the posterior pubis and Cooper’s ligaments bilaterally [180, 181] and then to the aponeurosis in a double-crown fashion. The inferior margin of the mesh should extend below the pubic arch by at least 2 cm to enable secure fixation to Cooper’s ligaments bilaterally [177, 178, 180]. The inherent difficulties associated with the laparoscopic repair of such hernias, including lack of adequate overlap, are associated with a relatively high recurrence rate [54], estimated 6 % on average [177, 178, 180]. The largest series support the additional use of transabdominal (TA) sutures to reduce the recurrence rate [177, 179]. Different ways of combining TA and tacks are described without any significant difference in terms of outcomes: TA sutures followed by circumferential tacks every 1 cm and additional TA sutures every 3 cm [177], spiral tacks every 1 cm, and TA sutures every 4–5 cm [179] or intracorporeal sutures [180] every 4–5 cm were alternatively proposed to circumferentially fix the mesh to the abdominal wall. TA sutures through the periosteum of the pubis [181] may cause pain and lead to the risk of osteitis [178]. A retrospective study reported the usefulness of intracorporeal polypropylene sutures in a running fashion to completely suture the hernial defect, thus restoring the abdominal domain and preventing the postoperative ‘‘bulge’’ in the anterior abdominal wall, potentially reducing the size of the mesh required to reinforce the repair [180]. Overall complication rate after laparoscopic
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repair is reported between 16.6 and 38 %. Morbidity has been specifically investigated in a review of 47 patients in 4 years, and the occurrence of complications was found to be related to larger defect size, history of previous hernia repair, greater number of previous surgeries, and higher BMI, although these correlations were not statistically significant [177]. STATEMENT PARASTOMAL INCISIONAL HERNIAS 6. 1. Laparoscopic parastomal hernia repair is a safe and feasible procedure and is at least as effective as open prosthetic repair with respect to recurrence, morbidity and mortality. STRONG RECOMMENDATION (Panel consensus 100 %) 6.2. When performing laparoscopic repair, the Sugarbaker technique should be preferred to the keyhole technique because of a significantly lower recurrence rate. WEAK RECOMMENDATION (Panel Consensus 87.5 %) STATEMENT INCISIONAL HERNIAS LOCATED ON THE ABDOMINAL BORDERS: 6.3 Laparoscopic repair is a safe and effective procedure in the management of incisional hernia of the abdominal borders with potentially better short -terms results and less recurrence rate than open repair in selected cases. 6.4 Careful standardization of mesh fixation technique is mandatory and must be tailored for each specific hernia site. WEAK RECOMMENDATION (Panel Consensus 100 %) Topic 7: Management of intraoperative and perioperative complications Diego Cuccurullo Intraoperative complications Enterotomies occur during adhesiolysis or are caused by traction maneuvers for the reduction in the hernia content. If unrecognized, they are diagnosed in the immediate postoperative period (peritonitis) [182]. A review of the literature [183] reported an incidence of 1.78 % in laparoscopic repair, higher than in laparotomic repair, without reaching statistical significance. Usually, it involved the small bowel and large bowel injury represented only 8.35 %. They are recognized and repaired intraoperatively in the 82 % of the cases. The prosthetic ventral hernia repair was completed laparoscopically in 57, and 43 % were converted to open. The mortality rate after
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a recognized enterotomy was 1.7 %, but it rose to 7.7 % if the lesion was unrecognized at the time of surgery. To prevent these complications, it is advisable to perform adhesiolysis by ‘‘cold’’ dissection using electrified instruments only at a safe distance from the viscera. Direct tractions on the bowel are to be avoided, and a gentle pulling of mesentery has to be preferred. [182–184]. Surgeon experience did not influence the enterotomy rate [183]. The management of a lesion of the bowel recognized during laparoscopic ventral hernia repair depends on the amount and type of contamination: in case of leakage from the small bowel, most authors perform a laparoscopic suture of the lesion and complete the procedure with prosthetic repair [1, 183]. For a colon perforation, some authors report a conversion to an open procedure to repair the visceral lesion and a direct suture of the hernia [85, 92, 99]; others repair the lesion, delaying the prosthetic repair within a week [183]. 18 % of bowel injuries remains unrecognized. CT scan should be obtained as soon as the suspicious arises, and early surgical revision should be considered [1, 183–185]. Excision of the previous mesh is recommended in case of evident contamination [183–185]; it is important to note the time of recognition, the type of contamination (small bowel or colon perforation), and also the type of mesh previously used (microporous or macroporous), but there are not enough data provide an evidence-based recommendation. STATEMENTS 7.1 An intraoperative perforation should be repaired immediately, laparoscopically or not, accordingly to the expertise of the surgical team. Prosthetic repair can be accomplished in the absence of a significant contamination. STRONG RECOMMENDATION (Panel Consensus 100 %) 7.2 A CT scan and/or a laparoscopy should be undertaken when a postoperative peritonitis is suspected. if the diagnosis is confirmed, the mesh removal is advisable. WEAK 75 %)
RECOMMENDATION
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Consensus
Postoperative complications Mechanical obstruction The incidence reported after LVHR is 0.5–1.0 % [133, 186]. A mechanical obstruction can be caused by an early recurrence through a slipped mesh (migration of the small bowel between the prosthesis and the anterior abdominal wall), the formation of secondary adhesions to the
prosthesis or to a ‘‘protruding’’ part (tacks, especially if not correctly placed, and the border of the mesh), or else a strangulated hernia at a port site [133]. If an obstruction is suspected, a CT scan is indicated before surgical revision. The management of this complication prompts new surgical intervention (laparoscopic if there is not abnormal distension, or laparotomic) according to the guidelines for mechanical obstruction [1, 133, 186]. Prolonged ileus This is a common postoperative condition in 0.5–16 % [1, 51, 187]. The possibility of a small bowel/colonic leak and/ or mechanical obstruction should be ruled out. The conservative treatment with mobilization, antiemetics, and nasogastric suction is usually effective [1, 48, 187]. Seroma and Hematoma A multicenter clinical trial showed that seroma rate is twofold in laparoscopic repair [188]. Other large trial reported contradictory data with higher seroma rates after open surgery [189]. There is an agreement to avoid puncturing the seroma because this procedure can cause later wound infection [40, 189]. Only for a persisting (6/ 8 weeks) or symptomatic seroma is recommended a needle aspiration [1]; no measure has been proven to prevent the onset of seroma; postoperative compression may reduce the size and duration of seroma [187]. The incidence of local hematoma is similar after laparoscopic and open repair [11] STATEMENT 7.3 The seroma should not be considered a complication unless it becomes symptomatic at least 3 months after surgery. In that case it could be treated with aspiration. STRONG RECOMMENDATION (Panel Consensus 100 %) Wound and prosthetic infection The rate of infection is significantly lower after laparoscopic than after open surgery [1, 11]. Two RCTs showed higher mesh removal rate in the open groups [189, 190]. Predisposing factors are obesity, diabetes mellitus, emergency surgery, contaminated surgery, recurrent incisional hernia, chronic obstructive pulmonary diseases, abdominal aortic aneurysm repair, prior surgical site infection, use of larger microporous or expanded polytetrafluoroethylene mesh, performance of concomitant procedures via the same incision, longer operative time, lack of tissue coverage of the mesh, enterotomy, and entero-cutaneous fistula [191,
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192]. However, those factors are identified in open surgery, and their relevance in laparoscopic surgery is to be demonstrated. The Boston University group advocated that the strategy to avoid mesh infection should be based on the best evidence and high-quality prospective trials and observational studies. A conservative treatment is possible in case of non-septic patients, with targeted antibiotic therapy and local percutaneous drainage [1]. Relevant properties of the meshes are the type of filament, tensile strength, and porosity. Large-pore meshes are also associated with a reduced risk of infection in open surgery [193, 194]. Those results have to be cautiously interpreted due to the much lower infection rate in the laparoscopic repair [11]. In a small retrospective series, mainly laparotomic, the risk of mesh infection with the use of PTFE was found to be higher in the open-surgery subgroup, and, to a much lesser and not statistically significant degree, in the smaller laparoscopic group [193]. Recently, several positive and promising experiences of salvage of infected meshes by topical negative pressure therapy are reported, particularly when large-pore mesh is used [195, 196]. The different properties of the meshes are analyzed in the literature more extensively in the context of an open than laparoscopic repair. STATEMENT 7.4 A conservative treatment of an infected mesh may be attempted. In case of failure, a mesh removal is the alternative. WEAK 100 %)
RECOMMENDATION
(Panel
Consensus
(adhesions, previously identified painful tacks or sutures) is advisable WEAK 100 %)
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Paolo Baccari Proposed follow-up plan The follow-up schedule after repair of incisional or ventral hernia either by laparoscopic or open approach is not clearly defined in the literature. The panel suggests a flowchart for follow-up after laparoscopic ventral/incisional hernia repair. A critical issue is the mixture of primary ventral, incisional, and spigelian hernia, as well as primary and recurrent incisional hernia in the different studies [11, 103]. Their outcomes should be individually studied. It is recommended to separate the results in short (\1 year), middle (1–3 years), and long-term ([3 years). Relevant data to collect: • • • • •
•
Patient demographics Body Mass Index (kg/m2) Previous open repair Previous laparoscopic repair Factors related to hernia defect according to EHS classification [151] (diameter in cm or area in cm2, localization of the hernia, multiple defects, occult hernias, incarcerated hernias, recurrence after previous repair) Technical details on the repair: type of prosthesis, size of the prosthesis, mesh-to-defect ratio, overlap, method of mesh fixation, whether or not the defect was reapproximated, adhesiolysis, and grade of adhesion severity by Mueller’s scale [199]. The following data should be collected in order to guarantee the comparison of the results: • • • •
STATEMENT 7.6 In case of chronic pain non-responsive to medical therapy and/or anesthetic local injection, a laparoscopic re-exploration to identify and remove the cause of pain
(Panel
Topic: 8 laparoscopic ventral/incisional hernia repair: how to structure a follow-up
Postoperative pain An imaging study (ultrasound or CT scan) can help to identify the possible cause of persisting pain (that is a known clinical entity, which becomes critical when still present after 6–8 weeks after surgery), such as seroma, retracted mesh due to abnormal inflammatory reaction, or recurrence [197]. The treatment of chronic pain with local injection of anesthetic has been described leading to the resolution of symptoms after one or two applications [198]. In non-responders, a laparoscopic lysis of the adhesions to the prosthesis and the tacks or removal of the fixation devices located in the areas of the referred pain could provide the solution of the problem [181].
RECOMMENDATION
•
Duration of surgery Conversion to open surgery and the reason thereof (bowel injury, bleeding) Length of postoperative hospital stay Necessity for and duration of intensive care unit (ICU) stay after surgery Acute pain (on day 1, 2, 3 after surgery) as measured with visual analog or numerical rating scale
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• • • • • • • •
Perioperative complications (30 days)(Clavien– Dindo classification) [54]. Local seroma or hematoma (Morales-Conde classification) [200]. Local infection (if possible divided into infections with or without mesh involvement) Re-operation within 30 days Time until return to normal activities or work Quality of life measured by questionnaires Chronic pain ([6 months after surgery) Recurrence
Suggested follow-up schedule The patients should be observed on the seventh postoperative day for clinical evaluation and replacement of postoperative dressing with pressure garment to wear for other 3 weeks. A second outpatient visit is planned at 4 weeks, then after 12 weeks; and every year for the first 3 years. When hernia recurrence is suspected by clinical assessment, imaging evaluation is recommended [103]. At follow-up, quality of life, or chronic pain are usually measured by different validated questionnaires: SF-36, Mc Gill pain questionnaire, VAS (visual analogic scale) or NRS (numeric rating scale), CCS (Carolina comfort scale), and GIQLI (Gastrointestinal Quality of Life Index) [14, 44, 50, 201]. The panel suggest VAS and NRS in the short-term, SF36, and McGill Pain Questionnaire in the long term. In absence of relevant event, a structured telephone interview can be useful to assess postoperative follow-up status. Recurrent ventral/incisional hernia The incidence of hernia recurrence after laparoscopic repair is less than 5 % at long-term follow-up. A metaanalysis suggests that the risk of recurrence be the same as for open abdominal hernia repair [11, 103]. When a recurrence is suspected but not clinically evident, an ultrasonography or computed tomography (CT scan) or both are indicated [43, 133]. The size of the defect is the most significant predictor for recurrence [32, 36, 44, 62]. Obesity and recurrent incisional hernia were already identified in the previous consensus conference as negative prognostic factors [1]. Technical pitfalls as small size of the mesh with an inadequate overlap of the defect, inadequate fixation, or unrecognized abdominal wall defects are the most frequent causes of early recurrence [202]. Furthermore, the surgical site infection has been identified as independent risk factor for recurrence [43].
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The recurrence, following either laparotomy or laparoscopy, can be treated successfully by laparoscopy with a low recurrence rate [43]. In two recent systematic reviews including approximately 8000 patients, recurrence was treated by laparoscopy after open or laparoscopic primary surgery: 27 % of the patients treated (nearly 2000 patients) had a recurrent hernia (range in the different studies: 10–51 %). All these patients were treated by laparoscopic repair, but no specific data have been reported [11, 103]. In other studies with a lower level of evidence, all the reported recurrences were approached by laparoscopy [18, 44, 51, 107, 133]. Non-comparative studies reported a recurrence rate, after laparoscopic recurrent hernia mesh repair, as low as 3.5–5.7 % at 41 month follow-up, comparable with primary repair [55]. Symptomatic mesh bulge, though strictly not a recurrence [203], should be considered an adverse outcome of laparoscopic incisional or ventral hernia repair. A loosely stretched mesh can protrude into the hernia defect when the pneumoperitoneum is released [204]. In patients with symptoms suggestive of recurrent hernia but in whom CT or laparoscopy excluded recurrence, the mesh bulging can be corrected by laparoscopy by stretching a new, larger mesh tightly over the past repair [133]. STATEMENTS 8.1 When hernia recurrence is suspected, imaging techniques are recommended to confirm the diagnosis and plan surgical revision. STRONG RECOMMENDATION (Panel Consensus 87.5 %) 8.2 Incisional hernia recurrence can be treated by laparoscopy either after open or after laparoscopic primary surgery without need of mesh removal. STRONG RECOMMENDATION (Panel Consensus 100 %) 8.3 Patients with bulging in whom US and CT scan excluded incisional hernia recurrence, if symptomatic can be treated by laparoscopy stretching a new larger mesh tightly. WEAK RECOMMENDATION (Panel Consensus 87.5 %)
Discussion Clinical practice guidelines are required to be reviewed and updated as necessary. The first evidence-based Italian Consensus Conference about laparoscopic ventral/incisional hernia repair was organized in January 2010. Its results were published in 2013 [1].
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The executive board of the Italian Society for Endoscopic Surgery (SICE) promoted a full review of those results after having acknowledged that the large amount of literature published in the last 4 years had to be analyzed and synthesized to help clinical practitioners in their work. As expected, some of the recommendations issued in 2010 were found to be still current and were confirmed, and others had to be challenged after having examined the most recent high-quality research. Besides the topics examined then, new relevant aspects were included in the review. Furthermore, the contents of this update differ from those of 2010 in many ways. In fact, the scientific committee elected to grade the strength of the clinical recommendations according to the ‘‘GRADE working group’’ grading system. This makes the recommendations consistent with all those delivered by GRADE methodology and allows easier interpretation of the guideline for clinical purpose. The level of recommendation is reflected in the very same wording of the statements that ‘‘recommend’’ when the grade of recommendation is strong or ‘‘suggest’’ when it is only weak. In fact, the entire work of the panel aimed at translating the available literature evidence into recommendation (when possible) easy to interpret and clear to apply in everyday clinical practice. The grading system adopted was instrumental in this effort, and even when the panel conclusions were similar to those reached in 2010, as in many instances, the GRADE recommendation could make them easier to be interpreted. Several aspects could be better defined than in 2010. The availability of recent level 1 evidence (a meta-analysis of 10 RCTs) allowed us to agree that not only laparoscopic repair is an acceptable alternative to the open repair (for the indications detailed above), but also it is advantageous in terms of shorter hospital stay and wound infection rate. This conclusion appears to be extremely relevant in a clinical setting. In 2010, it was not possible to get over the uncertainty about the outcome of different fixation methods. The most recent literature included more than one well-conducted RCTs comparing suture versus tack mesh fixation, and the statements about this topic could now be better defined. Indications about specific conditions could also be issued: laparoscopy can be considered recommended for the treatment of recurrent ventral hernias and obese patients, while it is a potential option for compensated cirrhotic and childbearing-age female patients. Many relevant and controversial topics were thoroughly examined by this consensus conference for the first time. Among them are the issue of safety of the intraperitoneal mesh placement, traditionally considered a major drawback of the laparoscopic technique, the role for the biologic meshes, and various aspects of the laparoscopic approach
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for particular locations of the defect such as abdominal border or parastomal hernias. The panel pointed out the examined literature was not homogeneous as far as follow-up criteria and suggested a follow-up schedule. All the recommendations are the result of a careful and complete literature review examined with autonomous judgment by the entire panel. The conclusions were independently supervised by experts in methodology and epidemiology from the most qualified Italian institution. Two external reviewers were designed by the EAES and EHS to guarantee the most objective and reliable work. Every issued recommendation, however, needs to be adapted to the specific organizational and professional context. Surgeons should use these recommendations to support their own judgment, taking into account their clinical scenario, their own technical experience and the specific organizational setting. Acknowledgments We gratefully acknowledge the contributions of Dr Salvator Morales Conde and Davide Lomanto, as external reviewers, designed, respectively, by the European Hernia Society and the European Association for Endoscopic Surgery. We are particularly grateful to Dr Marina Davoli (Director of Department of Epidemiology of SSR Lazio) and Dr. Michela Cinquini (Istituto Ricerche Farmacologiche Mario Negri—Head of the Unit ‘‘Methodology of Systematic Revision and Guideline Production’’), epidemiologists, who reviewed the methodological aspects and supported the Panel during all the steps of the consensus conference. Finally, Dr Antonio Corcione, designed by the Italian Society of Anesthesia (SIAARTI), who reviewed the aspects related to anesthesia. Thanks also to Dr Luigi Di Maggio, webmaster of the S.I.C.E. Web site, for his helpfulness and professional support in adapting the S.I.C.E. Forum to the needs of the consensus. We also express our gratitude to all the Presidents of the Scientific Societies that endorsed the consensus. The consensus conference was endorsed by: SICE, ITALIAN CHAPTER EUROPEAN HERNIA SOCIETY, SIC, ACOI, EAES, EHS, SIAARTI Disclosures Authors Gianfranco Silecchia, Fabio Cesare Campanile, Luis Sanchez, Graziano Ceccarelli, Armando Antinori, Luca Ansaloni, Stefano Olmi, Giovanni Carlo Ferrari, Diego Cuccurullo, Paolo Baccari, Ferdinando Agresta, Nereo Vettoretto, and Micaela Piccoli declare that they have no conflict of interest to disclose.
References 1. Cuccurullo D, Piccoli M, Agresta F, Magnone S, Corcione F, Stancanelli V, Melotti G (2013) Laparoscopic ventral incisional hernia repair: evidence-based guidelines of the first Italian Consensus Conference. Hernia 17(5):557–566 2. Howick J, Chalmers I, Glasziou P, Greenhalgh T, Heneghan C, Liberati A, Moschetti I, Phillips B, Thornton H. The 2011 Oxford CEBM Evidence Levels of Evidence (Introductory Document). Oxford Centre for Evidence-Based Medicine. http:// www.cebm.net/index.aspx?o=5653 3. Andrews J, Guyatt G, Oxman AD, Alderson P, Dahm P, FalckYtter Y, Nasser M, Meerpohl J, Post PN, Kunz R, Brozek J, Vist G, Rind D, Akl EA, Schu¨nemann HJ (2013) GRADE guidelines:
Surg Endosc (2015) 29:2463–2484
4.
5.
6. 7.
8. 9. 10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
14. Going from evidence to recommendations: the significance and presentation of recommendations. J Clin Epidemiol 66:719–725 Nieuwenhuizen J, Halm JA, Jeekel J, Lange JF (2007) Natural course of incisional hernia and indications for repair. Scand J Surg 96:293–296 Nieuwenhuizen J, Kleinrensink GJ, Hop WC, Jeekel J, Lange JF (2008) Indications for incisional hernia repair: an international questionnaire among hernia surgeons. Hernia 12:223–225 Sanders DL, Kingsnorth AN (2012) The modern management of incisional hernias. BMJ 9(344):e2843 Evans KK, Chim H, Patel KM, Salgado CJ, Mardini S (2012) Survey on ventral hernias: surgeon indications, contraindications, and management of large ventral hernias. Am Surg 78(4):388–397 Mudge M, Hughes LE (1985) Incisional hernia: a 10 year prospective study of incidence and attitudes. Br J Surg 72:70–71 Kingsnorth A, LeBlanc K (2003) Hernias: inguinal and incisional. Lancet 362:1561–1571 Vardanian AJ, Farmer DG, Ghobrial RM, Busuttil RW, Hiatt JR (2006) Incisional hernia after liver transplantation. J Am Coll Surg 203:421–425. doi:10.1016/j.jamcollsurg.2006.06.017 Sauerland S, Walgenbach M, Habermalz B, Seiler CM, Miserez M (2011) Laparoscopic versus open surgical techniques for ventral or incisional hernia repair. Cochrane Database Syst Rev 16(3):CD007781 Itani KM, Hur K, Kim LT, Anthony T, Berger DH, Reda D, Neumayer L, Veterans Affairs Ventral Incisional Hernia Investigators (2010) Comparison of laparoscopic and open repair with mesh for the treatment of ventral incisional hernia: a randomized trial. Arch Surg 145(4):322–328 Mason RJ, Moazzez A, Sohn HJ, Berne TV, Katkhouda N (2011) Laparoscopic versus open anterior abdominal wall hernia repair: 30-day morbidity and mortality using the ACS-NSQIP database. Ann Surg 254(4):641–652 Sasse KC, Lim DC, Brandt J (2012) Long-term durability and comfort of laparoscopic ventral hernia repair. JSLS 16(3):380–386 Colavita PD, Tsirline VB, Belyansky I, Walters AL, Lincourt AE, Sing RF, Heniford BT (2012) Prospective, long-term comparison of quality of life in laparoscopic versus open ventral hernia repair. Ann Surg 256(5):714–722 Liang MK, Clapp M, Li LT, Berger RL, Hicks SC, Awad S (2013) Patient satisfaction, chronic pain, and functional status following laparoscopic ventral hernia repair. World J Surg 7(3):530–537 Kaoutzanis C, Leichtle SW, Mouawad NJ, Welch KB, Lampman RM, Cleary RK (2013) Postoperative surgical site infections after ventral/incisional hernia repair: a comparison of open and laparoscopic outcomes. Surg Endosc 27(6):2221–2230 Huang CC, Lien HH, Huang CS (2013) Long-term follow-up of laparoscopic incisional and ventral hernia repairs. J Laparoendosc Adv Surg Tech A 23(3):199–203 Kurian A, Gallagher S, Cheeyandira A, Josloff R (2010) Laparoscopic repair of primary versus incisional ventral hernias: time to recognize the differences? Hernia 14(4):383–387 Subramanian A, Clapp ML, Hicks SC, Awad SS, Liang MK (2013) Laparoscopic ventral hernia repair: primary versus secondary hernias. J Surg Res 181(1):e1–e5 Gherardi D, Van Steenberghe M, Derrey AS, Malvaux P, Landenne J, Hauters P (2013) Laparoscopic repair of primary ventral hernias: a series of 118 consecutive patients. Acta Chir Belg 113(2):96–102 Lee K, Iqbal A, Vitamvas M, McBride C, Thompson J, Oleynikov D (2008) Is it safe to perform laparoscopic ventral hernia repair with mesh in elderly patients? Hernia 12:239–242
2479 23. Saber AA, Elgamal MH, Mancl TB, Norman E, Boros MJ (2008) Advanced age: is it an indication or contraindication for laparoscopic ventral hernia repair? JSLS 12:46–50 24. Tessier DJ, Swain JM, Harold KL (2006) Safety of laparoscopic ventral hernia repair in older adults. Hernia 10:53–57 25. Blount Al, Craft RO, Harold KL (2009) Safety of laparoscopic ventral hernia repair in octogenarians. JSLS 13:323–326 26. Polavarapu HV, Kurian AA, Josloff R (2012) Laparoscopic ventral hernia repair in the elderly: does the type of hernia matter? Hernia 16:425–429 27. Kurian A, Gallagher S, Cheeyandira A, Josloff R (2010) Predictors of in-hospital length of stay after laparoscopic ventral hernia repair: results of multivariate logistic regression analysis. Surg Endosc 24:2789–2792 28. Van Ramshorst GH, Nieuwenhuizen J, Hop WC, Arends P, Boom J, Jeekel J, Lange JF (2010) Abdominal wound dehiscence in adults: development and validation of a risk model. World J Surg 34:20–27 29. Kim WB, Kim J, Boo YJ, Park SH, Son YJ, Suh SO, Kim WB (2009) Successful vaginal delivery following laparoscopic abdominal wall reconstruction in an adult survivor of an omphalocele without prior surgical repair: report a case. Hernia 13(4):431–434 30. Schoemaeckers E, Stirler V, Raymakers J, Rakic S (2012) Pregnancy Following Laparoscopic Mesh Repair of Ventral Hernia. JSLS 16:85–88 31. Bencini L, Sanchez LJ, Bernini M, Miranda E, Farsi M, Boffi B, Moretti R (2009) Predictors of recurrence after laparoscopic ventral hernia repair. Surg Laparosc Endosc Percutan Tech 19:128–132 32. Helgstrand F, Rosenberg J, Kehlet H, Jorgensen LN, Bisgaard T (2013) Nationwide prospective study of outcomes after elective incisional hernia repair. J Am Coll Surg 216:217–228 33. Heniford BT, Park A, Ramshaw BJ, Voeller G (2003) Laparoscopic repair of ventral hernias. Nine years’ experience with 850 consecutive hernias. Ann Surg 238:391–400 34. Alder AC, Alder SC, Livingston EH, Bellows CF (2007) Current opinions about laparoscopic incisional hernia repair: a survey of practicing surgeons. Am J Surg 194:659–662 35. De Beaux AC, Tulloh B (2012) Laparoscopic ventral hernia repair. Br J Surg 99:1319–1321 36. Eker HH, Hansson BM, Buunen M, Janssen IM, Pierik RE, Hop WC, Bonjer HJ, Jeekel J, Lange JF (2013) Laparoscopic vs. open incisional hernia repair: a randomized clinical trial. JAMA Surg 148:259–263 37. Wormer BA, Walters AL, Bradley JF 3rd, Williams KB, Tsirline VB, Augenstein VA, Heniford BT (2013) Does ventral hernia defect length, width, or area predict postoperative quality of life? Answers from a prospective, international study. J Surg Res 184(1):169–177 38. Carbajo A, Martın del Olmo JC, Blanco JI, Toledano M, De la Cuesta C, Ferreras C, Vaquero C (2003) Laparoscopic approach to incisional hernia Lessons learned from 270 patients over 8 years. Surg Endosc 17:118–122 39. Olmi S, Scaini A, Cesana GC, Erba L, Croce E (2007) Laparoscopic versus open incisional hernia repair an open randomized controlled study. Surg Endosc 21:555–559 40. Franklin ME Jr, Gonzalez JJ Jr, Glass JL, Manjarrez A (2004) Laparoscopic ventral and incisional hernia repair: an 11-year experience. Hernia 8:23–27 41. Kirshtein B, Lantsberg L, Avinoach E, Bayme M, Mizrahi S (2002) Laparoscopic repair of large incisional hernias. Surg Endosc 16:1717–1719 42. Arteaga-Gonzalez I, Martin-Malagon A, Fernandez EM, Carrillo-Pallares A (2010) Which patients benefit most from laparoscopic ventral hernia repair? A comparative study. Surg Laparosc Endosc Percutan Tech 20(6):391–394
123
2480 43. Kurmann A, Visth E, Candinas D, Beldi G (2011) Long-term follow-up of open and laparoscopic repair of large incisional hernias. World J Surg 35(2):297–301 44. Baccari P, Nifosi J, Ghirardelli L, Staudacher C (2013) Shortand mid-term outcome after laparoscopic repair of large incisional hernia. Hernia 17(5):567–572 45. Moreno-Egea A, Carrillo-Alcaraz A (2012) Management of non-midline incisional hernia by the laparoscopic approach: results of a long-term follow-up prospective study. Surg Endosc 26:1069–1073 46. Den Hartog D, Dur AHM, Kamphuis AGA, Tuinebreijer WE, Kreis RW (2009) Comparison of ultrasonography with computed tomography in the diagnosis of incisional hernias. Hernia 13:45–48 47. Beck WC, Holzman MD, Sharp KW, Nealon WH, Dupont WD, Poulose BK (2012) Comparative effectiveness of dynamic abdominal sonography for hernia vs computed tomography in the diagnosis of incisional hernia. J Am Coll Surg 216:447–453 48. Zinther NB, Zeuten A, Marinovskij E, Haislund M, Friis-Andersen H (2010) Functional cine MRI and transabdominal ultrasonography for the assessment of adhesions to implanted synthetic mesh 5-7 years after laparoscopic ventral hernia repair. Hernia 14:499–504 49. Kirchhoff S, Ladurner R, Kirchhoff C, Mussack T, Reiser MF, Lienemann A (2010) Detection of recurrent hernia and intraabdominal adhesions following incisional hernia repair: a functional cine MRI-study. Abdom Imaging 35:224–231 50. Uranues S, Salehi B, Bergamaschi R (2008) Adverse events, quality of life and recurrence rates after laparoscopic adhesiolysis and recurrent incisional hernia mesh repair in patients with previous failed repairs. J Am Coll Surg 207:663 51. Moreno-Egea A, Castillo JA, Girela BE, Aguayo-Albasini JL (2010) Long-term results of laparoscopic repair of incisional hernias using an intraperitoneal composite mesh. Surg Endosc 24(2):359–365 52. Bingener J, Buck L, Richards M, Michalek J, Schwesinger W, Sirinek K (2007) Long-term outcomes in laparoscopic vs open ventral hernia repair. Arch Surg 142:562–567 53. Cobb WS, Kercher KW, Matthews BD, Burns JM, Tinkham NH, Sing RF, Heniford BT (2006) Laparoscopic ventral hernia repair: a single center experience. Hernia 10(3):236–242 54. Rogmark P, Petersson U, Bringman S, Eklund A, Ezra E, Sevonius D, Smedberg S, Osterberg J, Montgomery A (2013) Shortterm outcomes for open and laparoscopic midline incisional hernia repair: a randomized multicenter controlled trial: the ProLOVE (prospective randomized trial on open versus laparoscopic operation of ventral eventrations) trial. Ann Surg 258(1):37–45 55. Ferrari G, Bertoglio C, Magistro C, Girardi V, Mazzola M, Lernia SD, Pugliese R (2013) Laparoscopic repair for recurrent incisional hernias: a single institute experience of 10 years. Hernia 17(5):573–580 56. Mavros MN, Athanasiou S, Alexiou VG, Mitsikostas PK, Peppas G, Falagas ME (2011) Risk factors for mesh-related infections after hernia repair surgery: a meta-analysis of cohort studies. World J Surg 35(11):2389–2398 57. Shabanzadeh DM, Sørensen LT (2012) Laparoscopic surgery compared with open surgery decreases surgical site infection in obese patients: a systematic review and meta-analysis. Ann Surg 256(6):934–945 58. Colon MJ, Kitamura R, Telem DA, Nguyen S, Divino CM (2013) Laparoscopic umbilical hernia repair is the preferred approach in obese patients. Am J Surg 205:231–236 59. Colavita PD, Tsirline VB, Walters AL, Lincourt AE, Belyansky I, Heniford BT (2013) Laparoscopic versus open hernia repair: outcomes and sociodemographic utilization results from the nationwide inpatient sample. Surg Endosc 27(1):109–117
123
Surg Endosc (2015) 29:2463–2484 60. Tsereteli Z, Pryor BA, Heniford BT, Park A, Voeller G, Ramshaw BJ (2008) Laparoscopic ventral hernia repair (LVHR) in morbidly obese patients. Hernia 12(3):233–238 61. Forbes SS, Eskicioglu C, McLeod RS, Okrainec A (2009) Metaanalysis of randomized controlled trials comparing open and laparoscopic ventral and incisional hernia repair with mesh. Br J Surg 96:851–858 62. Moreno-Egea A, Carrillo-Alcaraz A, Aguayo-Albasini JL (2012) Is the outcome of laparoscopic incisional hernia repair affected by defect size? A prospective study. Am J Surg 203(1):87–94 63. Lee J, Mabardy A, Kermani R, Lopez M, Pecquex N, McCluney A (2013) Laparoscopic vs open ventral hernia repair in the era of obesity. JAMA Surg 12:1–4 64. Rao RS, Gentileschi P, Kini SU (2011) Management of ventral hernias in bariatric surgery. Surg Obes Relat Dis 7(1):110–116 65. Ching SS, Sarela AI, Dexter SP, Hayden JD, McMahon MJ (2008) Comparison of early outcomes for laparoscopic ventral hernia repair between nonobese and mordibly obese patient populations. Surg Endosc 22:2244–2250 66. Eid GM, Wikiel KJ, Entabi F, Saleem M (2013) Ventral hernias in morbidly obese patients: a suggested algorithm for operative repair. Obes Surg 23:703–709 67. Praveen Raj P, Senthilnathan P, Kumaravel R, Rajpandian S, Rajan PS, Anand Vijay N, Palanivelu C (2012) Concomitant laparoscopic ventral hernia mesh repair and bariatric surgery: a retrospective study from a tertiary care center. Obes Surg 22:685–689 68. Loriau J, Manaouil D, Mauvais F (2002) Management of umbilical hernia in cirrhotic patients. J Chir 139(3):135–140 69. Dokmak S, Aussilhou B, Belghiti J (2012) Umbilical hernias and cirrhose. J Visc Surg 149(5):s33–s41 70. Cobb WS, Heniford BT, Burns JM, Carbonell AM, Matthews BD, Kercher KW (2005) Cirrhosis is not a contraindication to laparoscopic surgery. Surg Endosc 19(3):418–423 71. Belli G, D’Agostino A, Fantini C, Cioffi L, Belli A, Russolillo N, Langella S (2006) Laparoscopic incisional and umbilical hernia repair in cirrhotic patients. Surg Laparosc Endosc Percutan Tech 16(5):330–333 72. Kurmann A, Beldi G, Vorburger SA, Seiler CA, Candinas D (2010) Laparoscopic incisional hernia repair is feasible and safe after liver transplantation. Surg Endosc 24(6):1451–1455 73. Marsman HA, Heisterkamp J, Halm JA, Tilanus HW, Metselaar HJ, Kazemier G (2007) Management in patients with liver cirrhosis and an umbilical hernia. Surgery 142(3):372–375 74. Eker HH, van Ramshorst GH, de Goede B, Tilanus HW, Metselaar HJ, de Man RA, Lange JF, Kazemier G (2011) A prospective study on elective umbilical hernia repair in patients with liver cirrhosis and ascites. Surgery 150(3):542–546 75. Sarit C, Eliezer A, Mizrahi S (2003) Minimally invasive repair of recurrent strangulated umbilical hernia in cirrhotic patient with refractory ascites. Liver Transpl 9(6):621–622 76. Hiremath BV, Rao N, Raja B (2012) Laparoscopic ventral hernia repair in patients with Child C cirrhosis: our experince. World J Laparosc Surg 5(2):59–62 77. Choi SB, Hong KD, Lee JS, Han HJ, Kim WB, Song TJ, Suh SO, Kim YC, Choi SY (2011) Management of umbilical hernia complicated with liver cirrhosis: an advocate of early and elective herniorrhaphy. Dig Liver Dis 43(12):991–995 78. McKay A, Dixon E, Bathe O, Sutherland F (2009) Umbilical hernia repair in the presence of cirrhosis and ascites: results of a survey and review of the literature. Hernia 13(5):461–468 79. Cho SW, Bhayani N, Newell P, Cassera MA, Hammill CW, Wolf RF, Hansen PD (2012) Umbilical hernia repair in patients with signs of portal hypertension: surgical outcome and predictors of mortality. Arch Surg 147(9):864–869 80. Nahas FX, Augusto SM, Ghelfond C (1997) Should diastasis recti be corrected? Aesthetic Plast Surg 21(4):285–289
Surg Endosc (2015) 29:2463–2484 81. Palanivelu C, Rangarajan M, Jategaonkar PA, Amar V, Gokul KS, Srikanth B (2009) Laparoscopic repair of diastasis recti using the ‘Venetian blinds’ technique of plication with prosthetic reinforcement: a retrospective study. Hernia 13(3):287– 292 82. Hickey F, Finch JG, Khanna A (2011) A systematic review on the outcomes of correction of diastasis of the recti. Hernia 15(6):607–614 83. Elkhatib H, Buddhavarapu SR, Henna H, Kassem W (2011) Abdominal musculoaponeuretic system: magnetic resonance imaging evaluation before and after vertical plication of rectus muscle diastasis in conjunction with lipoabdominoplasty. Plast Reconstr Surg 128(6):733e–740e 84. Agresta F, Ansaloni L, Baiocchi GL, Bergamini C, Campanile FC, Carlucci M, Cocorullo G, Corradi A, Franzato B, Lupo M, Mandala` V, Mirabella A, Pernazza G, Piccoli M, Staudacher C, Vettoretto N, Zago M, Lettieri E, Levati A, Pietrini D, Scaglione M, De Masi S, De Placido G, Francucci M, Rasi M, Fingerhut A, Uranu¨s S, Garattini S (2012) Laparoscopic approach to acute abdomen from the Consensus Development Conference of the Societa` Italiana di Chirurgia Endoscopica e nuove tecnologie (SICE), Associazione Chirurghi Ospedalieri Italiani (ACOI), Societa` Italiana di Chirurgia (SIC), Societa` Italiana di Chirurgia d’Urgenza e del Trauma (SICUT), Societa` Italiana di Chirurgia nell’Ospedalita` Privata (SICOP), and the European Association for Endoscopic Surgery (EAES). Surg Endosc 26:2134–2164 85. Grafen FC, Neuhaus V, Schob O, Turina M (2010) Management of acute small bowel obstruction from intestinal adhesions: indications for laparoscopic surgery in a community teaching hospital. Langenbecks Arch Surg 395(1):57–63 86. Landau O, Kyzer S (2004) Emergent laparoscopic repair of incarcerated incisional and ventral hernia. Surg Endosc 18:1374–1376 87. Franklin ME, Gonzalez JJ, Miter DB, Glass JL, Paulson D (2004) Laparoscopic diagnosis and treatment of intestinal obstruction. Surg Endosc 18:26–30 88. Szomstein S, Lo Menzo E, Simpfendorfer C, Zundel N, Rosenthal R (2006) Laparoscopic lysis of adhesions. World J Surg 30:535–540 89. Olmi S, Cesana G, Eba L, Croce E (2009) Emergency laparoscopic treatment of acute incarcerated incisional hernia. Hernia 3:605–608 90. Bessa SS, Abdel-Razek AH (2013) Results of prosthetic mesh repair in the emergency management of the acutely incarcerated and/or strangulated ventral hernias: a seven years study. Hernia 17(1):59–65 91. Sharma A, Mehrotra M, Khullar R, Soni V, Baijal M, Chowbey PK (2008) Limited-conversion technique: a safe and viable alternative to conversion in laparoscopic ventral/incisional hernia repair. Hernia 12:367–371 92. Lujan HJ, Oren A, Plasencia G, Canelon G, Gomez E, Hernandez-Cano A, Jacobs M (2006) Laparoscopic management as the initial treatment of acute small bowel obstruction. JSLS 10:466–472 93. Strickland P, Lourie DJ, Suddleson EA, Blitz JB, Stain SC (1999) Is laparoscopy safe and effective for treatment of acute small-bowel obstruction? Surg Endosc 13:695–698 94. Carlson MA, Frantzides CT, Shostrom VK, Laguna LE (2008) Minimally invasive ventral herniorrhaphy: an analysis of 6,266 published cases. Hernia 12:9–22 95. Campanelli G, Catena F, Ansaloni L (2008) Prosthetic abdominal wall hernia repair in emergency surgery: from polypropylene to biological meshes. World J Emerg Surg 3:33 96. Parra MW, Rodas EB, Niravel AA (2011) Laparoscopic repair of potentially contaminated abdominal ventral hernias using a xenograft: a case series. Hernia 15(5):575–578
2481 97. Franklin ME Jr, Trevino JM, Portollo G, Vela I, Glass JL, Gonzalez JJ (2008) The use of porcine small intestinal submucosa as a prosthetic material for laparoscopic hernia repair in infected and potentially contaminated fields: long-term follow up. Surg Endosc 22:1941–1946 98. Shah RH, Sharma A, Khullar R, Soni V, Baijal M, Chowbey PK (2008) Laparoscopic repair of incarcerated ventral abdominal wall hernias. Hernia 12(5):457–463 99. Lo´pez-Tomassetti Ferna´ndez EM, Martı´n Malago´n A, Delgado Plasencia L, Arteaga Gonza´lez I (2006) Laparoscopic repair of incarcerated low spigelian hernia with transperitoneal PTFE DualMesh. Surg Laparosc Endosc Percutan Tech 16(6):427–431 100. Leff DR, Hassell J, Sufi P, Heath D (2009) Emergency and elective laparoscopic repair of spigelian hernias: two case reports and a review of the literature. Surg Laparosc Endosc Percutan Tech 19(4):e152–e155 101. MacDonald E, Pringle K, Ahmed I (2009) Single port laparoscopic repair of incarcerated ventral hernia. Re: laparoscopic repair of incarcerated ventral abdominal wall hernias. Hernia 13(3):339 102. Deeken CR, Faucher KM, Matthews BD (2012) A review of the composition, characteristics, and effectiveness of barrier mesh prostheses utilized for laparoscopic ventral hernia repair. Surg Endosc 26(2):566–575 103. Moreau PE, Helmy N, Vons C (2012) Laparoscopic treatment of incisional hernia. State of the art in 2012. J Vasc Surg 149(5 Suppl):e40–e48 104. Miserez M, Grass G, Weiss C, Stu¨tzer H, Sauerland S, Neugebauer EA, LAPSIS Investigators (2010) Closure of the LAPSIS trial. Br J Surg 97(10):1598 105. Colon MJ, Telem DA, Chin E, Weber K, Divino CM, Nguyen SQ (2011) Polyester composite versus PTFE in laparoscopic ventral hernia repair. JSLS 15(3):305–308 106. Klinge U, Klosterhalfen B (2012) Modified classification of surgical meshes for hernia repair based on the analyses of 1,000 explanted meshes. Hernia 16(3):251–258 107. Sharma A, Mehrotra M, Khullar R, Soni V, Baijal M, Chowbey PK (2011) Laparoscopic ventral/incisional hernia repair: a single centre experience of 1,242 patients over a period of 13 years. Hernia 15(2):131–139 108. Hansson BM, Slater NJ, van der Velden AS, Groenewoud HM, Buyne OR, de Hingh IH, Bleichrodt RP (2012) Surgical techniques for parastomal hernia repair: a systematic review of the literature. Ann Surg 255(4):685–695 109. Chelala E, Debardemaeker Y, Elias B, Charara F, Dessily M, Alle´ JL (2010) Eighty-five redo surgeries after 733 laparoscopic treatments for ventral and incisional hernia: adhesion and recurrence analysis. Hernia 14(2):123–129 110. Wassenaar E, Schoenmaeckers E, Raymakers J, van der Palen J, Rakic S (2010) Mesh-fixation method and pain and quality of life after laparoscopic ventral or incisional hernia repair: a randomized trial of three fixation techniques. Surg Endosc 24(6):1296–1302 111. Jenkins ED, Yom V, Melman L, Brunt LM, Eagon JC, Frisella MM, Matthews BD (2010) Prospective evaluation of adhesion characteristics to intraperitoneal mesh and adhesiolysis-related complications during laparoscopic re-exploration after prior ventral hernia repair. Surg Endosc 24:3002–3007 112. Jonas J (2009) The problem of mesh shrinkage in laparoscopic incisional hernia repair. Zentralbl Chir 134(3):209–213 113. Schoenmaeckers EJ, van der Valk SB, van den Hout HW, Raymakers JF, Rakic S (2009) Computed tomographic measurements of mesh shrinkage after laparoscopic ventral incisional hernia repair with an expanded polytetrafluoroethylene mesh. Surg Endosc 23(7):1620–1623 114. Carter PR, LeBlanc KA, Hausmann MG, Whitaker JM, Rhynes VK, Kleinpeter KP, Allain BW (2012) Does expanded
123
2482
115.
116. 117.
118.
119. 120. 121.
122.
123.
124.
125.
126. 127.
128.
129.
130.
131.
Surg Endosc (2015) 29:2463–2484 polytetrafluoroethylene mesh really shrink after laparoscopic ventral hernia repair? Hernia 6(3):321–325 Beldi G, Wagner M, Bruegger LE, Kurmann A, Candinas D (2011) Mesh shrinkage and pain in laparoscopic ventral hernia repair: a randomized clinical trial comparing suture versus tack mesh fixation. Surg Endosc 25(3):749–755 Rutkow IM (1997) Surgical procedure in the United States. Then (1983) and now (1994). Arch Surg 132(9):983–990 Engelsman AF, van der Mei H, Ploeg RJ, Busscher HJ (2007) The phenomenon of infection in abdominal wall reconstruction. Biomaterials 28(14):2314–2327 Ansaloni L, Catena F, Coccolini F, Negro P, Campanelli G, Miserez M (2009) New ‘‘biological’’ meshes: the need for a register, the EHS Registry for Biological Prostheses: call for participating European surgeons. Hernia 13(1):103–108 Uscher FC (1962) Hernia repair with marlex mesh. An analysis of 514 cases. Arch Surg 84:325–328 Smart NJ, Bloor S (2012) Durability of biologic implants for use in hernia repair: a review. Surg Innov 19(3):221–229 Ansaloni L, Catena F, Coccolini F, Fini M, Gazzotti F, Giardino R, Pinna AD (2009) Peritoneal adhesions to prosthetic materials: an experimental comparative study of treated and untreated polypropylene meshes placed in the abdominal cavity. J Laparoendosc Adv Surg Tech A 19(3):369–374 Deeken CR, Melman L, Jenkins ED, Greco SC, Frisella MM, Matthews BD (2011) Histologic and biomechanical evaluation of crosslinked and noncrosslinked biologic meshes in a porcine model of ventral incisional hernia repair. J Am Coll Surg 212(5):880–888 Catena F, Ansaloni L, D’Alessandro L, Pinna A (2007) Adverse effects of porcine small intestine submucosa (SIS) implants in experimental ventral hernia repair. Surg Endosc 21(4):690 Ansaloni L, Catena F, Coccolini F, Gazzotti F, D’Alessandro L, Pinna AD (2009) Inguinal hernia repair with porcine small intestine submucosa: 3-year follow-up results of a randomized controlled trial of Lichtenstein’s repair with polypropylene mesh versus Surgisis Inguinal Hernia Matrix. Am J Surg 198(3):303–312 De Castro Bra´s LE, Shurey S, Sibbons PD (2012) Evaluation of crosslinked and non-crosslinked biologic prostheses for abdominal hernia repair. Hernia 16(1):77–89 Sipe JD (2002) Tissue engineering and reparative medicine. Ann N Y Acad Sci 961:1–9 Coccolini F, Agresta F, Bassi A, Catena F, Crovella F, Ferrara R, Gossetti F, Marchi D, Munegato G, Negro P, Piccoli M, Melotti G, Sartelli M, Schiano di Visconte M, Testini M, Bertoli P, Capponi MG, Lotti M, Manfredi R, Pisano M, Poiasina E, Poletti E, Ansaloni L (2012) Italian Biological Prosthesis WorkGroup (IBPWG): proposal for a decisional model in using biological prosthesis. World J Emerg Surg 7(1):34 Petter-Puchner AH, Fortelny RH (2010) Use of porcine small intestine submucosa as a prosthetic material for laparoscopic hernia repair in infected and potentially contaminated fields: long-term follow up assessment; Surg Endosc (2008) 22: 1941–1946. Surg Endosc 24:230–231. doi:10.1007/s00464-0090631-z Coccolini F, Poiasina E, Bertoli P, Gossetti F, Agresta F, Dassatti MR, Riccio P, Cavalli M, Agrusti S, Cucchi M, Negro P, Campanelli G, Ansaloni L, Catena F (2013) The italian register of biological prostheses. Eur Surg Res 50(3–4):262–272 Sajid MS, Parampalli U, McFall MR (2013) A meta-analysis comparing tacker mesh fixation with suture mesh fixation in laparoscopic incisional and ventral hernia repair. Hernia 17(2): 159–166 Bansal VK, Misra MC, Babu D, Singhal P, Rao K, Sagar R, Kumar S, Rajeshwari S, Rewari V (2012) Comparison of long-
123
132.
133.
134.
135.
136.
137.
138.
139.
140.
141. 142.
143.
144.
145.
146.
term outcome and quality of life after laparoscopic repair of incisional and ventral hernias with suture fixation with and without tacks: a prospective, randomized, controlled study. Surg Endosc 26(12):3476–3485 Baccari P, Nifosi J, Ghirardelli L, Staudacher C (2009) Laparoscopic incisional and ventral hernia repair without sutures: a single-center experience with 200 cases. J Laparoendosc Adv Surg Tech A 19(2):175–179 Wassenaar EB, Schoenmaeckers EJ, Raymakers JT, Rakic S (2009) Recurrences after laparoscopic repair of ventral and incisional hernia: lessons learned from 505 repairs. Surg Endosc 23(4):825–832 Bansal VK, Misra MC, Kumar S, Rao YK, Singhal P, Goswami A, Guleria S, Arora MK, Chabra A (2011) A prospective randomized study comparing suture mesh fixation versus tacker mesh fixation for laparoscopic repair of incisional and ventral hernias. Surg Endosc 25(5):1431–1438 Edwards C, Geiger T, Bartow K, Ramaswamy A, Fearing N, Thaler K, Ramshaw B (2009) Laparoscopic transperitoneal repair of flank hernias: a retrospective review of 27 patients. Surg Endosc 23(12):2692–2696 Muysoms F, Vander Mijnsbrugge G, Pletinckx P, Boldo E, Jacobs I, Michiels M, Ceulemans R (2013) Randomized clinical trial of mesh fixation with ‘‘double crown’’ versus ‘‘sutures and tackers’’ in laparoscopic ventral hernia repair. Hernia 17:603–612 Hollinsky C, Kolbe T, Walter I, Joachim A, Sandberg S, Koch T, Ru¨licke T, Tuchmann A (2010) Tensile strength and adhesion formation of mesh fixation systems used in laparoscopic incisional hernia repair. Surg Endosc 24(6):1318–1324 Lepere M, Benchetrit S, Bertrand JC, Chalbet JY, Combier JP, Detruit B, Herbault G, Jarsaillon P, Lagoutte J, Levard H, Rignier P (2008) Laparoscopic resorbable mesh fixation. Assessment of an innovative disposable instrument delivering resorbable fixation devices: I-Clip(TM). Final results of a prospective multicentre clinical trial. Hernia 12(2):177– 183 Byrd JF, Agee N, Swan RZ, Lau KN, Heath JJ, Mckillop IH, Sindram D, Martinie JB, Iannitti DA (2011) Evaluation of absorbable and permanent mesh fixation devices: adhesion formation and mechanical strength. Hernia 15(5):553–558 Cavallaro G, Campanile FC, Rizzello M, Greco F, Iorio O, Iossa A, Silecchia G (2013) Lightweight polypropylene mesh fixation in laparoscopic incisional hernia repair. Minim Invasive Ther Allied Technol 22(5):283–287 Eriksen JR (2011) Pain and convalescence following laparoscopic ventral hernia repair. Dan Med Bull 58(12):B4369 Fortelny RH, Petter-Puchner AH, Glaser KS, Redl H (2012) Use of fibrin sealant (Tisseel/Tissucol) in hernia repair: a systematic review. Surg Endosc 26(7):1803–1812 Rieder E, Stoiber M, Scheikl V, Poglitsch M, Dal Borgo A, Prager G, Schima H (2011) Mesh fixation in laparoscopic incisional hernia repair: glue fixation provides attachment strength similar to absorbable tacks but differs substantially in different meshes. J Am Coll Surg 212(1):80–86 Olmi S, Cesana G, Sagutti L, Pagano C, Vittoria G, Croce E (2010) Laparoscopic incisional hernia repair with fibrin glue in select patients. JSLS 14(2):240–245 Ceccarelli G, Patriti A, Batoli A, Bellochi R, Spaziani A, Pisanelli MC, Casciola L (2008) Laparoscopic incisional hernia mesh repair with the ‘‘double-crown’’ technique: a case-control study. J Laparoendosc Adv Surg Tech A 18(3):377–382 Ferrari GC, Miranda A, Sansonna F, Magistro C, Di Lernia S, Maggioni D, Franzetti M, Costanzi A, Pugliese R (2009) Laparoscopic repair of incisional hernias located on the abdominal borders: a retrospective critical review. Surg Laparosc Endosc Percutan Tech 19(4):348–352
Surg Endosc (2015) 29:2463–2484 147. Podolsky ER, Mouhlas A, Wu AS, Poor AE, Curcillo PG 2nd (2010) Single Port Access (SPA) laparoscopic ventral hernia repair: initial report of 30 cases. Surg Endosc 24(7):1557–1561 148. Bucher P, Pugin F, Morel P (2011) Single-port access prosthetic repair for primary and incisional ventral hernia: toward less parietal trauma. Surg Endosc 25(6):1921–1925 149. Bower CE, Love KM (2011) Single incision laparoscopic ventral hernia repair. JSLS 15(2):165–168 150. Tran H (2012) Safety and efficacy of laparoendoscopic singlesite surgery for abdominal wall hernias. JSLS 16(2):242–249 151. Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E, Dietz UA, Eker HH, El Nakadi I, Hauters P, Hidalgo Pascual M, Hoeferlin A, Klinge U, Montgomery A, Simmermacher RK, Simons MP, Smietan´ski M, Sommeling C, Tollens T, Vierendeels T, Kingsnorth A (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13(4): 407–414 152. Suarez S, Hernandez JD (2013) Laparoscopic repair of a lumbar hernia: report of a case and extensive review of the literature. Surg Endosc 27(9):3421–3429 153. Yavuz N, Ersoy YE, Demirkesen O, Tortum OB, Erguney S (2009) Laparoscopic incisional lumbar hernia repair. Hernia 13(3):281–286 154. Moreno-Egea A, Alcaraz AC, Cuervo MC (2013) Surgical options in lumbar hernia: laparoscopic versus open repair. A long-term prospective study. Surg Innov 20(4):331–344 155. Moreno-Egea A, Mengual-Ballester M, Cases-Baldo´ MJ, Aguayo-Albasini JL (2010) Repair of complex incisional hernias using double prosthetic repair: single-surgeon experience with 50 cases. Surgery 148(1):140–144 156. Palanivelu C, Rangarajan M, John SJ, Madankumar MV, Senthilkumar K (2008) Laparoscopic transperitoneal repair of lumbar incisional hernias: a combined suture and ‘double-mesh’ technique. Hernia 12(1):27–31 157. Gianchandani R, Moneva E, Marrero P, Alonso M, Palacios MJ, Del Pino JM, Concepcio´n V, Barrera M, Soriano A (2011) Feasibility and effectiveness of laparoscopic incisional hernia repair after liver transplantation. Transplant Proc 43(3):742–744 158. Anadol AZ, Tezel E, Yilmaz U, Kurukahvecioglu O, Ersoy E (2010) Laparoscopic primary repair of ventral hernias: early results of a new technique. Surg Today 40(1):88–91 159. Losanoff JE, Basson MD, Laker S, Weiner M, Webber JD, Gruber SA (2007) Subxiphoid incisional hernias after median sternotomy. Hernia 11(6):473–479 160. Landau O, Raziel A, Matz A, Kyzer S, Haruzi I (2001) Laparoscopic repair of poststernotomy subxiphoid epigastric hernia. Surg Endosc 15(11):1313–1314 161. Mackey RA, Brody FJ, Berber E, Chand B, Henderson JM (2005) Subxiphoid incisional hernias after median sternotomy. J Am Coll Surg 201(1):71–76 162. Eisenberg D, Popescu WM, Duffy AJ, Bell RL (2008) Laparoscopic treatment of subxiphoid incisional hernias in cardiac transplant patients. JSLS 12(3):262–266 163. Song IH, Ha HK, Choi SG, Jeon BG, Kim MJ, Park KJ (2012) Analysis of risk factors for the development of incisional and parastomal hernias in patients after colorectal surgery. J Korean Soc Coloproctol 28(6):299–303 164. Hansson BM, Bleichrodt RP, de Hingh IH (2009) Laparoscopic parastomal hernia repair using a keyhole technique results in a high recurrence rate. Surg Endosc 23(7):1456–1459 165. Muysoms F (2007) Laparoscopic repair of parastomal hernias with a modified Sugarbaker technique. Acta Chir Belg 107(4):476–480 166. Mancini GJ, McClusky DA 3rd, Khaitan L, Goldenberg EA, Heniford BT, Novitsky YW, Park AE, Kavic S, LeBlanc KA, Elieson MJ, Voeller GR, Ramshaw BJ (2007) Laparoscopic
2483
167.
168. 169.
170.
171.
172.
173.
174. 175.
176. 177.
178.
179.
180.
181.
182.
183.
184.
185.
parastomal hernia repair using a nonslit mesh technique. Surg Endosc 21(9):1487–1489 Wara P, Andersen LM (2011) Long-term follow-up of laparoscopic repair of parastomal hernia using a bilayer mesh with a slit. Surg Endosc 25(2):526–530 Safadi B (2004) Laparoscopic repair of parastomal hernias: early results. Surg Endosc 18(4):676–680 Asif A, Ruiz M, Yetasook A, Denham W, Linn J, Carbray J, Ujiki MB (2012) Laparoscopic modified Sugarbaker technique results in superior recurrence rate. Surg Endosc 26(12):3430–3434 Hansson BM, Morales-Conde S, Mussack T, Valdes J, Muysoms FE, Bleichrodt RP (2013) The laparoscopic modified Sugarbaker technique is safe and has a low recurrence rate: a multicenter cohort study. Surg Endosc 27(2):494–500 Pastor DM, Pauli EM, Koltun WA, Haluck RS, Shope TR, Poritz LS (2009) Parastomal hernia repair: a single center experience. JSLS 13(2):170–175 Craft RO, Harold KL (2009) Laparoscopic repair of incisional and other complex abdominal wall hernias. Perm J Summer 13(3):38–42 Berger D, Bientzle M (2009) Polyvinylidene fluoride: a suitable mesh material for laparoscopic incisional and parastomal hernia repair. A prospective, observational study with 344 patients. Hernia 13(2):167–172 Hiranyakas A, Ho YH (2010) Laparoscopic parastomal hernia repair. Dis Colon Rectum 53(9):1334–1336 Banerjee A, Beck C, Narula VK, Linn J, Noria S, Zagol B, Mikami DJ (2012) Laparoscopic ventral hernia repair: does primary repair in addition to placement of mesh decrease recurrence? Surg Endosc 26(5):1264–1268 Hirasa T, Pickleman J, Shayani V (2001) Laparoscopic repair of parapubic hernia. Arch Surg 136(11):1314–1317 Varnell B, Bachman S, Quick J, Vitamvas M, Ramshaw B, Oleynikov D (2008) Morbidity associated with laparoscopic repair of suprapubic hernias. Am J Surg 196(6):983–987 (discussion 987-8) Sharma A, Dey A, Khullar R, Soni V, Baijal M, Chowbey PK (2011) Laparoscopic repair of suprapubic hernias: transabdominal partial extraperitoneal (TAPE) technique. Surg Endosc 25(7):2147–2152 Carbonell AM, Kercher KW, Matthews BD, Sing RF, Cobb WS, Heniford BT (2005) The laparoscopic repair of suprapubic ventral hernias. Surg Endosc 19(2):174–177 Palanivelu C, Rangarajan M, Parthasarathi R, Madankumar MV, Senthilkumar K (2008) Laparoscopic repair of suprapubic incisional hernias: suturing and intraperitoneal composite mesh onlay. A retrospective study. Hernia 12:251–256 McKay R, Haupt D (2006) Laparoscopic repair of low abdominal wall hernias by tack fixation to the cooper ligament. Surg Laparosc Endosc Percutan Tech 16(2):86–90 Deffieux X, Ballester M, Collinet P, Fauconnier A, Pierre F (2011) Risks associated with laparoscopic entry: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians. Eur J Obstet Gynecol Reprod Biol 158(2):159–166 LeBlanc KA, Elieson MJ, Corder J III (2007) Enterotomy and mortality rates of laparoscopic incisional and ventral hernia repair: a review of the literature. JSLS 11:408–414 Wassenaar EB, Schoenmaeckers EJ, Raymakers J, Rakic S (2010) Subsequent abdominal surgery after laparoscopic ventral and incisional hernia repair with an expanded polytetrafluoroethylene mesh: a single institution experience with 72 reoperations. Hernia 14(2):137–142 Vilos GA, Ternamian A, Dempster J, Laberge PY (2007) Laparoscopic entry: a review of techniques, technologies, and complications. J Obstet Gynaecol Can 29(5):433–465
123
2484 186. Rosen M, Brody F, Ponsky J, Walsh RM, Rosenblatt S, Duperier F, Fanning A, Siperstein A (2003) Recurrence after laparoscopic ventral hernia repair. A five-year experience. Surg Endosc 17:123–128 187. LeBlanc KA, Whitaker JM, Bellanger DE, Rhynes VK (2003) Laparoscopic incisional and ventral hernioplasty: lessons learned from 200 patients. Hernia 7:118–124 188. Moreno-Egea A, Carrillo A, Aguayo JL (2008) Midline versus nonmidline laparoscopic incisional hernioplasty: a comparative study. Surg Endosc 22:744–749 189. Barbaros U, Asogulu O, Seven R, Erbil Y, Dinccag A, Deveci U, Ozarmagan S, Mercan S (2006) The comparison of laparoscopic and open ventral hernia repairs: a prospective randomized study. Hernia 11(1):51–56 190. Carbajo MA, Martin del Olmo JC, Blanco J, De la Cuesta C, Toledano M, Martin F, Vaquero C, Inglada L (1999) Laparoscopic treatment versus open surgery in the solution of major incisional and abdominal wall hernias with mesh. Surg Endosc 13(3):250–252 191. Memon AA, Khan A, Zafar H, Murtaza G, Zaidi M (2013) Repair of large and giant incisional hernia with onlay mesh: perspective of a tertiary care hospital of a developing country. Int J Surg 11(1):41–45 192. Sanchez VM, Abi-Hadair YE, Itani KM (2011) Mesh infection in ventral incisional hernia repair: incidence, contributing factors and treatment. Surg Infect (Larchmt) 12(3):205–210 193. Brown RH, Subramanian A, Hwang CS, Chang S, Awad SS (2013) Comparison of infectious complications with synthetic mesh in ventral hernia repair. Am J Surg 205(2):182–187 194. Brown CN, Finch JG (2010) Which mesh for hernia repair? Ann R Coll Surg Engl 92(4):272–278 195. Berrevoet Vanlander A, Sainz-Barriga M, Rogiers X, Troisi R (2013) Infected meshes may be salvaged by topical negative pressure therapy. Hernia 17(1):67–73
123
Surg Endosc (2015) 29:2463–2484 196. Chazoutlis G, Chazoutlis K, Spyridopulos P, Pappas P, Ploumis A (2012) Salvage of an infected titanium mesh in a large incisional ventral hernia using medicinal honey and vacuum-assisted closure: a case report and literature review. Hernia 16(4):475–479 197. Amid PK (2004) A new phenomenon causing chronic pain after prosthetic repair of abdominal wall hernias. Arch Surg 139:1297–1298 198. Carbonell AM, Harold KL, Mahmutovic AJ et al (2003) Local injection for the treatment of suture site pain after laparoscopic ventral hernia repair. Am Surg 69:688–692 199. Mueller MD, Tschudi J, Hermann U et al (1995) An evaluation of laparoscopic adhesiolysis in patients with chronic abdominal pain. Surg Endosc 9:802–804 200. Morales-Conde S (2012) A new classification for seroma after laparoscopic ventral hernia repair. Hernia 16(3):261–267 201. Heniford BT, Walters AL, Lincourt AE, Novitsky YW, Hope WW, Kw Kercher (2008) Comparison of generic versus specific quality-of-life scales for mesh hernia repairs. J Am Coll Surg 206:638–644 202. Sanchez LJ, Bencini L, Moretti R (2004) Recurrences after laparoscopic ventral hernia repair: results and critical review. Hernia 8:138–143 203. Tse GH, Stutchfield BM, Duckworth AD, de Beaux AC, Tulloh B (2010) Pseudo-recurrence following laparoscopic ventral and incisional hernia repair. Hernia 14:583–587 204. Schoenmaekers EJP, Wassenaar EB, Raymakers JTFJ, Rakic S (2010) Bulging of the mesh after laparoscopic repair of ventral and incisional hernias. JSLS 14:541–546
