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      Laparoscopic versus hybrid approach for treatment of incisional ventral hernia: a prospective randomised multicentre study, 1-year results

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          Abstract

          Purpose

          Laparoscopic incisional ventral hernia repair (LIVHR) is often followed by seroma formation, bulging and failure to restore abdominal wall function. These outcomes are risk factors for hernia recurrence, chronic pain and poor quality of life (QoL). We aimed to evaluate whether LIVHR combined with defect closure (hybrid) follows as a diminished seroma formation and thereby has a lower rate of hernia recurrence and chronic pain compared to standard LIVHR.

          Methods

          This study is a multicentre randomised controlled clinical trial. From November 2012 to May 2015, 193 patients undergoing LIVHR for primary incisional hernia with fascial defect size from 2 to 7 cm were recruited in 11 Finnish hospitals. Patients were randomised to either a laparoscopic (LG) or a hybrid (HG) repair group. The main outcome measure was hernia recurrence, evaluated clinically and radiologically at a 1-year follow-up visit. At the same time, chronic pain scores and QoL were also measured.

          Results

          At the 1-year-control visit, we found no difference in hernia recurrence between the study groups. Altogether, 11 recurrent hernias were found in ultrasound examination, producing a recurrence rate of 6.4%. Of these recurrences, 6 (6.7%) were in the LG group and 5 (6.1%) were in the HG group ( p > 0.90). The visual analogue scores for pain were low in both groups; the mean visual analogue scale (VAS) was 1.5 in LG and 1.4 in HG ( p = 0.50). QoL improved significantly comparing preoperative status to 1 year after operation in both groups since the bodily pain score increased by 7.8 points ( p < 0.001) and physical functioning by 4.3 points ( p = 0.014).

          Conclusion

          Long-term follow-up is needed to demonstrate the potential advantage of a hybrid operation with fascial defect closure. Both techniques had low hernia recurrence rates 1 year after operation. LIVHR reduces chronic pain and physical impairment and improves QoL.

          Trial Registry: Clinical trial number NCT02542085.

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          Most cited references28

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          Long-term Recurrence and Complications Associated With Elective Incisional Hernia Repair.

          Thue Bisgaard, Frederik Helgstrand, Dunja Kokotovic (2016)
          Prosthetic mesh is frequently used to reinforce the repair of abdominal wall incisional hernias. The benefits of mesh for reducing the risk of hernia recurrence or the long-term risks of mesh-related complications are not known.
          Article 0 comments Cited 104 times – based on 0 reviews     Review now
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            Laparoscopic repair of ventral hernias: nine years' experience with 850 consecutive hernias.

            Adrian Park, B. J. Ramshaw, B. Todd Heniford … (2003)
            To evaluate the efficacy and safety of laparoscopic repair of ventral hernias. The recurrence rate after standard repair of ventral hernias may be as high as 12-52%, and the wide surgical dissection required often results in wound complications. Use of a laparoscopic approach may decrease rates of complications and recurrence after ventral hernia repair. Data on all patients who underwent laparoscopic ventral hernia repair (LVHR) performed by 4 surgeons using a standardized procedure between November 1993 and October 2002 were collected prospectively (85% of patients) or retrospectively. LVHR was completed in 819 of the 850 patients (422 men; 428 women) in whom it was attempted. Thirty-four percent of completed LVHRs were for recurrent hernias. The patient mean body mass index was 32; the mean defect size was 118 cm2. Mesh, averaging 344 cm2, was used in all cases. Mean operating time was 120 min, mean estimated blood loss was 49 mL, and hospital stay averaged 2.3 days. There were 128 complications in 112 patients (13.2%). One patient died of a myocardial infarction. The most common complications were ileus (3%) and prolonged seroma (2.6%). During a mean follow-up time of 20.2 months (range, 1-94 months), the hernia recurrence rate was 4.7%. Recurrence was associated with large defects, obesity, previous open repairs, and perioperative complications. In this large series, LVHR had a low rate of conversion to open surgery, a short hospital stay, a moderate complication rate, and a low risk of recurrence.
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              [Factors influencing the development of incisional hernia. A retrospective study of 2,983 laparotomy patients over a period of 10 years].

              V. Schumpelick, J Höer, G Lawong … (2002)
              Incisional hernia formation is one of the most frequent complications in visceral surgery requiring reoperation. Risk factors for incisional hernia formation and preventive strategies are not clearly defined. In a retrospective study including 2983 patients over a 10-year period, the influence of demographic data, pre-, intra- and postoperative risk factors for incisional hernia development were evaluated. From the subgroups medical history, medication, laboratory values, indication, surgical technique, course of operation, postoperative course and wound healing, altogether 43 parameters were analysed. Statistical evaluation was performed using the chi 2-test according to Pearson, and binary logistic regression analysis. The mean incisional hernia incidence in the study was 4.3%. In the mean follow-up period of 21.1 months, the incisional hernia incidence was calculated at 9.8% using the Kaplan-Meier estimate; for a 10-year period it reached 18.7%. The study revealed that 31.5% of all incisional hernias developed in the first 6 months after the operation, 54.4% after 12 months, 74.8% after 2 years and 88.9% after 5 years. Significant demographic factors influencing incisional hernia incidence were age (> 45 years) and male gender. The preoperative factors anaemia (Hb 25, the intraoperative factors recurrent incision and previous laparotomy, and the postoperative factors catecholamin-therapy and disturbed wound healing were of significant influence. The calculated incisional hernia incidence for a 10 year period of almost 20% and the manifestation of 50% of all hernias more than 12 months after the operation, underline the necessity to intensify surgical research in the field of laparotomy healing. In comparison to demographic and endogenous risk factors, the surgical technique has less influence on laparotomy healing. Measures to ameliorate tissue perfusin seem to exert a positive influence on incisional hernia incidence.
              Article 0 comments Cited 89 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Mirella Ahonen-Siirtola: mirella.ahonen@oulu.fi
                Journal
                Journal ID (nlm-ta): Surg Endosc
                Journal ID (iso-abbrev): Surg Endosc
                Title: Surgical Endoscopy
                Publisher: Springer US (New York )
                ISSN (Print): 0930-2794
                ISSN (Electronic): 1432-2218
                Publication date (Electronic): 2 April 2019
                Publication date PMC-release: 2 April 2019
                Publication date (Print): 2020
                Volume: 34
                Issue: 1
                Pages: 88-95
                Affiliations
                [1 ]GRID grid.412326.0, ISNI 0000 0004 4685 4917, Department of Surgery, , Oulu University Hospital, ; Oulu, Finland
                [2 ]GRID grid.412326.0, ISNI 0000 0004 4685 4917, Department of Radiology, , Oulu University Hospital, ; Oulu, Finland
                [3 ]GRID grid.15485.3d, ISNI 0000 0000 9950 5666, Department of Surgery, , Helsinki University Hospital, ; Helsinki, Finland
                [4 ]GRID grid.440346.1, ISNI 0000 0004 0628 2838, Department of Surgery, , Päijät-Häme Central Hospital, ; Lahti, Finland
                [5 ]GRID grid.415465.7, ISNI 0000 0004 0391 502X, Department of Surgery, , Seinäjoki Central Hospital, ; Seinäjoki, Finland
                [6 ]Department of Surgery, Valkeakoski Regional Hospital, Valkeakoski, Finland
                [7 ]GRID grid.415595.9, ISNI 0000 0004 0628 3101, Department of Surgery, , Kymenlaakso Central Hospital, ; Kotka, Finland
                [8 ]GRID grid.410552.7, ISNI 0000 0004 0628 215X, Department of Surgery, , Turku University Hospital, ; Turku, Finland
                [9 ]GRID grid.412326.0, ISNI 0000 0004 4685 4917, Division of Gastroenterology, Department of Surgery, , Oulu University Hospital, OYS, ; PL 21, 90029 Oulu, Finland
                Article
                Publisher ID: 6735
                DOI: 10.1007/s00464-019-06735-9
                PMC ID: 6946755
                PubMed ID: 30941550
                SO-VID: ac4321a5-30ac-455d-9e15-3ac99f7c3559
                Copyright © © The Author(s) 2019
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Date received : 21 November 2018
                Date accepted : 6 March 2019
                Categories
                Subject: Article
                Custom metadata
                issue-copyright-statement © Springer Science+Business Media, LLC, part of Springer Nature 2020

                ScienceOpen disciplines: Surgery
                Keywords: incisional ventral hernia,laparoscopy,hybrid,recurrence,quality of life,chronic pain
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: incisional ventral hernia, laparoscopy, hybrid, recurrence, quality of life, chronic pain

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