Search

Purpose: The ideal location for mesh placement in minimally invasive ventral hernia repair (VHR) is still up for debate. We undertook a systematic review and meta-analysis (SRMA) to evaluate the outcomes of patients who received intraperitoneal mesh versus those that received extraperitoneal mesh in minimally invasive VHR.Methods: We searched PubMed, EMBASE, Cochrane, and Scopus from inception to May 3, 2021. We selected studies comparing intraperitoneal mesh versus extraperitoneal mesh placement in minimally invasive VHR. A meta-analysis was done for the outcomes of surgical site infection (SSI), seroma, hematoma, readmission, and recurrence. A subgroup analysis was conducted for a subset of studies comparing patients who have undergone intraperitoneal onlay mesh (IPOM) versus extended totally extraperitoneal approach (e-TEP).Results: A total of 11 studies (2320 patients) were identified. We found no statistically significant difference between patients who received intraperitoneal versus extraperitoneal mesh for outcomes of SSI, seroma, hematoma, readmission, and recurrence [(RR 1.60, 95% CI 0.60-4.27), (RR 1.39, 95% CI 0.68-2.81), (RR 1.29, 95% CI 0.45-3.72), (RR 1.40, 95% CI 0.69-2.86), and (RR 1.22, 95% CI 0.22-6.63), respectively]. The subgroup analysis had findings similar to the overall analysis.Conclusion: Based on short-term results, extraperitoneal mesh does not appear to be superior to intraperitoneal mesh in minimally invasive ventral hernia repair. The choice of mesh location should be based on the current evidence, surgeon, and center experience as well as individualized to each patient. [ABSTRACT FROM AUTHOR]

Purpose: To describe the feasibility of modified-TEP technique in reducing dead space in large inguinoscrotal and large femoral hernia to prevent seroma, reduce recurrence and complications. Methods: This is a case series of patients who have completed a minimum of 9 months follow-up after undergoing elective endo-laparoscopic inguinal hernia repair with modified-TEP technique for large inguinoscrotal and large femoral hernia in a single institution from June to October 2020. Results: 14 large inguinoscrotal hernia and 4 large femoral hernia were repaired using the modified-TEP technique in 15 patients. These patients reported minimal pain after surgery. There were no reported seroma, complications or recurrences up to 9 months follow-up period. Conclusion: Modified-TEP technique for large inguinoscrotal and large femoral hernia has shown good outcomes and patients reported minimum levels of pain. In experienced hands, it is safe, feasible and effective in reducing seroma formation and hernia recurrence. [ABSTRACT FROM AUTHOR]

Introduction: Lateral ventral hernia (LVH) is rare and can be primary or secondary. Surgical treatment of this rare hernia type is challenging due the anatomic location and technical challenges in placement and secure anchoring of mesh. Method: Patient demographic data, intra-operative data and post-operative outcomes on all LVH repairs performed with endo-laparoscopic and robotic approach between 2016 to 2018 were reviewed and analysed. Results: 22 LVH were repaired in 21 patients. 9 had primary hernia and 13 had secondary hernia. All patients underwent minimally invasive surgery (MIS) for hernia repair with no conversion to open surgery. Fascial defect closure and placement of mesh were performed in all cases. Different approaches were utilized: 9 hernia repaired with laparoscopic intra-peritoneal on-lay mesh technique with defect closure (IPOM +), 4 had laparoscopic trans-abdominal pre-peritoneal repair (TAPP), another 4 had extended totally extra-peritoneal repair (eTEP), 3 had robotic TAPP (rTAPP) and 2 repaired with trans-abdominal partial extra-peritoneal (TAPE) approach. 4 (19%) of the patients developed post-operative seroma which were managed conservatively. No other significant complication was noted, and no chronic pain or recurrence reported within a minimum follow-up of 12 months. Conclusion: This case series gives a broad outline of possible MIS options available for LVH repair and recommendations for a tailored approach. The surgical technique needs to be individualized according to the size and anatomic location of the defect, other intra-operative findings and patient characteristics. [ABSTRACT FROM AUTHOR]

Purpose: Seroma formation and recurrence in large inguinal hernia still remain an important clinical complication despite decades since the advent of mesh repair.Methods: In our prospective comparative analysis, we want to evaluate the effect of direct hernia defect closure on surgical outcomes in patients undergoing laparoscopic inguinal hernia repair in two tertiary care institutions in Singapore. The direct hernia defects were closed with non-absorbable sutures incorporating the pseudosac.Results: A group of 241 patients underwent laparoscopic inguinal hernia mesh repair for a total of 378 direct defects from April 2014 to July 2018. Of these patients, 98 (40.6%) patients underwent hernia repair without closure of their direct defect while 143 (59.4%) patients underwent direct defect closure. No significant differences were observed between the two patient populations' demographic information and the mean operative time. A total of 219 direct defects were closed and 159 direct defects were not repaired. Compared to the group that did not undergo direct defect closure, the group that had closure of the direct defects demonstrated a statistically significant reduction in recurrence (4.4% versus 0.9%, p = 0.036) and seroma formation (12.6% versus 6.4%, p = 0.045).Conclusion: Direct defect closure has proven to be effective in reducing recurrence and seroma formation post-operatively in patients undergoing laparoscopic inguinal hernia repair. Randomized controlled trials will be required to further evaluate these outcomes. [ABSTRACT FROM AUTHOR]

Therefore, it is important that the distal hernia sac is plicated in layers to the posterior abdominal wall and this may require grasping the superolateral edge of the sac at multiple sites and to use a layered suturing to achieve a safe imbrication. First, the authors advised to fix the lower edge of the distal hernia sac cranially and laterally to the posterior abdominal wall. We have specifically mentioned that for these large hernia sacs, simple suturing is not adequate, as there is a risk of tearing and retracting the sac back worsening the pneumoscrotum, which we have experienced before. [Extracted from the article]

The article presents abstracts of various studies on hernia management which includes acute paraoesophageal hiatus hernia, diagnostic dilemma and laproscopic hernia maangement and use of biological mesh to repair a contaminated wall defect related to fistulae. [ABSTRACT FROM AUTHOR]

The article presents abstracts of various studies on hernia management which includes double blind randomized controlled trial on surgery for chronic abdominal pain, outcomes after incisional hernia repair and long term outcome of abdominal wall surgery for anterior cutaneous nerve entrapment syndrome. [ABSTRACT FROM AUTHOR]

The article presents abstracts of several research papers on inguinal hernia including single port laparoscopic hemioplasty, trans-inguinal posterior prosthetic repair (TIPP) for recurrent groin hernia and learning curve in single port endoscopic inguinal hernia repair. [ABSTRACT FROM AUTHOR]

The article presents abstracts of several research papers on inguinal hernia including surgery for unilateral primary inguinal hernia repair, recurrent inguinal hernia treated with the Narrow Mesh (NM) and endo-laparoscopic inguinal hernia repair in female patients. [ABSTRACT FROM AUTHOR]

The article presents abstracts of several research papers on inguinal hernia including post-operative seroma after laparoscopic TEP repair of direct inguinal hernia, minimally invasive Trans-abdominal pre-peritoneal (TAPP) inguinal hernia repair and the ideal implantation technique for inguinal hernioplasty. [ABSTRACT FROM AUTHOR]