A new three-step hybrid approach is a safe procedure for incisional hernia: early experiences with a single centre retro
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A new three‑step hybrid approach is a safe procedure for incisional hernia: early experiences with a single centre retrospective cohort L. Matthijs van den Dop1 · Gijs H. J. de Smet1 · Michaël P. A. Bus3 · Johan F. Lange1,2 · Sascha M. P. Koch3 · Willem E. Hueting3 Received: 4 June 2020 / Accepted: 2 September 2020 © The Author(s) 2020
Abstract Purpose In this study, a three-step novel surgical technique was developed for incisional hernia, in which a laparoscopic procedure with a mini-laparotomy is combined: so-called ‘three-step incisional hybrid repair’. The aim of this study was to reduce the risk of intestinal lacerations during adhesiolysis and recurrence rate by better symmetrical overlap placement of the mesh. Objectives To evaluate first perioperative outcomes with this technique. Methods From 2016 to 2020, 70 patients (65.7% females) with an incisional hernia of > 2 and ≤ 10 cm underwent a elective three-step incisional hybrid repair in two non-academic hospitals performed by two surgeons specialised in abdominal wall surgery. Intra- and postoperative complications, operation time, hospitalisation time and hernia recurrence were assessed. Results Mean operation time was 100 min. Mean hernia size was 4.8 cm; 45 patients (64.3%) had a hernia of 1–5 cm, 25 patients (35.7%) of 6–10 cm. Eight patients had a grade 1 complication (11.4%), five patients a grade 2 (7.1%), two patients (2.8%) a grade 4 complication and one patient (1.4%) a grade 5 complication. Five patients had an intraoperative complication (7.0%), two enterotomies, one serosa injury, one omentum bleeding and one laceration of an epigastric vessel. Mean length of stay was 3.3 days. Four patients (5.6%) developed a hernia recurrence during a mean follow-up of 19.5 weeks. Conclusion A three-step hybrid incisional hernia repair is a safe alternative for incisional hernia repair. Intraoperative complications rate was low. Keywords Incisional hernia · Hybrid · Laparoscopic · Surgical technique · Hernia recurrence · Enterotomy
Introduction Incisional hernias occur in approximately ten to fifteen percent of the general patient population after abdominal surgery [1]. This percentage may exceed over 30% in high risk patients with obesity or an abdominal aorta aneurysm (AAA) [2]. An incisional hernia can develop after any sort * L. Matthijs van den Dop [email protected]; [email protected] 1
Department of Surgery, Erasmus University Medical Centre, Room Ee‑173, Dr. Molewaterplein 40, 3000 CA, PO BOX 2040, 3015 GD Rotterdam, The Netherlands
2
Department of Surgery, IJsselland Ziekenhuis, Capelle Aan Den IJssel, The Netherlands
3
Department of Surgery, Alrijne Ziekenhuis, Leiderdop, The Netherlands
of abdominal wall incision. However, abdominal incision through the midline is most prone to incisional hernia development [3, 4]. Known risk factors that contribute to the development of an incisional hernia are high age, high Body Mass Index (BMI), presence of AAA, immunosuppressants, lung disease and heav
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