A preliminary multicenter evaluation of endoscopic sublay repair for ventral hernia from China
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RESEARCH ARTICLE
Open Access
A preliminary multicenter evaluation of endoscopic sublay repair for ventral hernia from China Rui Tang1†, Huiyong Jiang2†, Weidong Wu3* , Tao Wang4, Xiangzhen Meng5, Guozhong Liu6, Xiaoyan Cai7, Jianwen Liu8, Xijun Cui9, Xianke Si10, Nan Liu1 and Nina Wei1
Abstract Background: For ventral hernia, endoscopic sublay repair (ESR) may overcome the disadvantages of open sublay and laparoscopic intraperitoneal onlay mesh repair. This retrospective study presents the preliminary multicenter results of ESR from China. The feasibility, safety, and effectiveness of ESR were evaluated; its surgical points and indications were summarized. Methods: The study reviewed 156 ventral hernia patients planned to perform with ESR in ten hospitals between March 2016 and July 2019. Patient demographics, hernia characteristics, operative variables, and surgical results were recorded and analyzed. Results: ESR was performed successfully in 153 patients, 135 with totally extraperitoneal sublay (TES) and 18 with transabdominal sublay (TAS). In 19 patients, TES was performed with the total visceral sac separation (TVS) technique, in which the space separation is carried out along the peritoneum, avoiding damage to the aponeurotic structure. Endoscopic transversus abdominis release (eTAR) was required in 17.0% of patients, and only 18.3% of patients required permanent mesh fixation. The median operative time was 135 min. Most patients had mild pain and resume eating soon after operation. No severe intraoperative complications occurred. Bleeding in the extraperitoneal space occurred in two patients and was stopped by nonsurgical treatment. Seroma and chronic pain were observed in 5.23 and 3.07% of patients. One recurrence occurred after TAS repair for an umbilical hernia. Conclusion: ESR is feasible, safe, and effective for treating ventral hernias when surgeons get the relevant surgical skills, such as the technique of “partition breaking,” TVS, and eTAR. Small-to-medium ventral hernias are the major indications. Keywords: Ventral hernia, Endoscopic sublay repair (ESR), Totally extraperitoneal sublay (TES), Transabdominal sublay (TAS), Total visceral sac separation (TVS) technique, Endoscopic transversus abdominis release (eTAR)
* Correspondence: [email protected] † Tang Rui and Jiang Huiyong contributed equally to this work. 3 Department of Gastrointestinal Surgery, Shanghai General Hospital, 86 Wujin Rd, Shanghai, China Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a cr
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