Laparoscopic transperitoneal sublay mesh repair: a new technique for the cure of ventral and incisional hernias
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and Other Interventional Techniques
Laparoscopic transperitoneal sublay mesh repair: a new technique for the cure of ventral and incisional hernias Alexander Daniel Schroeder • Eike Sebastian Debus • Michael Schroeder • Wolfgang Matthias Johann Reinpold
Received: 19 March 2012 / Accepted: 3 July 2012 / Published online: 6 September 2012 Ó Springer Science+Business Media, LLC 2012
Abstract Background Incisional hernia is a frequent complication after abdominal surgery. Today open sublay mesh repair and the laparoscopic intraperitoneal onlay mesh repair are the most widely used techniques for its cure. We developed a laparoscopic transperitoneal sublay mesh repair for the treatment of small- and medium-size ventral and incisional hernias. Outcomes of the new technique and the Rives– Stoppa repair were compared. Methods This prospective cohort study with a control group involved 93 patients. Between 2008 and 2010, 43 patients underwent the laparoscopic transperitoneal sublay mesh repair. During the same period of time, a control group of 50 patients underwent an open sublay repair after Rives and Stoppa. In 2011, all patients were invited for follow-up. This included pain assessments and physical examinations with use of ultrasound. Results The two groups were comparable in terms of patient characteristics and hernia data. The operating time was slightly longer for the laparoscopic technique. The hospital stay was shorter in the laparoscopy group. There was less chronic pain in the laparoscopy group, but this difference was not statistically significant. There was no A. D. Schroeder University of Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany e-mail: [email protected] E. S. Debus Department of Vascular Medicine, University Heart Center Hamburg-Eppendorf, Hamburg, Germany M. Schroeder W. M. J. Reinpold (&) Department of Surgery, Wilhelmsburg Gross-Sand Hospital, Gross-Sand 3, 21107 Hamburg, Germany e-mail: [email protected]
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significant difference in postoperative complications, use of analgetics, foreign body sensation, and paresthesia between the two groups. We found one long-term hematoma in the laparoscopy group and one seroma in the open group. In this series, there were no recurrences and no wound infections. Conclusions Our initial results indicate that the new laparoscopic transperitoneal sublay mesh repair is a safe and effective method for the treatment of small- and medium-size ventral and incisional hernias. Keywords New technique Laparoscopic repair Sublay repair Ventral hernia Incisional hernia
The development of an incisional hernia is one of the most common complications after abdominal surgery. The incidence of this complication is approximately 10–20 % [1–4]. Suture repair of primary and incisional abdominal wall hernia is reported to have a recurrence rate of approximately 25–63 %. Mesh repair is reported to have a lower recurrence rate of 2–32 % [5–10]. For the Rives– Stoppa repair, retromuscular mesh placement is performed via an open ap
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