Page 30 - WALS Journal

Long-term Outcomes in Laparoscopic vs Open Ventral Hernia Repair
left costal margin in mid clavicle line. Day before surgery bowel 1. It should be rapid and permanent in growth into the
should be prepared, that will give more working space during prosthesis.
surgery in the abdominal cavity. Laparoscopic Ventral Hernia 2. It should decrease the risk of intestinal adhesion.
Repair can be done with various methods either intraperitonial There are two types of mesh commonly used synthetic and
or extraperitonial. But in our study repair was done collagen based in most article ePTFE were used with
intraperitonially. polypropylene, because of a low affinity for adhesion, the PTFE
mesh is probably the first choice for intraperitoneal prosthesis.
Anesthesia In summary the use of mesh can reduce the recurrence rate from
General anesthesia with endotracial intubation and close 40 to 50% to about 10% only.

monitoring. The type of operation was determined by surgeon

preference. Patients were referred from the same patientpool to
Patient Position members of a surgical group.
Supine position without any tilt, so that the bowel is distributed Exclusion Criteria
evenly.
Patients, who underwent additional procedures at the time of

Port Position hernia repair, such as planned bowel resection or nonmesh

repairs, are excludedfrom this analysis.
Port Placement Technique Additional dates were collected from the review of patient

The patient is painted and draped and after that checking light records. Variables are assessed by patient demographics like
cable, insuffilation tube, electrosurgical cautery, suction age, sex, body mass index [BMI is calculated as the weight in
irrigation canula and veress needle patancy with focusing and kilograms divided by the height in meters squared], and co
white balancing of the camera, then pneumoperitoneum is morbidities like obesity diabetes, IHD, pulmonary diseases,
created by veress needle in the left palmar’s point (this point is details about the operative procedure (open versus laparoscopic

contraindicated in splenomegaly) other site like right repair and type and size of mesh used), and outcome data such

hypochondrium, flank or iliac fossa can also be used for as morbidity,recurrence rates, and duration of stay. The type of

telescope port. Once pneumoperitoneum created then 10 mm mesh used depends upon the operating surgeon’s preference

port put after desirable insufflation another one 5 mm port and and mesh availability. Polypropylene was used by some
10 mm port according to Baseball diamond concept put under surgeons and it was determined by intraoperatively so that the

vision, after diagnostic laparoscopy the procedure if there is amount of omentum present will preventbowel contact with the
any adhesion careful Adhesiolysis is done. Content of sac mesh to prevent adhesion. The duration of hospital stay was

returned back which is either omentum or bowel then the extent recordedeither as outpatient surgery and assigned the value of

of defect assessed thoroughly then measurement of the defect 0.5 days or as a postoperative inpatient admission with the

drawn on the external surface of anterior abdominal wall and number of days recorded. Comorbidities are specifically

adequate size mesh that cover the whole defect and addressed were the corners. If a patient was identified to have

overlapping up to 4 to 5 cm from the edge of the defect, all the pulmonary disease that was stated in the medical record for
necessary precaution to be taken to avoid contamination of the follow up. Patients who underwent a conversion to open repair

mesh, then the mesh rolled and inserted in port to the abdominal remained in the laparoscopic group for an intention-to-treat
cavity, then mesh unrolled and it is fixed by means of Tacker, analysis.
Endoanchor or Protack, to abdominal wall with out opening the
peritoneum technique. After completing the repair the ports Complications
withdrawn under vision and telescope port are removed last. Clavien classification was used for staging postoperative

Ports of 10 mm better to be repaired because cases of incisional complications. Complications of grade II or higher are considered
hernia reported in some articles. Recently two port laparoscopic as major complications. In this classification, grade I

ventral hernia repairs were also reported in some articles. complications not require pharmacological treatment or

intervention; gradeII complications that include patients those
Choice of Mesh requiring pharmacological treatment, total parenteral nutrition

For the hernia repair laparoscopically meshes underwent many orblood transfusions, grade IIIcomplications require surgical,

changes over the last few years, in general the ideal mesh is radiological or endoscopicintervention; grade IV complications

characterized by economic aspects, functionality, operative are life threatening andrequire intensive care unit management;

handling, sterility and even anti-infective property and and grade V complications result in death. Postoperative
optimized biocompatibility. occurrences of a seroma are identified by examine the patient.
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