Page 31 - WALS Journal

M Dhanesh Kumar

In laparoscopic hernia surgery, the hernia sac are not excised. unrecognized enterotomy on the first postoperative day and it
This effectively leaves behind a potential space for seroma required reoperation for mesh removal. The patient was

formation. It happens to be one of the complications inherent recovered and underwent open ileostomytakedown and hernia
to this procedure. A significant seroma was defined as a seroma repair done one year later. Six patients experienced mesh

that caused pain or discomfort, erythema, or infection. Most infection in theopen group which required removalof the mesh.

seromas resolve with time, some requiring eight to 12 weeks for None of the patients from the laparoscopic group had mesh

complete resolution. Majority of the authors considered the infection. Major complications seen in patients with preexisting

seromas for conservative management. Some surgeons have pulmonary comorbidities; Around 27% of patients with
advocated using dressing or abdominal binder to cause pulmonary comorbidities versus 10% of patients without
compression on abdominal wall to occlude the potential dead pulmonary disease suffered postoperative complications. The

space. recurrence rateand complication rate were not correlated with

In the laparoscopicgroup patients, significant seromas are the type of operation performed (laparoscopic vs. open) in

aspirated. In the open group, drains are placed at the time of patients with pulmonary comorbidities. By using a logistic

operation to prevent the formation of a seroma. No data were regression model, and the occurrence of the complication was

collected regarding fixation-related pain. A statistical analysis associated with the operative method without the adjustment

was done by using Fisher exact test and Wilcoxon rank sum for pulmonary disease and the remained associated after

test, and test with SAS statistical software version 9.3 (SAS adjustment for pulmonary disease. BMI did not alter these

Institute, Inc, Cary, NC). conclusions, and BMI did not contribute significantly to the

model. In 16 patients (13%) in the laparoscopic group and 21

Results patients (9%) in the open group had recurrenceat a mean follow-
up between 30 and 36 months respectively. Median follow-up
From the year 1995 October to December 2005, a total of 651 was done 25 months for patients with open hernia repair and 36
patients underwent ventral hernia repair at single institution. months for the patients with laparoscopic hernia repair.

Around 514 (79%) underwent an open ventral herniarepair and 75 patients (32%) in the open hernia group and 45 patients
137 (21%) underwent a laparoscopic ventral hernia repair. (36%) in the laparoscopic group had more than 36 months

Around two hundred eighty one patients (55%) who have duration for follow-up. Determination of recurrence was done

underwent the open repair and 10 patients (7%) who have by physical examination and documentation in the record. In

underwent the laparoscopic repair wereexcluded from the study addition to the records, all the available imaging studies that

because they underwent either additional procedure, like include computedtomography scans obtained in asymptomatic

planned bowel resection or a nonmeshventral hernia repair. A patients for unrelateddiagnoses like cancer follow-up or injury

total of two hundred and thirty three patients who underwent are reviewed. Anyinformation of recurrence in the record or on

an open procedure and one hundred twenty seven patients the imaging studies, whether they are symptomatic or not, are

who underwent a laparoscopic procedure are used in the final taken as recurrence. Statistical analysisdid not reveal about the

statistical analysis. Five patients (4%) requiredconversion from effect related to the type of mesh used on the recurrence rate.

the laparoscopic to the open procedure because of Studies revealed that patients who developed a postoperative

hemodynamic instability, or inability to obtain visualization,or abscess had increased recurrence rate that is 4.4-fold recurrence
technical difficulties during the mesh placement. when compared with those who did not develop an abscess.

Diagnosis of cancer in sixteen patients (7%) in the open

hernia group and 7 patients (6%) in the laparoscopic hernia Patients with higher BMI rates more than 30 had a 5-fold risk of

recurrence when compared with patients with normal weight
group had diagnosed prior to surgery. There are no data on (BMI<25) Postoperative inpatient admission was more frequent

preoperative prealbumin levels are collected.The mean BMI as in the open procedure than after the laparoscopic procedure

a proxy for obesity-related malnutrition are similar for both the respectively; The higher rate of outpatient surgery in the

groups. Describes the different types of mesh used for the laparoscopic group than in the open group wasassociated with

repairs, with the polypropylene mesh usedin the earlier phase a shorter mean duration of stay (mean ± SD length of stay,

of the study in patients with sufficient omentum present. No 0.9 ± 1.4 days vs. 1.4 ± 2.0days, respectively).

mesh-related bowel fistula was recorded.
Around, 43 patients (12%) experienced Clavien grade II DISCUSSION

complication or much higher. in the open hernia repair group

major complications were significantly seen when compared to Ventral hernias are more common, and controversy are stillexists
laparoscopic hernia group. One patient (0.4%) had a as to the best method for surgery. There are no large randomized

postoperative DVT after open ventral hernia repair which was or multicenter trial has been completed till today, although one
complicated by Candida septicemia and he was died. In the systematic review was published in the year 2004. Data from

laparoscopic group one patient manifested sepsis by an smaller trials and cohort studies represent the availableevidence.
34