Page 54 - World Journal of Laparoscopic Surgery

Laparoscopic Ventral Hernia Repair
The most common complications of abdominal ventral hernia augmentation of the defect with vicryl suture, the usage of either
are intestinal obstruction, strangulation, incarceration, in addition technique still need further studies. 20,21
to frequent postoperative complications associated with hernia The aim of this study was to compare two laparoscopic repair
surgery such as wound infection, seroma formation, and hernia techniques the IPOM repair and TARM repair in non-complicated
recurrence. These postoperative complications can frequently be ventral abdominal hernia regarding operative observations and
revealed at physical examination. 9 information, postoperative pain, and recurrence rate, intra and
Cases with ventral abdominal hernia should have an postoperative complications, cost-effectiveness, and return to
appropriate preoperative preparation to get perfect surgical normal daily activity.
repair. Obesity or overweight is one of the most significant factors
of ventral abdominal hernias. The ideal weight for surgery is the PAtIents And Methods
body mass index (BMI) of 18.5–25. Cases should be advised and
promoted to cease smoking. Proper preoperative management Study Design and Recruitment of Population
of many comorbidities should be conducted as respiratory, It was a prospective clinical trial which had been conducted at the
cardiovascular, diabetes, renal conditions, hypertension, and other Department of General Surgery, Mansoura University Hospital,
general illness. The candidates should be investigated for all of Egypt during the period from May 2018 till August 2019. This
these preoperatively. 10–14 study involved 60 eligible candidates with uncomplicated ventral
The management of ventral hernia is surgical hernia repair. abdominal hernia (either primary or incisional), who were simply
These procedures involve 1ry closure of the fascial defect, open randomized between two groups: group I had 24 cases, with
hernia repair using a prosthetic mesh, and laparoscopic hernia uncomplicated ventral hernia, for IPOM procedures were done and
repair. The concept of tension-free repair of any hernia using group II consisted of 36 cases, with abdominal ventral hernia, for
mesh has been standardized and customized as being the main whom the TARM procedures were achieved for them.
technique for most of the hernias, whatever be the size of the
defect. 5 Inclusion and Exclusion Criteria
The different types of mesh with the different structure All eligible cases, who were 18-year old and on with non-
utilized as follows: Polypropylene (prolene) mesh and expanded complicated ventral hernia were included. They should be fit for
polytetrafluoroethylene (PTFE) mesh. The prolene mesh is the general anesthesia and accept to share in the research. The size of
most commonly used and it contains an inert, durable, non- the hernia defect was less than or 60 mm in diameter to be suitable
absorbable, and knitted monofilaments that enhance rapid fibrotic for the start of the learning curve. Complicated and recurrent
incorporation into the surrounding tissues. The PTFE mesh is a ventral hernias were excluded. The patients with uncontrolled
durable, inert, and macrofilament that quickly becomes adherent medical comorbidities, pregnancy, and psychological instability
to the tissues. 5 were also excluded.
Because of the high postoperative incidence of recurrence, All the eligible cases were carefully evaluated and were
repair of an incisional hernia is still one of the most challenging optimized preoperatively. All details of the techniques were
surgeries for general surgeons with high morbidities and rising explained to all patients. All patients provided informed consent
costs. The frequent postoperative complications include wound to participate in the study and for the surgical procedure. The
infection, seroma formation, and hernia recurrence. 15 procedure was approved by the local health committee. All routine
In 1993, LeBlanc and William had started the repair of preoperative measures, such as fasting, administration of a single
abdominal wall hernia using laparoscopy. Over many years, ventral dose of IV antibiotic, anti-VTE measures, etc., were secured before
hernioplasty using laparoscopy is standardized now and widely the procedure for all cases. The study was conducted after securing
done. It may exhibit advantages for the cases from the use of the the ethical approval from the local ethical committee, Institutional
laparoscopic approach in which there is shorter hospital stay, Research Board, Faculty of Medicine, Mansoura University.
less operative time, improved the surgical outcome of patients,
and fewer morbidities. Deciding the surgical approach, the type Operative Techniques
of mesh to use, and the type of repair surgery are the principal Intraperitoneal Onlay Mesh Repair
challenges in hernia treatment, in addition to where to put the Pneumoperitoneum creation was performed using the closed
mesh to ensure the most powerful repair with the least probability method, commonly at the umbilical area or palmer’s point
of recurrence. 16–18 according to the location of the ventral hernia. Carbon dioxide gas
In spite of the wide acceptance of laparoscopic hernioplasty as insufflation was done till reaching a pressure of 14–17 mm Hg intra-
a standard procedure in elective hernia repair, there are still some abdominally which was a safe one during the performance of all
concerns regarding challenging learning curve, higher costs, and laparoscopic procedures of the study. The telescope was introduced
risks of intestinal injuries from instruments and trocars or from through a 10-mm port and 2 or 3.5-mm ports were put depending
operative manipulation intra-abdominally during the processing on the site of the ventral hernia.
of the surgery of hernia repair. 19 The most common site used for the placement of ports is the left
The role of laparoscopy in ventral hernia is still in progress to flank region. Adhesions of the omentum and bowel were released
reach an ideal technique, one of the most accepted techniques by the use of sharp dissection diathermy and reduced. A careful
is IPOM that include the use of a composite mesh that fixed abdominal survey of the inner parietal side using laparoscopy
to the peritoneum with tacks and transfacial sutures, but with was done to identify the defect of the hernia and to exclude other
IPOM technique, there is a limitation in its use due to the cost parietal defects. The defect size was measured by the use of a part
of the mesh and the tacks. So, the other alternative technique of suture or a paper ruler. The ideal placement of the dual mesh
is the transcomposite mesh after creating a peritoneal flap and of appropriate size was achieved by overlapping 3–5 cm beyond

150 World Journal of Laparoscopic Surgery, Volume 15 Issue 2 (May–August 2022)