Laparoscopic Ventral Hernia Repair versus Open Hernioplasty

Background: Ventral hernia repair is the most common and usual procedure which applies various treatment approaches. Aim: To compare the laparoscopic ventral hernia repair surgery with open surgical procedure. Study design: Prospective comparative study Place and duration of study: Department of Surgery Unit-II, Fatima Memorial Hospital, Shadman Lahore from 1stJuly 2016 to 1st March 2021. Methodology: Ninety six patients who underwent either open or laparoscopic surgery. They were divided in two groups. Group A (n=40) was of open surgery and Group B (n=56) was laparoscopic. Patients’ demographic and clinical information was documented, postoperative pain, wound healing, duration of hospital stay, and recurrence rate was also recorded. Results: There were 43 males and 53 females. The mean age of patients was 52.2±14 years. The mean fascial defect size was 6.94±0.3 cm2. Majority of patients were obese. The postoperative study analysis revealed no wound infections and reduced hospital stay in laparoscopic operated patients than open surgery operated cases. Conclusion: Laparoscopic surgery is much safer and more efficient than open surgery protocol for ventral hernia repair in context to wound infection and postoperative complications. Keywords: Ventral hernia, Laparoscopic, Open surgery

Role of Tranexamic Acid for Seroma Prevention in Obese Patients Undergoing Laparoscopic Ventral Hernia Repair Under Spinal Anesthesia

Objective: The aim of this study is to determine the effectiveness of tranexamic acid for seroma prevention in obese patients undergoing laparoscopic ventral hernia repair under spinal anesthesia. Study Design: Cross sectional study Place and Duration: Jinnah Postgraduate Medical Center (JPMC) Karachi, 1st July 2020 to 30th June 2021. Methods: There were one hundred and ten patients f both genders had abdominal hernia were included in this study. We have taken written consent from all the patients for detailed demographics age, sex and body mass index. Patients were undergone for laparoscopic ventral hernia repair under spinal anesthesia in OPD. The size and contents of the defect were determined by an abdominal and pelvic ultrasound. All patients received postoperative tranexamic acid. Drains were put in to measure the amount of seroma that was produced as a result of the procedure. SPSS 22.0 was used to analyze all of the data. Results: 42.23±6.55 years were the mean age of the patients. Mean Body mass index was 32.13±3.43 kg/m2. Majority of the patients 74 (67.3%) were females and rest of the patients 36 (32.7%) were males. In 91 (82.7%) cases seroma reduction was calculated within week. Only 41 of the 110 patients had drain output of less than 150 ml, 55 had drain output of 150-300 ml, and 14 had drain output greater than 300 ml. Seroma formation was found among 7 (6.4%) cases. Conclusion: Tranexamic acid was found to be efficient in minimizing postoperative seroma formation in ventral hernia repairs, according to the findings of this study. Keywords: Laparoscopic, Tranexamic acid, Plasminogen, Seroma, Obese Patients

Long term outcome and elasticity of a polyester mesh used for laparoscopic ventral hernia repair

Background Repair of a ventral hernia is increasingly being performed by a laparoscopic approach despite lack of good long term follow up data on outcomes. The aim of this study was to examine the long term performance of a polyester mesh and to assess its elastic properties in patients undergoing laparoscopic ventral hernia repair. Methods All patients being assessed for a ventral hernia repair between August 2011 and November 2013 were placed on a prospective database. Those undergoing laparoscopic repair with a polyester mesh were seen at clinic at one month and one year, while their electronic records were assessed at 34 months (range 24–48 months) and 104 months (range 92–116 months). In addition, CT scans of the abdomen and pelvis performed for any reason on these patients during the follow up period were reviewed by a consultant gastrointestinal radiologist. Mechanical failure testing of the mesh was also performed. Results Thirty-two of the 100 patients assessed for ventral hernia repair had a laparoscopic repair with a polyester mesh. Nineteen (59%) had CT scans performed during the follow-up period. No recurrence was recorded at 34 months, while three (9.4%) had a recurrence at 104 months. Two had central breakdown of the mesh at 81 and 90 months, while 1 presented acutely at 116 months after operation. Mesh had stretched across the defect by an average of 21% (range 5.7–40%) in nine patients. Mechanical testing showed that this mesh lost its elasticity at low forces ranging between 1.8 and 3.2 N/cm. Conclusion This study shows that late recurrence is a problem following laparoscopic ventral hernia repair with polyester mesh. The mesh loses it elasticity at a low force. This combined with degradation of mesh seems the most likely cause of failure. This is unlikely to be a unique problem of polyester mesh and further long-term studies are required to better assess this operative approach to ventral hernia repair.

A new criterion to predict recurrence after laparoscopic ventral hernia repair: mesh/defect area ratio

<b>Introduction:</b>Minimizing recurrence in hernia surgery is one of the major aims. Defining surgeon-dependent risk factors for recurrence is therefore of great importance in laparoscopic ventral hernia repair (LVHR). This study aims to analyze the predictive value of the mesh area/defect area ratio (M/D ratio) in terms of recurrence as a new criterion in LVHR.</br> </br> <b>Methods:</b> A total of 124 patients were enrolled in the study. Age, gender, hernia type, body mass index, defect size, size of the mesh, mesh overlapping, area of the defect, area of the mesh, M/D ratio, postoperative complications, follow-up time, recurrences and timing of recurrence were also recorded. The potential variables that may affect recurrence were examined by univariate and multivariate analysis.</br> </br> <b>Results:</b> There were 12 (9.7%) recurrences in our series. A statistically significant difference was found if either the mesh/defect ratio was ≤6 or >6 (p = 0.012). Multivariate analysis confirmed that M/D ratio was the only independent parameter for recurrence. </br></br><b>Conclusion:</b> Understanding M/D ratio concept and using it in surgical clinical practice may help reduce recurrence rates after LVHR.</br>