Natasha Denicola, MD1, Claire M Eden, BA2, Fred Kimmelstiel, MD1. 1Icahn School of Medicine at Mount Sinai St. Luke’s Roosevelt Hospital, 2Icahn School of Medicine at Mount Sinai
Background: Open ventral hernia repair may be limited by the ability to adequately visualize the underlying peritoneum and ensure complete reduction of the hernia sac for flat placement of mesh. Although laparoscopic repair permits better visualization, long term outcomes are unknown and many patients experience significant postoperative pain, especially with larger mesh use and more fixation materials.
Methods: We retrospectively analyzed all patients who underwent ventral hernia repair by a single surgeon who performed a hybrid open and laparoscopic technique from 2010-2018. An open incision was made over the hernia to reduce the sac and clear off the fascia circumferentially. 2 5mm trocars were placed in the bilateral upper quadrants or suprapubic regions. The sac was fully reduced under pneumoperitoneum to ensure circumferential clearance around the defect. A traditional open composite mesh was placed through the fascial defect, manipulated laparoscopically and secured with fascial sutures. Tacks were rarely used, usually for mesh grafts > 8cm. We evaluated perioperative outcomes to determine the feasibility and effectiveness of this technique.
Results: 181 patients with ventral hernias underwent hybrid repair over an 8-year period. Median age was 50 years and 62% were male. Median BMI was 28 (IQR 25-32). 9% were smokers and 4% used steroids perioperatively. 50% had prior abdominal surgery and 12% had a prior ventral hernia repair. The most common indication for repair was pain (91%) from an incarcerated hernia (59%). At the time of surgery, median hernia defect size was 2.0cm (IQR 1.9-2.5cm), and median mesh diameter was 6.4cm (IQR 6.4-8.0cm). 1 patient required conversion to open repair. Median EBL was 5cc (IQR 5-10cc). Postoperatively, only 3% of patients experienced pain after 2 weeks. There were 11 (6%) 30-day perioperative complications; 6 seromas managed conservatively, 4 superficial surgical site infections managed with antibiotics and 1 small bowel obstruction requiring reoperation. There were no mesh infections. At a median follow-up time of 4 months (IQR 2-12 months), 7 (4%) patients experienced hernia recurrence at a median time of 19 months (IQR 13-44 months); 2 were managed with re-operation (both laparoscopic).
Conclusions: Our experience using a hybrid technique for ventral hernia repair suggests that it is safe and effective with low rates of postoperative complications and recurrence. Comparison to open and laparoscopic long-term outcomes will better define its utility.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94012
Program Number: P543
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster