Igor Belyansky, MD4, Jorge Daes, MD1, B Ramana, MD2, Victor Radu, MD3, Adam S Weltz, MD4, Nan Wu, MD4, Heidi Miller, MD5, Adrian Park, MD4, Hamid R Zahiri, DO4, Yuri Novitsky, MD5. 1Clinica Porto Azul, 2Belle Vue Clinic, 3Stiinte Medicale, 4Anne Arundel Medical Center, 5Case Medical Center
Introduction: Minimally invasive ventral and incisional hernia repair techniques have evolved to incorporate primary closure of the fascial defect. Laparoscopic Abdominal Wall Reconstruction (AWR) and retromuscular mesh placement with optional addition of Transversus Abdominis Release (TAR) has been recently reported. This technique is an alternative to traditional laparoscopic IPOM repairs or open AWR cases in selective candidates.
Methods: Retrospective review of prospectively collected data of consecutive Laparoscopic Retromuscular Hernia Repair (LRHR) cases from five different surgeons on four different continents between August 2015 and August 2016 was conducted. Main outcomes analysis included demographics, hernia characteristics, operative details and perioperative complications
Results: Sixty-eight patients who underwent LRHR with mean age, BMI, and ASA of 54.8 years, 31.6 kg/m2 and 2.3, respectively were included. Twenty-two percent of patients had a prior ventral hernia repair. Laparoscopic TAR was performed in 36 patients in order to reconstruct linea alba. An average mesh size of 650.1 cm2 was used for an average defect size of 135.6 cm2. Mean operative time, blood loss and length of hospital stay were 233.5 minutes, 52.3 mL and 1.9 days, respectively. There was one conversion to intraperitoneal mesh placement and one conversion to open retromuscular mesh placement. Post-operative complications consisted of chronic pain (n=1) and trocar site dehiscence (n=1). There were no readmissions within 30-days. No hernia recurrences were noted at mean follow up of 103 days.
Conclusions: This is the largest multinational series of laparoscopic ventral and incisional hernia repairs with retromuscular mesh placement and selective addition of TAR reported to date. Early results demonstrate feasibility and safety of this novel technique, it combines the effectiveness of open complex AWR with benefits of reducing wound morbidity and decreasing length of hospital stay.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80327
Program Number: S051
Presentation Session: Ventral Hernias
Presentation Type: Podium