Laparoscopic Ventral Hernia Repair – Long-term Prognosis and the Analysis of Mesh Shrinkage By Computed Tomography

Kanyu Nakano, MD, Hitoshi Idani, MD, Shinya Asami, MD, Sathoshi Koumoto, MD, Tetsushi Kubota, MD, Yohei Kurose, MD, Katsuyoshi Hioki, MD, Shinichiro Kubo, MD, Hiroki Nojima, MD, Yasushi Ohmura, MD, Takashi Yoshioka, MD, Hiroshi Sasaki, MD, Masahiko Muro, MD, Hitoshi Kin, MD, Norihisa Takakura, MD. Department of Surgery, Fukuyama City Hospital


 Background: Laparoscopic incisional and ventral hernia repair (LIVR) has been introduced expecting lower recurrence rate as well as lower morbidity compared to open repair. However, Long term prognosis of LIVR and the shrinkage rate of mesh have not been precisely evaluated.
Objective: The aim of this study was to evaluate the outcome of the LIVR and to analyze the shrinkage rate of mesh after surgery.
Surgical technique: The initial port was inserted at the left upper abdomen by minilaparotomy followed by the insertion of two trocars at the left lateral abdomen. The size of the hernia defect was measured laparoscopically after the adhesiolysis. Composix E/X mesh (n=20), Dual mesh (n=35), C-QUR edge (n=3) or Ventralex (n=1) was fashioned so that the defect was overlapped in all dimensions by 3-5 cm. The mesh was fixed intracorporealy on the anterior abdomen by O nonabsorbable monofilament suture materials and tucks.
Patients and Methods: A total of 60 patients undergoing LIVR in our hospital between April 2002 and July 2011 were enrolled in this study. The degree of mesh shrinkage after LIVR were evaluated on eighteen patients who were performed CT scanning after surgery. The outline of the mesh was traced under CT image and its area was calculated. Shrinkage rate was defined as the relative loss of surface as compared with the original size of the mesh (%).
Results: The patients consisted of 16 men and 44 women with a mean age of 71.9 years. There were 44 midline incisional, 8 umbilical, 5 right lower quadrant, and three others.
Conversion to an open repair was required in two patients because of massive adhesion into the hernia sac. The mean operation time was 111.2±41.9 min (range, 44-208 min) and the mean duration of postoperative hospital stay was 8.0±2.8 days. There was no mortality and the morbidity was 10%. During a median follow up period of 54 months, recurrence was noted on one patient (1.7%). The mean period to CT scanning from surgery was 50.6 ± 29.2 (range 8-77) months in Composix mesh cases (n=5), and 12.7 ± 11.2 months (range 3-41) in Dual mesh cases (n=13). The shrinkage rate of Composix mesh and Dual mesh was 30.3 ± 13.6% (range 15-46.4) and 17.6 ± 14.0% (range 0-38.5%), respectively. In the patient with recurrence 21 months after the repair with Dual mesh, the shrinkage rate of the mesh was 28.8%.
Conclusion: LIVR has an excellent long term prognosis. Our results clearly supported that an overlap of 3-5cm is necessary in the treatment of LIVR using mesh.

Session Number: SS15 – Hernia
Program Number: S083

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