Totally Extraperitoneal Repair for Incisional Hernia

Chen Kuo-Hsin, MD, Chio U-Chon, MD, Wu Jiann-Ming, MD, Chen Shian-dian, MD, Chen Ying-Da, MD, Huang Shu-Yi, MD, Jeng Kuo-Shyang, MD, Lin Tzu-Chao, MD, Siow Tiing-Foong, MD, Sum Shao-Yin, MD, Loi Chao-Man, MD. Division of General Surgery, Department of Surgery, Far Eastern Memorial Hospital, Ban Ciao, Taipei, Taiwan.

INTRODUCTION – surgical repair of incisional hernia was challenging with high recurrence and complication rate. Laparoscopic onlay mesh repair has been used successfully to reduce the postoperative recovery and associated wound complications. However, tissue ingrowth to the raw surface of the onlay mesh might not be as good as that after retromuscular polypropylene mesh repair. Extraperitoneal mesh herniorrhaphy has been proved to be beneficial in surgical result and was widely used in inguinal hernia repair. Therefore, totally extraperitoneal (TEP) mesh repair was attempted for incisional hernia repair.

METHODS AND PROCEDURES – Incisional hernia with abdominal wall defect less than 10 cm in diameter was included. Retromuscular space was created by manual telescope dissection and hernia sac was pulled back or transected, a polypropylene mesh was implanted over the intact peritoneum. Peritoneal tear was always closed. Midline fascial defect was closed whenever possible. Patient demographic profile and perioperative results were analyzed from a prospectively collected data base.

RESULTS – From September 2008 to June 2013, fourteen patients with incisional hernia underwent totally extraperitoneal herniorrhaphy were enrolled. Mean diameter of hernia sac was 7.3cm. All procedures were completed endoscopically without open conversion. Mean operation time was 132 minutes. Mean blood loss was 12 cc. Mean hospital stay length was 1.9 days. Post operation morbidity included subcutaneous seroma and hematoma but no wound or mesh infection, which was treated conservative. After mean following up for 30 months, one obese patient developed recurrence.

CONCLUSION – From this preliminary experience, totally extraperitoneal dissection of retromuscular space and mesh placement is a safe and effective technique for incisional hernia repair. The advantages of TEP repair could be expected. However, large randomized control study is needed to demonstrated the true benefits.
 

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