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Endoscopic enhanced-view totally extraperitoneal retromuscular approach for ventral hernia repair

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Abstract

Background

Primary or incisional ventral hernia repair is one of the most common surgical procedures, addressed to general surgeons. The enhanced view-totally extraperitoneal technique (eTEP) was first described by Deas for inguinal hernias, but lately it has been applied to ventral hernias by Belyansky et al. So far, results are promising and data about the procedure are rising.

Methods

Retrospective comparative analysis of 27 recruited eTEP procedures and 27 IPOM operations for the period between April 2017 and June 2018 at the department of Endoscopic surgery of Military Medical Academy, Sofia. Baseline characteristics, operative records and perioperative data are provided and compared for both groups.

Results

Fifty-four patients were included. There were no differences between age, sex, BMI, primary or incisional hernias, co-morbidity, active smoking, EHS-classification and immunosuppression through the patients in different groups. Mean defect area—eTEP is 71 cm2 with no statistical difference, compared to IPOM—76 cm2. Operative time in eTEP is significantly longer with mean time of 186 min and 90 min in IPOM patients. Mean length of stay did not differ between the groups, with 2.9 days after eTEP and 3.4 after IPOM. Median pain score from the intraoperative (the day of surgery) to the seventh postoperative day is lower in the eTEP group. No surgical site infections and/or mesh infections were present. There was one readmission in the IPOM group with ASBO, and it was managed conservatively. There were no reinterventions and perioperative mortality in the sample.

Conclusion

We found out that the eTEP/eRS approach is feasible and safe. Our study shows comparable results of eTEP/eRS to the IPOM procedure with reduced video analogue scale pain score to the 7th postoperative day and increased operative time. The study contributes to the upcoming evidence in the field of new minimally invasive techniques for ventral hernia repair.

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References

  1. Poulose K, Shelton J, Phillips S, Moore D, Nealon W, Penson D, Beck W, Holzman M (2012) Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia 16:179–183

    Article  CAS  Google Scholar 

  2. Breuing K, Butler C, Ferzoco S, Franz M, Hultman C, Kilbridge J, Rosen M, Silverman R, Vargo (2010) Incisional ventral hernias: Review of the literature and recommendations regarding the grading and technique of repair The Ventral Hernia. Surgery 148(3):544–558

    Article  Google Scholar 

  3. Holihan J, Nguyen D, Nguyen M, Mo J, Kao L, Liang M (2016) Mesh location in open ventral hernia repair: a systematic review and network meta-analysis. World J Surg 40(1):89–99

    Article  Google Scholar 

  4. Sajid M, Bokhari S, Mallick A, Cheek E, Baig M (2009) Laparoscopic versus open repair of incisional/ventral hernia: a meta-analysis. Am J Surg 197:64–72

    Article  Google Scholar 

  5. Poelman M, Apers J, Brand H, Cense H, Consten E, Deelder J, Dwars B, Geloven N, Lange E, Simmermacher R, Simons M, Sonneveld E, Schreurs H, Bonjer J (2013) The INCH-Trial: a multicenter randomized controlled trial comparing the efficacy of conventional open surgery and laparoscopic surgery for incisional hernia repair. BMC Surg 13(8):13–18

    Google Scholar 

  6. Itani K, Hur K, Kim L, Anthony T, Berger D, Reda D, Neumayer L (2010) Comparsion of laparoscopic and open repair with mesh for the treatment of ventral incisional hernia. Arch Surg 145(4):322–328

    Article  Google Scholar 

  7. Robinson T, Clarke J, Schoen J, Walsh M (2005) Major mesh-related complications following hernia repair Events reported to the Food and Drug Administration. Surg Endosc 19:1556–1560

    Article  CAS  Google Scholar 

  8. Colavita P, Tsirline MD, Belyansky V, Walters I, Lincourt A, Sing A, Heniford R B (2012) Prospective, long-term comparison of quality of life in laparoscopic versus open ventral hernia repair. Ann Surg 256(50):714–723

    Article  Google Scholar 

  9. Busnelli G, Nardi W, Featherston C, Pirichi D, Medina P (2018) Laparoscopic retromuscular incisional hernia repair. J Min Access Surg 0:0:0

    Google Scholar 

  10. Daes J (2012) The enhanced view-totally extraperitoneal technique for repair of inguinal hernia. Surg Endosc 26:1187–1189

    Article  Google Scholar 

  11. Warren J, Cobb W, Ewing J, Carbonell A (2017) Standard laparoscopic versus robotic retromuscular ventral hernia repair. Surg Endosc 31(1):324–332

    Article  Google Scholar 

  12. Vorst A, Kaoutzanis C, Carbonell A, Franz M (2015) Evolution and advances in laparoscopic ventral and incisional hernia repair. World J Gastrointest Surg 27(7):293–305

    Article  Google Scholar 

  13. Luque J, Luque A, Valdivia J, Gra´u J, Menchero J, Moreno J, Jurado J (2015) Totally endoscopic surgery on diastasis recti associated with midline hernias. The advantages of a minimally invasive approach. Prospective cohort study. Hernia 19(3):493–501

    Article  Google Scholar 

  14. Schwarz J, Reinpold W, Bittner R (2017) Endoscopic mini/less open sublay technique (EMILOS)-a new technique for ventral hernia repair. Langenbecks Arch Surg 402(1):173–180

    Article  CAS  Google Scholar 

  15. Orthopoulos G, Kudsi O (2017) Feasibility of robotic-assisted transabdominal preperitoneal ventral hernia repair. J Laparoendosc Adv Surg Tech 28(4):434–438 https://doi.org/10.1089/lap.2017.0595

    Article  Google Scholar 

  16. Iqbal C, Pham T, Joseph A, Mai J, Thompson G, Sarr M (2007) Long-term outcomes of 254 complex incisional hernia repairs using the modified Rives-Stoppa technique. World J Surg 31(12):2398–2404

    Article  Google Scholar 

  17. Forbes S, Eskicioglu C, McLeod R, Okrainec A (2009) Meta-analysis of randomized controlled trials comparing open and laparoscopic ventral and incisional hernia repair with mesh. Br J Surg 96(8):851–858

    Article  CAS  Google Scholar 

  18. Jenkins E, Yom V, Melman L, Brunt L, Eagon J, Frisella M,. Matthews B (2010) Prospective evaluation of adhesion characteristics to intraperitoneal mesh and adhesiolysis-related complications during laparoscopic re-exploration after prior ventral hernia repair. Surg Endosc 24:3002–3007

    Article  Google Scholar 

  19. Belyansky I, Daes J, Radu V, Balasubramanian R, Zahiri H, Weltz A, Sibia U, Park A (2018) A novel approach using the enhanced-view totally extraperitoneal (eTEP) technique for laparoscopic retromuscular hernia repair. Surg Endosc 32(3):1525–1532

    Article  Google Scholar 

  20. Eriksen J, Poornoroozy P, Jørgensen L, Jacobsen B, Friis-Andersen H, Rosenberg J (2009) Pain, quality of life and recovery after laparoscopic ventral hernia repair. Hernia 13(1):13–21

    Article  CAS  Google Scholar 

  21. Brill JB, Turner PL (2011) Long-term outcomes with transfascial sutures versus tacks in laparoscopic ventral hernia repair: a review. Am Surg 77(4):458–465

    PubMed  Google Scholar 

  22. Nguyen S, Divino C, Buch K, Schnur FNP, Weber J, Katz KMD, Reiner L, Aldoroty M, Herron R D (2008) Postoperative pain after laparoscopic ventral hernia repair: a prospective comparison of sutures versus tacks. JSLS 12(2):113–116

    PubMed  PubMed Central  Google Scholar 

  23. Wassenaar E, Raymakers J, Rakic S (2007) Removal of transabdominal sutures for chronic pain after laparoscopic ventral and incisional hernia repair. Surg Laparosc Endosc Percutan Tech 17(6):514–516

    Article  Google Scholar 

  24. Booth J, Garvey P, Baumann D, Selber J, Nguyen A, Clemens M, Liu J, Butler C (2013) Primary fascial closure with mesh reinforcement is superior to bridged mesh repair for abdominal wall reconstruction. J Am Coll Surg 217:999–1009

    Article  Google Scholar 

  25. Carter S, Hicks S, Brahmbhatt R, Liang M (2014) Recurence and pseudorecurrence after laparoscopic ventral hernia repair: predictors and patient-focused outcomes. Am Surg 80:138–148

    PubMed  Google Scholar 

  26. Hauters P, Desmet J, Gherardi D, Dewaele S, Poilvache H, Malvaux P (2017) Assessment of predictive factors for recurrence in laparoscopic ventral hernia repair using a bridging technique. Surg Endosc 31(9):3656–3663

    Article  CAS  Google Scholar 

  27. Mitura K, Skolimowska-Rzewuska M, Garnysz K (2017) Outcomes of bridging versus mesh augmentation in laparoscopic repair of small and medium midline ventral hernias. Surg Endosc 31(1):382–388

    Article  Google Scholar 

  28. Nguyen D, Chen D (2017) Laparoendoscopic stapled rives stoppa sublay technique for extraperitoneal ventral hernia repair. Eur Surg, 49(4): 175–179 https://doi.org/10.1007/s10353-017-0483-z

    Article  Google Scholar 

  29. Eker H, Hansson M, Buunen M, Janssen M, Pierik E, Hop C, Bonjer J, Jeekel J, Lange F (2013) Laparoscopic vs. open incisional hernia repair: a randomized clinical trial. JAMA Surg 148(3):259–263

    Article  Google Scholar 

  30. Torur D, Morten J, Sci M, Dorthe H, Berit M, Annemette J, Bente J (2018) Robotic surgery is less physically demanding then laparoscopic surgery: paired cross sectional study. Ann Surg, https://doi.org/10.1097/SLA.0000000000002845

    Article  Google Scholar 

  31. Kaufmann R, Halm J, Eker H, Klitsie P, Nieuwenhuizen J, Geldere D, Simons M, Harst E, Riet M, Holt B, Kleinnrensink G, Jeekel J, Lange J (2018) Mesh versus suture repair of umbilical hernia in adults: a randomised, double-blind, controlled, multicentre trial. Lancet 391:860–869

    Article  Google Scholar 

  32. Earle D, Roth J, Saber A, Haggerty S, Bradley J, Fanelli R, Price R, Richardson W, Stefanidis D (2016) SAGES guidelines for laparoscopic ventral hernia repair. Surg Endosc 30(8):3163–3183

    Article  Google Scholar 

  33. Belyanski I, Reza Z, Sandord Z, Welz A, Park A (2018) Early operative outcomes of endoscopic (eTEP access) robotic-assisted retromuscular abdominal wall hernia repair. Hernia 22(5):837–847

    Article  Google Scholar 

  34. Reinpold W, Schroder M, Berger C, Nehls J, Schroder A, Hukauf M, Kockerling F, Bittner R (2018) Mini- or less-open sublay operation (MILOS): a new minimally invasive technique for the extraperitoneal mesh repair of incisional hernias. Ann Surg. https://doi.org/10.1097/SLA.0000000000002661

    Article  PubMed  Google Scholar 

  35. Martin Del Campo L, Weltz A, Belyanski I, Novitsky (2017) Comparative analysis of perioperative outcomes of robotic versus open transversus abdominis release. Surg Endosc 32(2):840–845

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Endoscopic Surgery, Military Medical Academy – Sofia, Sofia, Bulgaria

    D. Penchev, G. Kotashev & V. Mutafchiyski

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  1. D. Penchev
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Correspondence to D. Penchev.

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Drs. Penchev, Kotashev and Mutafchiyski have no conflicts of interest or financial ties to disclose.

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Penchev, D., Kotashev, G. & Mutafchiyski, V. Endoscopic enhanced-view totally extraperitoneal retromuscular approach for ventral hernia repair. Surg Endosc 33, 3749–3756 (2019). https://doi.org/10.1007/s00464-019-06669-2

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