Laparoscopic and open incisional hernia repair: A comparison study

Objective: To ruleout whether there was a difference in, recurrence rate, morbidity, and duration of hospital stay between patients undergoing open or laparoscopic ventral hernia surgery. Materials and methods: Cohort study in single-institution was compared prospectively collected from patient cohorts undergoing laparoscopic or open intraperitoneal onlay mesh repair. Literature search was performed using search engine Google and our online facility of Springer Link. The following search terms were used. Laparoscopic versus ventral hernia repair, ‘laparoscopic repair of ventral hernia, controversies in laparoscopic ventral hernia repair, comparison of laparoscopic and open (Ventral Hernia) repair, Laparoscopic Repair of Ventral Hernia during obesity. About 143 citations found in total. Data collected from 360 consecutive patients who had undergone laparoscopic or open intraperitoneal onlay mesh repair of a ventral hernia were prospectively collected from October 1995 and December 2005 are recorded . Main outcome of the study: Hernia recurrence and duration of hospital stay and morbidity. Postoperative complications of Clavien grade 2 or more than grade 2 were considered as major complications. Results: Intraperitoneal onlay mesh surgery was performed in 233 patients by open approach and in 127 patients by laparoscopic approach. Groups were similar for sex and body mass index and it is calculated by weight in kilograms divided by the height in meters squared and the mean age for the laparoscopic group was 3 years younger; and the mesh was selected larger for the laparoscopic group. Mean follow-up for both laparoscopic and open groups was 30 and 36 months; and the conversion rates are 4%. Major morbidities were 15% in the open group and 7% in the laparoscopic group. Recurrence rates were 9% in the open group and 12% in the laparoscopic group. Postoperative inpatient admission was more frequent after the open procedure than after the laparoscopic procedure (28% and 16%, respectively). Conclusions: Outcomes of the study shows not much difference with respect to recurrence rates after long-term follow-up; however, lower rate of major morbidity and increased outpatient-based procedure rates favor laparoscopic repair in this study.

Objectives: The aim of our study is to compare the usefulness of laparoscopic ventral hernia repair with conventional open ventral hernia repair. Methodology: The comparative type of study was conducted on 60 patients with incisional hernia of which 30 patients were included in the Laparoscopy group while the other 30 were included in the open surgery group. Results: The peak incidence of hernia in our study was in the 31-50 years of age group. The mean operation time of Laparoscopic ventral hernia was 142.1 minutes with an SD of ± 24.69 as compared to open repair which was 100.7 minutes. Postoperative complications were less in the laparoscopic repair group in comparison with the open repair group. In the open group, the majority of patients were discharged on 5-7 days as compared to the laparoscopic group in which the majority of patients were discharged on days 3-5. Conclusion: Laparoscopic ventral hernia repair is a novel technique, various benefits found in the current study include lesser postoperative pain, lesser postoperative hospital stay, decreased incidence of postoperative complications, and obviously better cosmesis.

Conventional incisional hernia repair, even with a piece of mesh incorporated, has high recurrence and morbidity. Laparoscopic incisional hernia repair was reported in western countries to be a better alternative. The purpose of this study is to report the early experiences of laparoscopic incisional hernia repair among Taiwanese patients. Thirty-seven patients with incisional hernia, twelve were recurrent, received laparoscopic underlay Dualmesh(superscript R) (ePTFE) repair at Cathay General Hospital in past two years with one conversion. The mean area of defect was 50.2 cm^2. Multiple defects were found in 13(35%) patients. Peri-operative complications included dysuria (2), seroma (2), ileus (1), trocar site bleeding (1) and wound infection (1). Post-operative hospitalizations ranged from 3 to 8 (mean; 4.3) days. Post-operative patients' questionnaire revealed less pain experienced during laparoscopic repair by those who had previous open repair. There were no recurrences during a 3 to 21 (mean; 9.1) months follow-up. Based on our initial results, laparoscopic incisional hernia repair is safe and feasible among Taiwanese. Comparing to the open repair, laparoscopic incisional hernia repair has less perioperative complications, debility, and short-term recurrence rate. Long-term recurrence is expected to be lower than conventional repair due to less surgical trauma and the tension-free nature of laparoscopic repair.

Background: An incisional hernia develops in 7% to 11% of laparotomy incisions. Laparoscopic repair was applied to the ventral hernias, with the expectation of earlier recovery, fewer postoperative complications, and decreased recurrence rates. This prospective study was performed to compare the outcomes after open and laparoscopic ventral hernia repair. Methods: It is prospective study involved 100 patients with ventral hernia, were subjected either to repair by laparoscopy or to open repair. The open surgical operations were performed by the retro-rectus mesh repair, whereas the laparoscopic repairs were performed using the intra-peritoneal on lay dual mesh (IPOM) repair technique. Results: The mean surgery durations were significantly lower in laparoscopic repair when compared to open repair (p=0.000). The mean duration of post-operative analgesics used in laparoscopic group is 2.84±0.60 days as compared to open ventral hernia repair 5.47±2.16 days (p=0.000) which is significant. The mean postoperative stay in hospital was shorter for the laparoscopic group than for the open hernia group (2.66 versus 6.88 days; p=0.000). Antibiotics used in laparoscopy group is for 1.33±0.70 days as compared to open repair 2.52±0.98 days (p=0.000). Return to the activity or normal daily work is significantly low in laparoscopic group as compared to open repair of hernia (4.13 versus 13.98 days; p=0.000). There were fewer post-operative complications in laparoscopy. Conclusions: The findings demonstrate that laparoscopic ventral hernia repair in our experience was safe and resulted in shorter operative time, fewer complications; shorter hospital stays, and earlier returns to daily activity. Hence, it should be considered as the procedure of choice for ventral hernia repair.

Polyester-based mesh for ventral hernia repair: is it safe?

Background: Incisional hernia that may occur following abdominal surgeries affect the quality of life and lead to loss of labor by causing morbidity. It is a continuing problem of surgery due to high rates of prevalence and morbidity. This study aimed to compare laparoscopic versus conventional method of incisional hernia repair. Methods: Forty patients with incisional hernia who underwent hernia repair by laparoscopic (n = 20) or conventional (n = 20) technique between January 2010 and January 2011 in our clinic were included in the study . Preoperative, peroperative and postoperative data were collected prospectively, and the patients were followed up for a period of 1 year. Results: No statistical difference was found between two hernia repair groups in terms of age, sex, number of previous abdominal surgery, distribution of incisional hernia and size of the defect. Mean body mass index (BMI) was significantly (P = 0.001) greater in laparoscopic group. No statistical difference was found between two groups in terms of duration of operation, while laparoscopic repair group was significantly advantageous over conventional repair group with regard to pain and discharge time. Complication rates were 15% and 40% in laparoscopic and conventional repair group, respectively. Only one recurrence occurred in either group within 1 year follow-up period. Conclusions: Technological advances in laparoscopic surgery lead to shorter duration of operation, less pain and more rapid discharge from the hospital. It is concluded that lower rate of complication and applicability to obese patients render laparoscopic incisional hernia repair a more reliable and satisfactory technique compared with the conventional technique. doi: http://dx.doi.org/10.4021/jcs154w

Parastomal hernia (PSH) is a frequent complication following the creation of a stoma. While a significant number of cases require operative management, data comparing short-term outcomes of laparoscopic versus open repair of parastomal hernias are limited. The ACS-NSQIP was retrospectively reviewed from 2005 to 2011 for all PSH cases that underwent open or laparoscopic repair. Patients characteristics, operative details, and outcomes were listed for both procedure types. Selected end points were compared on multivariate regression analysis. Among the 2,167 identified parastomal hernia cases, only 222 (10.24 %) were treated laparoscopically. The open and laparoscopic groups were similar with respect to mean patient age (63 vs. 63 years; p = 1) and gender distribution as the majority of patients were females (56.8 %). However, open repair was more likely to be performed in patients with a higher ASA class (III and IV) (p < 0.001). Also, the open approach was more likely to be used emergently (8.64 vs. 3.60 %; p = 0.01) and for recurrent hernias (6.99 vs. 3.15 %; p < 0.05). After adjusting for all potential confounders including age, gender, ASA, emergency designation of the operation, hernia type, and wound class, laparoscopy was associated with shorter operative time (137.5 vs. 153.4 min; p < 0.05), shorter length of hospital stay by 3.32 days (p < 0.001), lower risk of overall morbidity (OR = 0.42; p < 0.001), and a lower risk of surgical site infections (OR = 0.35; p < 0.01) compared to open repair. Mortality rates were similar in the laparoscopic and open groups (0.45 vs. 1.59 %, respectively; p = 0.29). Laparoscopic parastomal hernia repair is safe and appears to be associated with better short-term outcomes compared to open repair in selected cases. Large prospective randomized trials are needed to confirm those results and to assess long-term recurrence rates.

Background: Ventral abdominal wall hernia surgery is a common procedure in the armamentarium of surgeons. The most common forms of these surgical procedures in adults are the repair of incisional hernias and surgery for paraumbilical hernias. Aims and Objectives: Open onlay mesh repair versus laparoscopic intraperitoneal dual mesh repair (intraperitoneal onlay mesh[IPOM]) for ventral hernia compared to the duration of surgery, post-operative pain, postoperative complications, post-operative hospital stay, return to normal activity, recurrence, and cosmesis. Materials and Methods: The prospective non-randomized study was done in the Maharani Laxmi Bai Medical College, Jhansi, between January 2021 and June 2022 including 100 patients was applied for treatment of ventral hernia repair. Fifty patients were subjected to Group A (open onlay mesh repair) and 50 patients were subjected to Group B (laparoscopic intraperitoneal dual mesh repair). Results: The mean surgery durations were significantly lower in laparoscopic repair when compared to open repair (P&lt;0.001). Themean post-operative stay in the hospital was shorter for the laparoscopic group than for the open hernia group (10.28±2.100 vs. 8.02±1.378 days; P≤0.001). Return to activity or normal daily work is significantly lower in the laparoscopic group as compared to open repair of hernia (5.12±0.659 vs. 2.94±0.550 days; P&lt;0.001). There were fewer post-operative complications with laparoscopy. Conclusion: Laparoscopic intraperitoneal dual mesh repair (IPOM) for ventral hernia in our experience was safe and resulted in fewer complications, shorter hospital stays, and better cosmesis results. Hence, it should be considered the better choice for ventral hernia repair.

Background: There is great controversy regarding the choice of procedure for perforated duodenal ulcer patients. The purpose of this study was to compare the early outcome results of laparoscopic and open repair and to propose which risk factors in?uence the outcome. Methods: Between January 2009 and June 2021, 60 patients underwent laparoscopic and 162 patients under - went open repair of perforated peptic ulcers in SMIMER Hospital. The results were retrospectively analysed. The primary outcome measures included operative time, duration of hospital stay, morbidity, and mortality. Results: The operative time was signi?cantly longer in the laparoscopy group compared to the open repair group (76.2 ? 35.3 vs 57.3 ? 26.1 min, respectively). The hospital stay in surviving patients appeared to be signi?cantly shorter after laparoscopy than after open repair (7.8 ? 5.3 vs 10.3 ? 10.6 days, respectively). Eight patients (13%) in the laparoscopic group and 41patients (25%) in the open repair group had morbidity in the postoperative period. Suture leakage was con?rmed in four patients (7%) following laparoscopic repair and in three patients (2%) in the open repair group. There were 20 deaths (9%), all in the open repair group. Conclusions: Independent Boey risk factors, patient age, and large perforation size have a negative impact on patient recovery. Both laparoscopic and open repair are equally safe and e?ective in perforated duodenal ulcer patients with a Boey score of 0or1.

There is great controversy regarding the choice of procedure for perforated duodenal ulcer patients. The purpose of this study was to compare the early outcome results of laparoscopic and open repair and to propose which risk factors influence the outcome. Between October 1996 and May 2004, 60 patients underwent laparoscopic and 162 patients underwent open repair of perforated peptic ulcers in a tertiary care academic center. The results were retrospectively analyzed. The primary outcome measures included operative time, duration of hospital stay, morbidity, and mortality. The operative time was significantly longer in the laparoscopy group compared to the open repair group (76.2 +/- 35.3 vs 57.3 +/- 26.1 min, respectively). The hospital stay in surviving patients appeared to be significantly shorter after laparoscopy than after open repair (7.8 +/- 5.3 vs 10.3 +/- 10.6 days, respectively). Eight patients (13%) in the laparoscopic group and 41 patients (25%) in the open repair group had morbidity in the postoperative period. Suture leakage was confirmed in four patients (7%) following laparoscopic repair and in three patients (2%) in the open repair group. There were 20 deaths (9%), all in the open repair group. Independent Boey risk factors, patient age, and large perforation size have a negative impact on patient recovery. Both laparoscopic and open repair are equally safe and effective in perforated duodenal ulcer patients with a Boey score of 0 or 1.

Background: Inguinal hernias are a common medical problem that can significantly decrease the quality of life.Repair of inguinal hernia is one of the commonest surgical procedures worldwide irrespective of the country, race, or socioeconomic state. The inguinal hernia repair has been a controversial area in surgical practice from the time it has been conceived. Laparoscopic inguinal hernia repair has shown a great deal of promise as a treatment for the condition.Objectives: To compare the outcome of laparoscopic versus open inguinal hernia mesh repair in terms of operative time , analgesics requirement , postoperative complication , hospital stay and return to daily activities and work.Patients and methods: A prospective study of 80 patients with inguinal hernia repair, carried out during the period from January 2010 till January 2013, Baghdad Teaching Hospital\Medical City, Iraq, to compare the effectiveness and safety of laparoscopic and conventional open mesh techniques. Those patients were divided into 2 groups (each group of 40 patients); 1st group treated by laparoscopic (TAPP) repair and the 2nd one by open technique (mesh repair).Results: The mean operating time in laparoscopic repair was 55 minutes (45-120) while in open repair it was 38 minutes (30-110) .The laparoscopic repair was superior to open repair in regard to ; less analgesic requirement post operatively , short hospital stay , and faster return to daily activities and workThere was no statistically significant difference between the two groups regarding complications.Conclusion: Laparoscopic hernia repair is equally safe and can provide less postoperative morbidity in experienced hands Therefore laparoscopic hernia repair can be safely recommended for most cases of inguinal hernia unless laparoscopy itself is contraindicated.

Chronic pain is an important outcome variable after inguinal hernia repair that is generally not assessed by objective methods. The aim of this study was to objectively investigate chronic pain and hypoesthesia after inguinal hernia repair using three types of operation: open suture, open mesh, and laparoscopic. A total of 96 patients were included in the study with a median follow-up of 4.7 years. Open suture repair was performed in 40 patients (group A), open mesh repair in 20 patients (group B), and laparoscopic repair in 36 patients (group C). Hypoesthesia and pain were assessed using von Frey monofilaments. Quality of life was investigated with Short Form 36. Pain occurring at least once a week was found in 7 (17.5%) patients of group A, in 5 (25%) patients of group B, and in 6 (16.6%) patients of group C. Area and intensity of hyposensibility were increased significantly after open nonmesh and mesh repair compared to those after laparoscopy (p = 0.01). Hyposensibility in patients who had laparoscopic hernia repair was significantly associated with postoperative pain (p = 0.03). Type of postoperative pain was somatic in 19 (61%), neuropathic in 9 (29%), and visceral in 3 (10%) patients without significant differences between the three groups. The incidence of hypoesthesia in patients who had laparoscopic hernia repair is significantly lower than in those who had open hernia repair. Hypoesthesia after laparoscopic but not after open repair is significantly associated with postoperative pain. Von Frey monofilaments are important tools for the assessment of inguinal hypoesthesia and pain in patients who had inguinal hernia repair allowing quantitative and qualitative comparison between various surgical techniques.

Laparoscopic ventral incisional hernia repair: a more effective alternative to conventional repair of recurrent incisional hernia.

Background: Laparoscopic and open are the two main ways of doing inguinal hernia repair. Laparoscopic repair has advantages including reduced postoperative pain and quicker recovery, however, feasibility, efficacy, and accessibility of this procedure in resource limited settings like Pakistan is not clear. Objective: To compare, evaluate and quantify the postoperative outcomes, complications, recovery time and patient satisfaction between laparoscopic and open inguinal hernia repair at tertiary care setting in Pakistan. Methods: This was a prospective comparative study conducted at three tertiary care hospitals in Pakistan. Eighty adult patients with primary unilateral reducible inguinal hernia were randomly assigned to undergo laparoscopic versus open inguinal hernia repair. Operative time, hospital stay and postoperative complications were the primary outcomes. Other outcomes included pain assessment by the Visual Analog Scale (VAS), return to normal activities, and patient satisfaction. SPSS version 26.0 was used to perform statistical analysis, significance of p &lt; 0.05. Results: Operative time was longer with laparoscopic repair (91.2 ± 14.7 min vs. 57.9 ± 11.5 min, p &lt; 0.001) but shorter with hospital stay (1.1 ± 0.5 days vs. 2.5 ± 1.0 days, p &lt; 0.001). There was significantly lower postoperative pain in the LIHR group (p &lt; 0.001). The total complication rates were lower in the laparoscopic group (7.5 vs. 15.0, p = 0.048). The patients who have undergone laparoscopic repair were found to be more satisfied with the outcome. Conclusion: The postoperative outcomes after laparoscopic inguinal hernia repair are better, such as less pain, less time in hospital and faster recovery. Despite it, in Pakistan its adoption is limited to due to cost and training requirements. Keywords: Inguinal hernia, Laparoscopic repair, Open repair, Postoperative outcomes, Patient satisfaction, minimally invasive surgery, Pakistan.

During laparoscopic groin hernia repair, the surgeon may transect the round ligament of uterus to facilitate mesh placement. Transection during open repair is rarer and anatomically further from the uterus. Our aim was to compare long-term genitourinary outcomes, particularly genital prolapse, between open and laparoscopic repair in women with a primary groin hernia. The study was reported according to RECORD guidelines. All women having received a primary anterior open or laparoscopic groin hernia repair from 1998 to 2014 were identified through The Danish Hernia Database and linked with data from The Danish National Patient Registry and the Danish Register of Causes of Death. Our outcome was postoperative genital prolapse and other long-term complications related to gynecology, urology, and infertility. We included 10,867 women having received a primary groin hernia repair, 7732 (71%) had an open anterior repair and 3135 (29%) a laparoscopic repair. The median (range) age was 59 (19-102) and 64 (18-105), respectively (p < 0.001). Median follow-up was 65 (range 0-203) months. After open repair, 313/7340 (4.2%) had a postoperative genital prolapse, and 46/2,934 (1.5%) after laparoscopic repair (p < 0.001). In multivariate Cox Regression analyses adjusting for age and hernia type, there were no difference between the two methods (p = 0.474). Women with an inguinal hernia had a higher risk of genital prolapse than women with a femoral hernia, independent of repair method [HR = 1.455 (1.143-1.853), p = 0.002]. We found no significant differences between open and laparoscopic methods in multivariate analyses assessing other long-term postoperative genitourinary and/or infertility outcomes. We found no differences in postoperative genital prolapse or other complications related to gynecology, urology, and/or infertility between open anterior and laparoscopic groin hernia repair in women. Assuming the round ligament of uterus is being transected more often in laparoscopic repair than in open, the urogenital consequences of transection seem to be minimal.