Prospective, multicenter study of laparoscopic ventral hernioplasty. Preliminary results.

Laparoscopic ventral hernia repair (LVHR) is associated with shorter hospitalization and lower complication rates compared to open ventral hernia repair. We sought to determine if hernia-related factors, such as defect size and re-operative status correlate with postoperative complications, operative times and length of stay (LOS). The study is a retrospective review of 30-day perioperative outcomes following LVHR in 91 patients who underwent surgery at a single institution from August 2009 through June 2012. A single surgeon performed all procedures. Indications for surgery were recurrent incisional hernia in 33% of patients and primary incisional or ventral abdominal hernias in the rest. Coated polyester mesh with an average size of 348cm(2) (±214; range 113-1,036) was used. Mean operative time was 132min (±66.1; range 53-412). The mean LOS was 4.0days (±3.5; range 1-22). Complications occurred in 13 patients for overall morbidity of 16.5% and no mortality. There was one recurrence in 30days (1.1%). Patients who had a surgery >120min or a LOS >1day were statistically more likely to have multiple hernias, larger defect sizes (>40cm(2)), larger mesh sizes (>300cm(2)) or a history of recurrent hernia (P<0.05). No other clinical or demographic variable evaluated in this study correlated with operative time or LOS. LVHR is safe with a low incidence of perioperative complications. Patients with multiple, larger and recurrent hernias have longer operative times and LOS. This information can be used to guide preoperative planning for the patient, surgeon and treating institution.

The treatment of recurrent incisional hernias (RIH) has been associated with unsatisfactory postoperative (PO) morbidity and high failure rates. The aim of this study is to retrospectively investigate our single-center experience of laparoscopic repair (LR) for RIH. The case records of 69 patients with RIH who underwent LR in our institution between January 2002 and November 2011 were reviewed. The operative technique has been standardized and provides onlay placement of an ePTFE mesh fixed with titanium tacks. Patients' demographic data and comorbidities, intraoperative course, PO complications and recurrences at follow-up were systematically collected and analyzed. The influence of defect's size and obesity variables on clinical outcomes was also investigated. The mean operative time was 147.6±71.2 min and mean hospital stay was 5.8±1.8 days. No conversion occurred while five intraoperative complications (7.2%) were recorded: three bowel injuries treated by laparoscopic sutures, one omentum bleeding and one epigastric vessel lesion. PO mortality was null, while overall morbidity was 13% (9 patients) with a prevalence of seroma lasting over 8weeks in six patients (8.7%). Along a mean follow-up of 41months (range 6-119), recurrence rate was 5.7% (4 patients). Univariate analysis for width of defects and BMI showed no significant influence on patients' outcomes. Surgical treatment for RIH remains controversial because of lack in literature of specific studies on this topic. Morbid obesity and large defects have been often associated with technical difficulties and worse results. Our 10years' experience with LR provided satisfactory results in terms of PO morbidity and recurrence rate, despite any kind of patient selection.

To study the causes of recurrent postoperative ventral hernias and methods for their prevention. There were 58 patients with recurrent postoperative ventral hernias after various methods of abdominal wall repair for the period 2005-2017. The main causes of recurrent postoperative ventral hernias were identified. Local tissue rearrangement resulted recurrent hernia in 21 (36.2%) patients, that was observed even in patients with small hernia. Size discrepancy between endoprosthesis and hernial orifice caused a recurrence in 20 (34.5%) patients. In 11 (19%) patients, implant detachment followed by recurrent hernia occurred. Postoperative wound complications followed by recurrent hernia were diagnosed in 6 (10.3%) patients. Non-compliance with recommendations for wearing a bandage and restricting physical exertion also contributed to the development of recurrent hernia. Moreover, recurrent hernia occurred mainly in obese patients. Mean body mass index was 34.27±2.2 kg/m2. Recurrent hernia was again detected in 12 out of 35 patients in long-term period after surgical treatment. It is necessary to abandon local tissue rearrangement and to select a correct size of synthetic material for prevention of recurrent postoperative hernia. Preoperative body weight control is essential in patients with obesity. Wearing a bandage and restricting physical exertion are obligatory in postoperative period. Annual examination during 3-5 years after surgery is essential for timely diagnosis of recurrent hernia.

Objective: To compare operative time, hospital stay and post-operative complications between laparoscopic and open pyloromyotomy. Study Design: Randomized Prospective study. Setting: Department of Paediatric Surgery, Pak Emirates Military Hospital, Rawalpindi. Period: 7th May 2022 to 7th November 2022. Material &amp; Methods: This study included 20 patients each in the two groups. Group A underwent laparoscopic whereas group B underwent open pyloromyotomy. Both groups were compared regarding operative time (OT), hospital stay (HS) and post-operative complications. Results: OT ranged from 20 to 70 min with a mean of 15.4 min in group A. In group B, the mean OT was 25.6 min (range, 25–60 min). HS ranged from 14 to 58 hours with a mean of 16.8 hours in group A. In group B, it ranged from 19 to 30 hours, and the mean was 24.2 hours. One case in group A was converted to open approach (conversion rate 5%) because of mucosal perforation while one case of incomplete pyloromyotomy was found. Conclusion: Laparoscopic technique has shorter operative time and hospital stay than open surgery. Complication like mucosal perforation were seen in laparoscopy group, however, it was not found statistically significant.

Objective: To introduce a novel endoscopic surgical technique with mini-nephroscope by suprapubic transvesical route for cystolithotripsy in children. Material and methods: This was a non-randomized study with a series of 12 boys, between February 2012 and September 2013. Demographic, operative, and postoperative data were recorded. Our new endoscopic surgery technique could be performed in all patients. Complications were noted. Results: Mean age was 35.1 ± 8.6 months (19–46 months), the average stone size was 16.5 ± 5.2 mm (10–20 mm). Mean operation time was 28.9 min (21–40), and mean hospital stay was 2.2 (2–3) days. In all procedures, stones were successfully fragmented and extracted by the new surgical technique. There was no intraoperative and/or postoperative complication or urethral stricture during follow-up period. In stone analyses, the main components were ammonium acid urate, calcium oxalate, and struvite. Conclusions: The new endoscopic surgery technique is safe and effective for bladder stones in children. Thus, our technique can be a strong candidate for an alternative treatment of childhood bladder stones.

Background: Groin hernia surgery is one of the most common procedures performed by surgeons worldwide. With the advent of minimal access surgery, the procedure for repair is now done either by transabdominal preperitoneal approach Transabdominal preperitoneal (TAPP) or totally extraperitoneal (TEP) approach. The advantage of one procedure over the other is still controversial. Objectives: This prospective study was conducted to find out the intraoperative and postoperative outcomes of TEP and TAPP for inguinal hernia repair in terms of operative time, intraoperative complications, conversion to open, visual analog scale (VAS) score, postoperative complications, length of hospital stay, and recurrence of hernia and chronic pain. Materials and Methods: A total of 88 patients of inguinal hernia enrolled prospectively between November 2017 and November 2019 and patients aged 18 years and above admitted in Jawaharlal Nehru Medical College and Hospital were included in this study. Forty-four patients were included in TEP group, while 44 patients were allocated to TAPP group. Results: The statistical analysis was done using Chi-square test and unpaired t-test, respectively. The mean operative time in TEP was 91.14 ± 11.14 min and in TAPP repair was 103.16 ± 6.79 min, which was found to be significantly significant. The mean pain score on VAS score on postoperative day 1 was 5.70 ± 0.95 in laparoscopic TEP group and 5.86 ± 0.97 in laparoscopic TAPP group. The mean pain score on VAS score on postoperative day 2 was 3 ± 1.27 in laparoscopic TEP group and 2.95 ± 1.29 in laparoscopic TAPP group. Similarly, the mean pain score on VAS scale on postoperative day 7 was 0.863 ± 1.26 in laparoscopic TEP group and 0.659 ± 1.21 in laparoscopic TAPP group. No significant difference was observed in VAS between TEP and TAPP groups during follow-up. Both TEP and TAPP mesh techniques were comparable in terms of the intraoperative complications and postoperative complications (seroma [during hospital stay, after 1 week of discharge, after 1 month of follow-up]; hematoma [during hospital stay, after 1 week of discharge]; wound infection) and in conversion to open and length of hospital stay. The difference in mean cost of surgery was found to be statistically significant. Conclusion: Although the mean operative time and cost of surgery were significantly more in TAPP than in TEP group, no significant difference could be found between the intraoperative and postoperative complication rates, conversion to open, and length of hospital stay. Recurrence was observed in one case of TEP groups during follow-up. Our study supports the view that both laparoscopic TEP and TAPP mesh repairs of inguinal hernia are safe and efficacious.

Background: Recurrent inguinal hernia accounts for 10 % of the recurrence rate in all recurrent hernia cases. Aim: This study aimed to operate recurrent hernia by laparoscopic transabdominal preperitoneal technique (TAPP) then evaluate its outcomes. Patients and methods: This a prospective clinical study included 30 patients complaining of recurrent inguinal hernia. All of them were treated by laparoscopic transabdominal preperitoneal stapling of prolene mesh 10 X 15 cm by the endo-tacker in the preperitoneal (Bogros) space. The patients were assessed preoperatively. Then, we assessed the results of the operative finding, difficulties and complication. Results: The TAPP approach was easier in operating bilateral recurrent inguinal hernia but with high cost. The laparoscopic approach has several advantages over the open approach like: Less postoperative pain, operative time was less as we operated the unilateral recurrent inguinal hernia in 40 minutes and bilateral hernia in 60 minutes. The disadvantages of the TAPP approach were: It cannot be performed under local anesthesia, higher patient expectation, increased cost and difficult approach in huge hernias.Postoperatively, no significant serious complications were recorded, only one patient developed mild seroma in the early postoperative period, which resolved within 5 days and another one patient developed mild hydrocele late postoperatively, which resolved within 5 weeks. Conclusion: The transabdominal preperitoneal approach is the best technique for the treatment of recurrent inguinal hernia and the most important pre-step of the TAPP was the familiarity with the intra-abdominal laparoscopic anatomy.

Introduction:Despite an exponential rise in laparoscopic surgery for inguinal herniorrhaphy, overall recurrence rates have remained unchanged. Therefore, an increasing number of patients present with recurrent hernias after having failed anterior and laparoscopic repairs. This study reports our experience with single-incision laparoscopic (SIL) intraperitoneal onlay mesh (IPOM) repair for these hernias.Materials and methods:All patients referred with multiply recurrent inguinal hernias underwent SIL-IPOM from November 1 2009 to October 30 2013. A 2.5-cm infraumbilical incision was made and a SIL surgical port was placed intraperitoneally. Modified dissection techniques, namely, “chopsticks” and “inline” dissection, 5.5 mm/52 cm/30° angled laparoscope and conventional straight dissecting instruments were used. The peritoneum was incised above the symphysis pubis and dissection continued laterally and proximally raising an inferior flap, below a previous extraperitoneal mesh, while reducing any direct/indirect/femoral/cord lipoma before placement of antiadhesive mesh that was fixed into the pubic ramus as well as superiorly with nonabsorbable tacks before fixing its inferior border with fibrin sealant. The inferior peritoneal flap was then tacked back onto the mesh.Results:There were 9 male patients who underwent SIL-IPOM. Mean age was 55 years old and mean body mass index was 26.8 kg/m2. Mean mesh size was 275 cm2. Mean operation time was 125 minutes with hospital stay of 1 day and umbilical scar length of 21 mm at 4 weeks' follow-up. There were no intraoperative/postoperative complications, port-site hernias, chronic groin pain, or recurrence with mean follow-up of 20 months.Conclusions:Multiply recurrent inguinal hernias after failed conventional anterior and laparoscopic repairs can be treated safely and efficiently with SIL-IPOM.

Objective To compare the curative effect of laparoscopic and open radical resection of rectal cancer. Methods The clinical data of 380 patients with rectal cancer that had received operation from September 2009 to January 2015 in Gastrointestinal Surgery Department of Subei People Hospital were selected, and there were 190 cases of laparoscopic assisted rectal cancer radical resection (laparoscopic group), and 190 cases of open rectal cancer radical resection(open group).A retrospective analysis was conducted on the clinical data of two groups and the intraoperative blood loss, operative length, lymph node dissection number, postoperative drainage volume, postoperative complications, postoperative discharge time, postoperative follow-up data of two groups were compared and analyzed. Results Patients from two groups had significant difference in intraoperative blood loss (t=9.06, P<0.0001) , lymph node dissection number (Χ2=2.07, P=0.039), postoperative hospital stay (Χ2=2.87, P=0.004), operative length (t=5.43, P<0.001), infection of incision (Χ2=4.49, P=0.03), Sexual dysfunction (Χ2=4.43, P=0.04) and intestinal obstruction (Χ2=4.49, P=0.03). The laparoscopic assisted rectal cancer radical resection had less intraoperative blood loss, more intraoperative lymph node dissection number, shorter postoperative hospital stay, less infection of incision, less Intestinal obstruction and less Sexual dysfunction etc., while the open group had shorter operation length. They had no statistical significance in post-operative drainage volume within three days (t=1.024, P=0.306), the number of lymph node metastasis (Χ2=0.70, P=0.484), and survival rate after operation (Χ2=0.74, P=0.39). Conclusion Laparoscopic and open radical resection of rectal cancer are safe and feasible surgical approach, both ways have their own advantages and disadvantages, is still lack of related prospective clinical randomized controlled trials. Key words: Rectal neoplasms; Laparoscopes; Open surgery; Efficacy; Complication

PurposeVentral hernia repair is one of the most frequently performed surgical procedures, though recurrences are common. Recurrence can be caused by impaired collagen formation or maturation; hence, patients with Ehlers-Danlos syndrome (EDS) are potentially at increased risk for hernia recurrence. EDS causes altered collagen metabolism, though little is known about the influence of EDS on ventral hernioplasty outcomes. This study aims to analyze these patients to report complication rates, recurrence rates, and, if possible, to give recommendations for surgical intervention.MethodsA retrospective analysis between January 2000 and January 2017 was performed in a university hospital Belgium (UZ Ghent). Data on baseline characteristics, primary surgery, and hernias were extracted from patients’ medical charts. Noted endpoints were postoperative complications and recurrences.ResultsFourteen patients (50% males) were included. Ten (71%) had an incisional hernia and four (29%) had a primary ventral hernia. Median age was 45 years (IQR 37.75–52.75), median BMI was 24.82 (IQR 22.43–26.87). Four patients (29%) smoked, one patient (7.1%) had diabetes mellitus, and five patients (36%) had an aneurysm of the abdominal aorta. All patients underwent elective open hernioplasty with mesh reinforcement. Three patients (21%) had a postoperative complication (two infections, one seroma). Recurrence rate was 7.1% (one patient).ConclusionsThis series describes 14 patients with a median follow-up of 50 months and a recurrence rate of 7.1%. The low recurrence rate could be explained by the use of large meshes that reinforce the entire midline to compensate for the reduced collagen strength in EDS patients.

Objective To analyze the safety and effectiveness of ambulatory surgery in inguinal herniorraphy. Methods The clinical data of 3 852 cases of inguinal hernia repair patients admitted from January 2009 to December 2013 in this single center was analyzed retrospectively. Cases of emergency surgery were excluded. Results All patients had long-term follow-up (12-60 months). 1 575 patients underwent day-surgery , mean operation time was (43.84±12.35)min, mean time of ambulation was (1.12±0.91) d, mean time of recovery was (5.78±1.12) d, mean hospitalization was (1.34±0.48) d, mean hospitalization cost was (7 546.49±2 962.57) RMB. In contrast, there were 511 patients underwent a non day-surgery, mean operation time was (48.59±14.52) min, mean time of ambulation was (2.43±1.38) d, mean time of recovery was (7.46±2.62) d, mean hospitalization was (4.8±2.91) d, mean hospitalization cost was (9 165.16±4 281.83) RMB. Patients with day-surgery were significantly superior to those with non day-surgery in operation time (P=0.000), mean time of ambulation (P=0.000), mean hospitalization (P=0.000), mean hospitalization cost (P=0.000) and mean time of recovery(P=0.000). Infection and readmission in non day-surgery patients was higher than that in day-surgery (P=0.000). There was no difference in postoperation pain and hernia recurrence. Conclusions Ambulatory surgery in inguinal herniorraphy is safe with similar recurrence rate; but significantly lower cost and shorter hospitalization. Key words: Hernia, inguinal; Surgical procedures, operative; Day surgery

Objective To observe the clinical effect of hand-assisted laparoscopic nephrectomy(HALN) in urological surgery. Methods From March 2017 to October 2017, 15 patients with indications for nephrectomy received HALN and tomographic, intraoperative and postoperative data and complications were recorded. Results There were 15 patients, including 7 patients with renal tuberculosis, 1 patient suspected cancer of lower ureter( renal and ureteral tuberculosis identified postoperatively), 6 patients renal calculi with hydronephrosis and infection and 1 ureteral stenosis with pyonephrosis. Mean operation time was (93.0±29.8)min and mean hemorrhage was (79.3±87.9)mL with no conversion to open surgery or blood transfusion in any patient. Postoperative complications were mainly Clavien grade 1, including fever (n=1), prolonged abdominal distention (n=3), pain which need analgesics (n=3) and prolonged urinary leakage which disappear two weeks later. There were no Clavien grade 2 to 5 complications. Conclusions HALN converges advantages of LN and open nephrectomy (ON) and is an effective and safety procedure, thus it could be a substitute for laparoscopic nephrectomy(LN). Key words: Nephrectomy; Laparoscopy

INTRODUCTION: Although robot-assisted surgery is no longer considered to be a “novel” technology, its application to hernia repair remains relatively new. As a result, there is limited data available in the literature regarding robot-assisted ventral hernia repair. The purported benefits of robot-assisted surgery include high definition three-dimensional visualization, improved surgeon ergonomics, and 6-degrees of freedom with range of motion. The cited potential drawbacks include increased expense and longer operative/anesthesia times, but these have not been definitively proven. We therefore seek to compare operative details and patient outcome data among patients undergoing open, laparoscopic, robot-assisted ventral hernia repairs. METHODS: Institutional Review Board approval was obtained (Study Number: 16-00011). A retrospective study was performed of all patients who underwent elective open, laparoscopic, and robot-assisted ventral hernia repair at a single institution in 2015. Procedure-related details such as anesthesia and operative times, length of stay, use of mesh, primary closure of the fascia, and postoperative complications were compared between groups. Those patients undergoing emergent procedures or a separate procedure simultaneous with ventral hernia repair were excluded. RESULTS: 160 patients were included in the study. Mean age was 56.7 years. Mean BMI was 30.1 kg/m2. 138 patients (81%) had a history of previous intra-abdominal surgery. Hernia was recurrent in 32 (20%) of the cohort. Twenty seven patients (16.9%) underwent laparoscopic hernia repair, 110 (68.7%) underwent open repair, and 23 (14.4%) patients underwent robot-assisted repair. Robot-assisted repairs were associated with significantly increased anesthesia and operative times (p<0.0001). There was no significant difference in length of hospital stay, complications (which included seromas, hematomas, abscesses, pneumonia, dehiscence, small bowel obstruction, and mesh infections), or hernia recurrence between robot-assisted procedures and laparoscopic or open repairs. CONCLUSION: These preliminary data suggest that although robot-assisted ventral hernia repairs are associated with increased anesthesia and operative times, the outcomes with regard to length of hospital stay, safety profile, and risk of recurrence are comparable to those of more traditional hernia repair methods. Therefore application of robotic technology to ventral hernia repair is both safe and feasible, although larger, prospective, multi-center studies are necessary before definitive conclusions regarding this novel application are drawn.

Peritoneal closure during laparoscopic trans-abdominal preperitoneal (TAPP) inguinal hernia repair has been the standard of care to prevent bowel obstruction due to adhesions generated by contact with mesh. However, with newer coated meshes, leaving the peritoneal layer open may be safe. While many studies compare methods of peritoneal flap closure, there is a deficit of literature reporting the outcomes of non-closure. A retrospective comparison of peritoneal flap closure versus non-closure during primary laparoscopic TAPP inguinal hernia repair with coated mesh was performed for all patients at Baystate Medical Center meeting inclusion criteria between January 2005 and August 2016. Primary outcome was any procedure-related adverse outcome following repair. Secondary outcomes included operative time, resolution of pre-operative pain and/or gastrointestinal symptoms, and hernia recurrence. Of 231 patients, 55 (24%) underwent peritoneal flap closure and 176 (76%) underwent non-closure. Demographic, comorbidity, and hernia characteristics were comparable between groups with the exception of obesity (p=0.01), current smoking status (p=0.05) and hernia side [p=0.04 (left), 0.0003 (right)]. Mean operative time was higher in the closure group than non-closure (98.1±37.1min vs. 76.8±32.9, p<0.0001). No cases were converted to open. Average follow-up was 21.6±23.8months. Ninety-three percent of closure patients had documented resolution of pre-operative pain versus 94.0% of non-closure (p=0.81). The closure group experienced a higher percentage of post-operative complications, though this did not reach significance (5.5 vs. 2.3%; p=0.36). Compared to the closure group, the non-closure groups experienced similar post-operative pain (3.6 vs. 1.2%; p=0.24) and recurrence rate (1.8 vs. 4.0%; p=0.68). There were no bowel obstructions, surgical site infections, unplanned readmissions, or unplanned re-operations. Equivalent patient outcomes were seen for both procedure types post-operatively and during follow-up. Operative times were significantly shorter for non-closure patients. Larger study population and longer follow-up is necessary to evaluate true long-term complication rates in flap non-closure.

IntroductionFractures in the ankylotic spine may have an insidious presentation but are prone to displace with devastating consequences. The long lever arm of ankylosed spine fragments may lead to pulmonary and great vessel injury and is difficult to adequately immobilize. Conservative treatment will produce in many cases poor outcomes with high morbidity and mortality. Open surgical treatment is also fraught with technical difficulties and can lead to major blood loss and prolonged operative times.In recent years, percutaneous instrumentation of non-ankylotic spine fractures has gained popularity, producing similar outcomes to open surgery with shorter operative times and reduced blood loss and hospital length of stay. We describe our experience implementing these techniques in ankylotic spine patients.MethodsWe retrospectively retrieved from our hospital’s electronic health records all patients treated for thoracolumbar spine fractures between 2008 and 2015 with a diagnosis of ankylosing spondylitis (AS) or diffuse idiopathic skeletal hyperostosis (DISH). Operative and postoperative data, results, and complications were tabulated, and radiographic parameters were evaluated.ResultsTwenty-four patients with ankylotic spine disease underwent percutaneous augmented instrumentation between 2008 and 2015. The mean age was 76. All patients had at least one comorbidity. The mean number of ankylosed levels was 14. Mean operative time was 131 min. The average postoperative hemoglobin decrease was 1.21 gr/%, with only 4 patients requiring blood transfusion.45.8% of the patients had postoperative medical complications. One patient (4.2%) had a superficial postoperative infection, and one patient died in hospital. The average hospital length of stay was 14.55 days.All patients retained their preoperative ASIA grades, and 3 improved one grade. All patients united their fractures without losing reduction.ConclusionsPMMA-augmented percutaneous instrumentation is an attractive surgical option for this difficult patient subset, especially when compared to other available current alternatives.