Main Article Content
Abstract
Background:
To evaluate the short term recurrence, pain scores, infection rates and cost factors by using 5cm all around composite mesh reinforcement of the closed defect after endoscopic video-assisted component separation for large ventral hernia repair.
Methods:
All patients who were clinically assessed to have large (≥5cm diameter of defect) midline ventral hernia underwent an abdominal CT as per protocol to calculate the Component Separation Index and were subjected to endoscopic video-assisted component separation. Next laparoscopy is done, hernial contents were reduced with adhesiolysis and midline defect is closed vertically with VLoc sutures, under physiologic tension. The closed suture line is reinforced with a mesh having a 5cm all round overlap irrespective of the original hernia defect.
Results:
A total of 30 patients were operated. Over a follow up period ranging from 3-18 months there were no recurrences, no surgical site infection, no seroma formation, no mesh infection, fewer tackers were required resulting in more favorable pain scores. Due to smaller mesh and fewer tackers there was significant cost reduction per case.
Conclusion:
Endoscopic component separation technique is useful in tension less large midline ventral hernia repair. Only 5cm all around mesh reinforcement of midline closure is required thus significantly cutting down the cost of surgery with excellent patient outcome.
Keywords
Article Details
References
- K. LeBlanc. Proper mesh overlap is a key determinant in hernia recurrence following laparoscopic ventral and incisional hernia repair. Hernia 2016 ;20(1):85-99
- Rosen MJ, Jin J, McGee MF, Williams C, Marks J, Ponsky JL. Laparoscopic Component Separation in the Single-stage Treatment of Infected Abdominal Wall Prosthetic Removal. Hernia (2007);11:435-440.
- C. Palanivelu, K. V. Jani, P. Senthilnathan, R. Parthasarathi, M. V. Madhankumar, V. K. Malladi . Laparoscopic sutured closure with mesh reinforcement of incisional hernias. Hernia 2007;11:223–228
- Duncan light , Sadiq Bawa . Trans-fascial closure in laparoscopic ventral hernia. Surgical endoscopy 2016;30(12):5228-5231
- Switzer NJ, Dykstra MA, Gill RS, Lim S, Lester E, De Gara C. et al. Endoscopic versus open component separation: systematic review and meta-analysis. Surg Endosc 2015; 29:787–795.
- Holihan JL, Askenasy EP, Greenberg JA, Keith JN, Martindale RG, Roth JS, Mo J, Ko TC, Kao LS, Liang MK. Component Separation vs. Bridged Repair for Large Ventral Hernias: A Multi-Institutional Risk-Adjusted Comparison, Systematic Review, and Meta-Analysis. Surg Infect (Larchmt). 2016 ;17(1):17-26.
- Harth C K , M.H.S.,Rosen M J. Endoscopic Versus Open Component Separation in Complex Abdominal Wall Reconstruction. American journal of surgery; vol 199, issue 3: 342-47
- Kanters AE, Krpata DM, Blatnik JA, et al. Modified hernia grading scale to stratify surgical site occurrence after open ventral hernia repairs. J Am Coll Surg 2012;215:787–93
- Sailes FC, Walls J, Guelig D, Mirzabeigi M, Long WD, Crawford A, et al.Synthetic and biological mesh in component separation: a 10-year single institution review. Ann Plast Surg 2010; 64:696–698
- Azoury SC, Dhanasopon AP, Hui X, Tuffaha SH, De La Cruz C, Liao C et al; Endoscopic component separation for laparoscopic and open ventral hernia repair: a single institutional comparison of outcomes and review of the technique. Hernia 2014; 18:637–645.
- Agnew SP, Small W Jr, Wang E, Smith LJ, Hadad I, Dumanian GA. Prospective Measurements of Intra-abdominal Volume and Pulmonary Function After Repair of Massive Ventral Hernias With the Component Separation Technique. Annals of Surgery 2010; 251:981-88.
References
K. LeBlanc. Proper mesh overlap is a key determinant in hernia recurrence following laparoscopic ventral and incisional hernia repair. Hernia 2016 ;20(1):85-99
Rosen MJ, Jin J, McGee MF, Williams C, Marks J, Ponsky JL. Laparoscopic Component Separation in the Single-stage Treatment of Infected Abdominal Wall Prosthetic Removal. Hernia (2007);11:435-440.
C. Palanivelu, K. V. Jani, P. Senthilnathan, R. Parthasarathi, M. V. Madhankumar, V. K. Malladi . Laparoscopic sutured closure with mesh reinforcement of incisional hernias. Hernia 2007;11:223–228
Duncan light , Sadiq Bawa . Trans-fascial closure in laparoscopic ventral hernia. Surgical endoscopy 2016;30(12):5228-5231
Switzer NJ, Dykstra MA, Gill RS, Lim S, Lester E, De Gara C. et al. Endoscopic versus open component separation: systematic review and meta-analysis. Surg Endosc 2015; 29:787–795.
Holihan JL, Askenasy EP, Greenberg JA, Keith JN, Martindale RG, Roth JS, Mo J, Ko TC, Kao LS, Liang MK. Component Separation vs. Bridged Repair for Large Ventral Hernias: A Multi-Institutional Risk-Adjusted Comparison, Systematic Review, and Meta-Analysis. Surg Infect (Larchmt). 2016 ;17(1):17-26.
Harth C K , M.H.S.,Rosen M J. Endoscopic Versus Open Component Separation in Complex Abdominal Wall Reconstruction. American journal of surgery; vol 199, issue 3: 342-47
Kanters AE, Krpata DM, Blatnik JA, et al. Modified hernia grading scale to stratify surgical site occurrence after open ventral hernia repairs. J Am Coll Surg 2012;215:787–93
Sailes FC, Walls J, Guelig D, Mirzabeigi M, Long WD, Crawford A, et al.Synthetic and biological mesh in component separation: a 10-year single institution review. Ann Plast Surg 2010; 64:696–698
Azoury SC, Dhanasopon AP, Hui X, Tuffaha SH, De La Cruz C, Liao C et al; Endoscopic component separation for laparoscopic and open ventral hernia repair: a single institutional comparison of outcomes and review of the technique. Hernia 2014; 18:637–645.
Agnew SP, Small W Jr, Wang E, Smith LJ, Hadad I, Dumanian GA. Prospective Measurements of Intra-abdominal Volume and Pulmonary Function After Repair of Massive Ventral Hernias With the Component Separation Technique. Annals of Surgery 2010; 251:981-88.