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Open versus laparoscopic incisional hernia repair: something different from a meta-analysis

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Abstract

Background

Incisional hernias after laparotomy are a large financial burden for society as well as for the patients suffering from pain and limitations of activity over time. The introduction of alloplastic materials such as polypropylene seems to improve the results. The question of whether to apply open or laparoscopic implantation of the mesh is of ongoing interest. We compare the available alloplastic materials and try to clarify the question of whether the laparoscopic procedure is superior to the conventional (open) technique based on the available randomized studies.

Methods

All available meshes for intraperitoneal and extraperitoneal implantation were described regarding their handling and their pros and cons. A database search (PubMed, Medline, Ovid, and in the secondary literature) was carried out to retrieve all randomized studies comparing laparoscopic and open hernia repair. Data were reviewed by two independent scientists for surgical and statistical design.

Results

The ideal mesh for a laparoscopic maintenance of abdominal wall hernias as well as the optimal fixation of the mesh has not been found yet. Recent available literature shows no evidence demonstrating the superiority of one of these meshes. The available studies found a lower infection rate, but higher occurrence of seroma for the laparoscopic procedure. The value of the different studies is reduced due to deficiency in study design and power. Guidelines for further studies are discussed to avoid surgical and statistical pitfalls.

Conclusions

Laparoscopic incisional hernia repair shows, in some (randomized) studies as well as a large number of retrospective analyses and in case control studies, superiority compared to conventional hernia repair. Long-term results with a high level of evidence are not available. Additional well-designed randomized trials including long-term observation of patients are required in order to clarify a number of interesting questions.

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References

  1. Luijendijk RW, Hop WC, van den Tol MP, de Lange DC, Braaksma MM, J.N. J, Boelhouwer RU, de Vries BC, Salu MK, Wereldsma JC, Bruijninckx CM, Jeekel J (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 343:392–398

  2. Clark JL (2001) Ventral incisional hernia recurrence. J Surg Res 99:33–39

    Article  PubMed  CAS  Google Scholar 

  3. LeBlanc KA, Whitaker JM, Bellanger DE, Rhynes VK (2003) Laparoscopic incisional and ventral hernioplasty: lessons learned from 200 patients. Hernia 7:118–124

    Article  PubMed  CAS  Google Scholar 

  4. Heniford BT, Park A, Ramshaw BJ, Voeller G (2003) Laparoscopic repair of ventral hernias: nine years’ experience with 850 consecutive hernias. Ann Surg 238:391–399; discussion 399–400

    PubMed  Google Scholar 

  5. LeBlanc KA, Booth WV (1993) Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: preliminary findings. Surg Laparosc Endosc 3:39–41

    PubMed  CAS  Google Scholar 

  6. Besim H, Yalcin Y, Hamamci O, Arslan K, Sonisik M, Korkmaz A, Erdogan S (2002) Prevention of intraabdominal adhesions produced by polypropylene mesh. Eur Surg Res 34:239–243

    Article  PubMed  CAS  Google Scholar 

  7. Matthews BD, Mostafa G, Carbonell AM, Joels CS, Kercher KW, Austin C, Norton HJ, Heniford BT (2005) Evaluation of adhesion formation and host tissue response to intra-abdominal polytetrafluoroethylene mesh and composite prosthetic mesh. J Surg Res 123:227–234

    Article  PubMed  CAS  Google Scholar 

  8. Yoshinari N, Tohya T, Mori A, Koide M, Kawase H, Takada T, Inagaki K, Noguchi T (1998) Inflammatory cell population and bacterial contamination of membranes used for guided tissue regenerative procedures. J Periodontol 69:460–469

    PubMed  CAS  Google Scholar 

  9. Koehler RH, Begos D, Berger D, Carey S, LeBlanc K, Park A, Ramshaw B, Smoot R, Voeller G (2003) Minimal adhesions to ePTFE mesh after laparoscopic ventral incisional hernia repair: reoperative findings in 65 cases. Zentralbl Chir 128:625–630

    Article  PubMed  CAS  Google Scholar 

  10. Robinson TN, Clarke JH, Schoen J, Walsh MD (2005) Major mesh-related complications following hernia repair: events reported to the Food and Drug Administration. Surg Endosc 19:1556–1560

    Article  PubMed  CAS  Google Scholar 

  11. Bleichrodt RP, Simmermacher RK, van der Lei B, Schakenraad JM (1993) Expanded polytetrafluoroethylene patch versus polypropylene mesh for the repair of contaminated defects of the abdominal wall. Surg Gynecol Obstet 176:18–24

    PubMed  CAS  Google Scholar 

  12. Diaz JJ Jr, Gray BW, Dobson JM, Grogan EL, May AK, Miller R, Guy J, O’Neill P, Morris JA Jr (2004) Repair of giant abdominal hernias: does the type of prosthesis matter? Am Surg 70:396–401

    PubMed  Google Scholar 

  13. LeBlanc KA, Bellanger D, Rhynes KVt, Baker DG, Stout RW (2002) Tissue attachment strength of prosthetic meshes used in ventral and incisional hernia repair. A study in the New Zealand White rabbit adhesion model. Surg Endosc 16:1542–1546

    Article  PubMed  CAS  Google Scholar 

  14. LeBlanc KA (2005) Incisional hernia repair: laparoscopic techniques. World J Surg 29:1073–1079

    Article  PubMed  Google Scholar 

  15. Coda A, Bendavid R, Botto-Micca F, Bossotti M, Bona A (2003) Structural alterations of prosthetic meshes in humans. Hernia 7:29–34

    PubMed  CAS  Google Scholar 

  16. Kapischke M, Prinz K, Tepel J, Tensfeldt J, Schulz T (2005) Comparative investigation of alloplastic materials for hernia repair with improved methodology. Surg Endosc 19:1260–1265

    Article  PubMed  CAS  Google Scholar 

  17. Klinge U, Klosterhalfen B, Muller M, Ottinger AP, Schumpelick V (1998) Shrinking of polypropylene mesh in vivo: an experimental study in dogs. Eur J Surg 164:965–969

    Article  PubMed  CAS  Google Scholar 

  18. Riepe G, Loos J, Imig H, Schroder A, Schneider E, Petermann J, Rogge A, Ludwig M, Schenke A, Nassutt R, Chakfe N, Morlock M (1997) Long-term in vivo alterations of polyester vascular grafts in humans. Eur J Vasc Endovasc Surg 13:540–548

    Article  PubMed  CAS  Google Scholar 

  19. Amid PK (1997) Classification of biomaterials and their related complications in abdominal wall hernia surgery. Hernia 1:15–21

    Article  Google Scholar 

  20. Amid PK (1998) Today’s controversies in hernia surgery. Croat Med J 39:10–14

    PubMed  CAS  Google Scholar 

  21. Amid PK, Shulman AG, Lichtenstein IL, Sostrin S, Young J, Hakakha M (1994) Experimental evaluation of a new composite mesh with the selective property of incorporation to the abdominal wall without adhering to the intestines. J Biomed Mater Res 28:373–375

    Article  PubMed  CAS  Google Scholar 

  22. Bageacu S, Blanc P, Breton C, Gonzales M, Porcheron J, Chabert M, Balique JG (2002) Laparoscopic repair of incisional hernia: a retrospective study of 159 patients. Surg Endosc 16:345–348

    Article  PubMed  CAS  Google Scholar 

  23. Amid PK (2000) Intraperitoneal polypropylene mesh repair of incisional hernia is not associated with enterocutaneous fistula. Br J Surg 87:1436–1437

    Article  PubMed  CAS  Google Scholar 

  24. Kapischke M, Prinz K, Tepel J, Tensfeldt J, Schulz T (2005) Precoating of alloplastic materials with living human fibroblasts–a feasibility study. Surg Endosc 19:791–797

    Article  PubMed  CAS  Google Scholar 

  25. Felemovicius I, Bonsack ME, Hagerman G, Delaney JP (2004) Prevention of adhesions to polypropylene mesh. J Am Coll Surg 198:543–548

    Article  PubMed  Google Scholar 

  26. Baptista ML, Bonsack ME, Delaney JP (2000) Seprafilm reduces adhesions to polypropylene mesh. Surgery 128:86–92

    Article  PubMed  CAS  Google Scholar 

  27. Greenawalt KE, Butler TJ, Rowe EA, Finneral AC, Garlick DS, Burns JW (2000) Evaluation of sepramesh biosurgical composite in a rabbit hernia repair model. J Surg Res 94:92–98

    Article  PubMed  CAS  Google Scholar 

  28. Burger JW, Halm JA, Wijsmuller AR, ten Raa S, Jeekel J (2006) Evaluation of new prosthetic meshes for ventral hernia repair. Surg Endosc 20:1320–1325

    Article  PubMed  CAS  Google Scholar 

  29. Junge K, Klinge U, Klosterhalfen B, Mertens PR, Rosch R, Schachtrupp A, Ulmer F, Schumpelick V (2002) Influence of mesh materials on collagen deposition in a rat model. J Invest Surg 15:319–328

    Article  PubMed  CAS  Google Scholar 

  30. van’t Riet M, Burger JW, Bonthuis F, Jeekel J, Bonjer HJ (2004) Prevention of adhesion formation to polypropylene mesh by collagen coating: a randomized controlled study in a rat model of ventral hernia repair. Surg Endosc 18:681–685

    Article  PubMed  CAS  Google Scholar 

  31. Gonzalez R, Rodeheaver GT, Moody DL, Foresman PA, Ramshaw BJ (2004) Resistance to adhesion formation: a comparative study of treated and untreated mesh products placed in the abdominal cavity. Hernia 18:18

    Google Scholar 

  32. Harrell AG, Novitsky YW, Peindl RD, Cobb WS, Austin CE, Cristiano JA, Norton JH, Kercher KW, Heniford BT (2006) Prospective evaluation of adhesion formation and shrinkage of intra-abdominal prosthetics in a rabbit model. Am Surg 72:808–813; discussion 813–804

    PubMed  Google Scholar 

  33. Klinge U, Klosterhalfen B, Ottinger AP, Junge K, Schumpelick V (2002) PVDF as a new polymer for the construction of surgical meshes. Biomaterials 23:3487–3493

    Article  PubMed  CAS  Google Scholar 

  34. Junge K, Klinge U, Rosch R, Lynen P, Binnebosel M, Conze J, Mertens PR, Schwab R, Schumpelick V (2007) Improved collagen type I/III ratio at the interface of gentamicin-supplemented polyvinylidenfluoride mesh materials. Langenbecks Arch Surg 19:19

    Google Scholar 

  35. LeBlanc KA (2007) Laparoscopic incisional hernia repair: are transfascial sutures necessary? A review of the literature. Surg Endosc 21:508–513

    Article  PubMed  CAS  Google Scholar 

  36. Vermeulen J, Alwayn I, Stassen LP (2003) Prolonged abdominal wall pain caused by transfascial sutures used in the laparoscopic repair of incisional hernia. Surg Endosc 19:19

    Google Scholar 

  37. Bellows CF, Berger DH (2006) Infiltration of suture sites with local anesthesia for management of pain following laparoscopic ventral hernia repairs: a prospective randomized trial. JSLS 10:345–350

    PubMed  Google Scholar 

  38. Chelala E, Thoma M, Tatete B, Lemye AC, Dessily M, Alle JL (2006) The suturing concept for laparoscopic mesh fixation in ventral and incisional hernia repair: mid-term analysis of 400 cases. Surg Endosc 6:6

    Google Scholar 

  39. Olmi S, Scaini A, Erba L, Croce E (2007) Use of fibrin glue (Tissucol) in laparoscopic repair of abdominal wall defects: preliminary experience. Surg Endosc 21:409–413

    Article  PubMed  CAS  Google Scholar 

  40. Lomanto D, Iyer SG, Shabbir A, Cheah WK (2006) Laparoscopic versus open ventral hernia mesh repair: a prospective study. Surg Endosc 20:1030–1035

    Article  PubMed  CAS  Google Scholar 

  41. McGreevy JM, Goodney PP, Birkmeyer CM, Finlayson SR, Laycock WS, Birkmeyer JD (2003) A prospective study comparing the complication rates between laparoscopic and open ventral hernia repairs. Surg Endosc 17:1778–1780

    Article  PubMed  CAS  Google Scholar 

  42. Holzman MD, Purut CM, Reintgen K, Eubanks S, Pappas TN (1997) Laparoscopic ventral and incisional hernioplasty. Surg Endosc 11:32–35

    Article  PubMed  CAS  Google Scholar 

  43. Carbajo MA, Martin del Olmo JC, Blanco JI, de la Cuesta C, Toledano M, Martin F, Vaquero C, Inglada L (1999) Laparoscopic treatment versus open surgery in the solution of major incisional and abdominal wall hernias with mesh. Surg Endosc 13:250–252

    Article  PubMed  CAS  Google Scholar 

  44. DeMaria EJ, Moss JM, Sugerman HJ (2000) Laparoscopic intraperitoneal polytetrafluoroethylene (PTFE) prosthetic patch repair of ventral hernia. Prospective comparison to open prefascial polypropylene mesh repair. Surg Endosc 14:326–329

    Article  PubMed  CAS  Google Scholar 

  45. Bencini L, Sanchez LJ, Boffi B, Farsi M, Scatizzi M, Moretti R (2003) Incisional hernia: repair retrospective comparison of laparoscopic and open techniques. Surg Endosc 17:1546–1551

    Article  PubMed  CAS  Google Scholar 

  46. Park A, Birch DW, Lovrics P (1998) Laparoscopic and open incisional hernia repair: a comparison study. Surgery 124:816–821

    Article  PubMed  CAS  Google Scholar 

  47. Robbins SB, Pofahl WE, Gonzalez RP (2001) Laparoscopic ventral hernia repair reduces wound complications. Am Surg 67:896–900

    PubMed  CAS  Google Scholar 

  48. Olmi S, Magnone S, Erba L, Bertolini A, Croce E (2005) Results of laparoscopic versus open abdominal and incisional hernia repair. JSLS 9:189–195

    PubMed  Google Scholar 

  49. Earle D, Seymour N, Fellinger E, Perez A (2006) Laparoscopic versus open incisional hernia repair: a single-institution analysis of hospital resource utilization for 884 consecutive cases. Surg Endosc 20:71–75

    Article  PubMed  CAS  Google Scholar 

  50. van’t Riet M, Vrijland WW, Lange JF, Hop WC, Jeekel J, Bonjer J (2002) Mesh repair of incisional hernia: comparison of laparoscopic and open repair. Eur J Surg 168:684–689

    Article  PubMed  CAS  Google Scholar 

  51. Olmi S, Scaini A, Cesana GC, Erba L, Croce E (2007) Laparoscopic versus open incisional hernia repair: an open randomized controlled study. Surg Endosc 21:555–559

    Article  PubMed  CAS  Google Scholar 

  52. Ramshaw BJ, Esartia P, Schwab J, Mason EM, Wilson RA, Duncan TD, Miller J, Lucas GW, Promes J (1999) Comparison of laparoscopic and open ventral herniorrhaphy. Am Surg 65:827–831

    PubMed  CAS  Google Scholar 

  53. Chari R, Chari V, Eisenstat M, Chung R (2000) A case controlled study of laparoscopic incisional hernia repair. Surg Endosc 14:117–119

    PubMed  CAS  Google Scholar 

  54. Misra MC, Bansal VK, Kulkarni MP, Pawar DK (2006) Comparison of laparoscopic and open repair of incisional and primary ventral hernia: results of a prospective randomized study. Surg Endosc 20:1839–1845

    Article  PubMed  CAS  Google Scholar 

  55. Barbaros U, Asoglu O, Seven R, Erbil Y, Dinccag A, Deveci U, Ozarmagan S, Mercan S (2007) The comparison of laparoscopic and open ventral hernia repairs: a prospective randomized study. Hernia 11:51–56

    Article  PubMed  CAS  Google Scholar 

  56. Zanghi A, Di Vita M, Lomenzo E, De Luca A, Cappellani A (2000) Laparoscopic repair vs open surgery for incisional hernias: a comparison study. Ann Ital Chir 71:663–667; discussion 668

    PubMed  CAS  Google Scholar 

  57. ICH_E9 (1998) Statistical principles for clinical trials. In: International conference on harmonisation. CPMP, London

  58. Itani KM, Neumayer L, Reda D, Kim L, Anthony T (2004) Repair of ventral incisional hernia: the design of a randomized trial to compare open and laparoscopic surgical techniques. Am J Surg 188:22S–29S

    Article  PubMed  Google Scholar 

  59. Goodney PP, Birkmeyer CM, Birkmeyer JD (2002) Short-term outcomes of laparoscopic and open ventral hernia repair: a meta-analysis. Arch Surg 137:1161–1165

    Article  PubMed  Google Scholar 

  60. Sains PS, Tilney HS, Purkayastha S, Darzi AW, Athanasiou T, Tekkis PP, Heriot AG (2006) outcomes following laparoscopic versus open repair of incisional hernia. World J Surg 30:2056–2064

    Article  PubMed  Google Scholar 

  61. Klinge U, Conze J, Krones CJ, Schumpelick V (2005) Incisional hernia: open techniques. World J Surg 29:1066–1072

    Article  PubMed  Google Scholar 

  62. Doctor H (2006) Evaluation of various prosthetic materials and newer meshes for hernia repairs. J Minimal Access Surg 2(3):110–116

    Google Scholar 

  63. Burger JW, Luijendijk RW, Hop WC, Halm JA, Verdaasdonk EG, Jeekel J (2004) Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 240:578–583; discussion 583–575

    PubMed  Google Scholar 

  64. McCormack K, Scott NW, Go PM, Ross S, Grant AM (2003) Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev 1:CD0001785

  65. Heniford BT, Park A, Ramshaw BJ, Voeller G (2000) Laparoscopic ventral and incisional hernia repair in 407 patients. J Am Coll Surg 190:645–650

    Article  PubMed  CAS  Google Scholar 

  66. Flum DR, Horvath K, Koepsell T (2003) Have outcomes of incisional hernia repair improved with time? A population-based analysis. Ann Surg 237:129–135

    Article  PubMed  Google Scholar 

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Kapischke, M., Schulz, T., Schipper, T. et al. Open versus laparoscopic incisional hernia repair: something different from a meta-analysis. Surg Endosc 22, 2251–2260 (2008). https://doi.org/10.1007/s00464-008-9773-7

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