Peritoneal Bridging Versus Nonclosure in Laparoscopic Ventral Hernia Repair
Introduction:. Postoperative seroma and pain are common problems following laparoscopic intraperitoneal onlay mesh (IPOM) repair of ventral hernias. These adverse outcomes may be avoided by dissecting and using the peritoneum in the hernial sac to bridge the hernia defect. Methods:. This was a patie...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Health
2023-03-01
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| Series: | Annals of Surgery Open |
| Online Access: | http://journals.lww.com/10.1097/AS9.0000000000000257 |
| _version_ | 1827856041146056704 |
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| author | Fathalla Ali, MD, FRCS Gabriel Sandblom, MD Bianka Forgo, MD, PhD Göran Wallin, MD |
| author_facet | Fathalla Ali, MD, FRCS Gabriel Sandblom, MD Bianka Forgo, MD, PhD Göran Wallin, MD |
| author_sort | Fathalla Ali, MD, FRCS |
| collection | DOAJ |
| description | Introduction:. Postoperative seroma and pain are common problems following laparoscopic intraperitoneal onlay mesh (IPOM) repair of ventral hernias. These adverse outcomes may be avoided by dissecting and using the peritoneum in the hernial sac to bridge the hernia defect.
Methods:. This was a patient- and outcome assessor-blinded, parallel-design, randomized controlled trial comparing nonclosure and peritoneal bridging approaches in patients scheduled for elective midline ventral hernia repair. The primary endpoint was seroma volume on ultrasonography. The secondary endpoints were postoperative pain, recurrence, and complications.
Results:. Between November 2018 and December 2020, 112 patients were randomized, of whom 60 were in the nonclosure group and 52 were in the peritoneal bridging group. The seroma volume in the nonclosure and peritoneal bridging groups were 17 cm3 (6–53 cm3) versus 0 cm3 (0–26 cm3) at 1-month follow-up (P = 0.013). The median volume was zero at the 3-, 6-, and 12-month follow-ups in both groups. No significant differences were observed in early postoperative pain (P = 0.447) and in recurrence rate (P = 0.684). There were 4 (7%) and 1 (2%) perioperative complications that lead to reoperations in simple IPOM (sIPOM) and IPOM with peritoneal bridging (IPOM-pb), respectively.
Conclusions:. Seroma was less prevalent after IPOM-pb at 1-month follow-up compared with sIPOM, with similar postoperative pain 1 week after index surgery in both groups. At subsequent follow-ups, the differences in seroma were not statistically significant. Further studies are required to confirm these results. Trial registration (NCT04229940). |
| first_indexed | 2024-03-12T12:19:06Z |
| format | Article |
| id | doaj.art-c807922aa6db4a6d9c8b356c935242bb |
| institution | Directory Open Access Journal |
| issn | 2691-3593 |
| language | English |
| last_indexed | 2024-03-12T12:19:06Z |
| publishDate | 2023-03-01 |
| publisher | Wolters Kluwer Health |
| record_format | Article |
| series | Annals of Surgery Open |
| spelling | doaj.art-c807922aa6db4a6d9c8b356c935242bb2023-08-30T06:10:49ZengWolters Kluwer HealthAnnals of Surgery Open2691-35932023-03-0141e25710.1097/AS9.0000000000000257202303000-00022Peritoneal Bridging Versus Nonclosure in Laparoscopic Ventral Hernia RepairFathalla Ali, MD, FRCS0Gabriel Sandblom, MD1Bianka Forgo, MD, PhD2Göran Wallin, MD3From the * Faculty of Medicine and Health, Department of Surgery, Örebro University, Örebro, Sweden‡ Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden‖ Department of Radiology, Örebro University Hospital, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.From the * Faculty of Medicine and Health, Department of Surgery, Örebro University, Örebro, SwedenIntroduction:. Postoperative seroma and pain are common problems following laparoscopic intraperitoneal onlay mesh (IPOM) repair of ventral hernias. These adverse outcomes may be avoided by dissecting and using the peritoneum in the hernial sac to bridge the hernia defect. Methods:. This was a patient- and outcome assessor-blinded, parallel-design, randomized controlled trial comparing nonclosure and peritoneal bridging approaches in patients scheduled for elective midline ventral hernia repair. The primary endpoint was seroma volume on ultrasonography. The secondary endpoints were postoperative pain, recurrence, and complications. Results:. Between November 2018 and December 2020, 112 patients were randomized, of whom 60 were in the nonclosure group and 52 were in the peritoneal bridging group. The seroma volume in the nonclosure and peritoneal bridging groups were 17 cm3 (6–53 cm3) versus 0 cm3 (0–26 cm3) at 1-month follow-up (P = 0.013). The median volume was zero at the 3-, 6-, and 12-month follow-ups in both groups. No significant differences were observed in early postoperative pain (P = 0.447) and in recurrence rate (P = 0.684). There were 4 (7%) and 1 (2%) perioperative complications that lead to reoperations in simple IPOM (sIPOM) and IPOM with peritoneal bridging (IPOM-pb), respectively. Conclusions:. Seroma was less prevalent after IPOM-pb at 1-month follow-up compared with sIPOM, with similar postoperative pain 1 week after index surgery in both groups. At subsequent follow-ups, the differences in seroma were not statistically significant. Further studies are required to confirm these results. Trial registration (NCT04229940).http://journals.lww.com/10.1097/AS9.0000000000000257 |
| spellingShingle | Fathalla Ali, MD, FRCS Gabriel Sandblom, MD Bianka Forgo, MD, PhD Göran Wallin, MD Peritoneal Bridging Versus Nonclosure in Laparoscopic Ventral Hernia Repair Annals of Surgery Open |
| title | Peritoneal Bridging Versus Nonclosure in Laparoscopic Ventral Hernia Repair |
| title_full | Peritoneal Bridging Versus Nonclosure in Laparoscopic Ventral Hernia Repair |
| title_fullStr | Peritoneal Bridging Versus Nonclosure in Laparoscopic Ventral Hernia Repair |
| title_full_unstemmed | Peritoneal Bridging Versus Nonclosure in Laparoscopic Ventral Hernia Repair |
| title_short | Peritoneal Bridging Versus Nonclosure in Laparoscopic Ventral Hernia Repair |
| title_sort | peritoneal bridging versus nonclosure in laparoscopic ventral hernia repair |
| url | http://journals.lww.com/10.1097/AS9.0000000000000257 |
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