Totally Extra Peritoneal (e-TEP) Approach for Ventral Hernias

Bui NH, Jørgensen LN, Jensen KK. Laparoscopic intraperitoneal versus enhanced-view totally extraperitoneal retromuscular mesh repair for ventral hernia: a retrospective cohort study. Surg Endosc. 2021 Mar 15.

Full-text for Emory users.

Results: A total of 72 patients were included in the study, 43 and 29 of whom underwent IPOM and eTEP-RM repair, respectively. Patient demographics showed no differences in terms of gender, age, smoking and comorbidity. The median age was 57 years and body mass index 30.5 kg/m2. The rate of patients with incisional hernia was higher in the IPOM group (39.5% vs. 20.7%, p = 0.154). There was no difference in horizontal and vertical hernia size defect. The duration of surgery was significantly shorter for IPOM (mean 82.4 vs. 103.4 min, p = 0.010), whereas the length of stay was significantly longer after IPOM (median 1 days vs. 0 days (p < 0.001). The rate of patients requiring postoperative transversus abdominis plane (TAP) block or epidural analgesia was significantly higher after IPOM (33% vs. 0%, p = 0.002). A subgroup analysis on patients undergoing primary ventral hernia showed similar results.

Conclusion: The study found laparoscopic eTEP-RM safe and effective compared to traditional laparoscopic IPOM. The patients undergoing eTEP-RM had significantly reduced need for additional analgesic treatment and length of stay.

Continue reading

What is the impact of abdominal binder on seroma formation?

One discussion this week included the impact of abdominal binder on seroma formation.


Reference: Christoffersen MW, Olsen BH, Rosenberg J, Bisgaard T. Randomized clinical trial on the postoperative use of an abdominal binder after laparoscopic umbilical and epigastric hernia repair. Hernia. 2015 Feb;19(1):147-153. doi:10.1007/s10029-014-1289-6

Summary: Application of an abdominal binder is often part of a standard postoperative regimen after ventral hernia repair to reduce pain and seroma formation. However, there is lack of evidence of the clinical effects.

Continue reading

Types of abdominal wall mesh for hernia repair: a brief review

One discussion this week included abdominal wall mesh.


Reference: Cevasco M, Itani KMF. Ventral hernia repair with synthetic, composite, and biologic mesh: characteristics, indications, and infection profile. Surgical Infections. 2012 Aug;13(4):209-215. doi:10.1089/sur.2012.123.

Summary: Cevasco and Itani (2012) provide a succinct overview of available mesh materials, as well as their characteristics and special situations.

Continue reading