Analysis on Curative Effect of Laparoscopic Repair for Suprapubic Incisional Hernia Using Composite Patch_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Feide , LI Jiye , YAO Sheng , WANG Shibin , PEI Lijuan , ZHU Yingmei , SHI Xianjie

Department of General Surgery， The First Affiliated Hospital， General Hospital of PLA， Beijing 100048， China;

Corresponding author：

Keywords：

Laparoscopy; Incisional hernia; Suprapubic hernia; Hernia repair

Video：

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Objective 　To summarize the surgical technique and curative effect of laparoscopic repair for suprapubic incisional hernia using composite patch.　
Methods 　The clinical data of 25 cases performed laparoscopic repair of suprapubic incisional hernia using composite patch from March 2007 to October 2010 were reviewed retrospectively. There were 13 males and 12 females， and aged 35-83 years （median age was 52 years）. Among them 2 patients were recurrences. The distance between the lower margin of hernia defect and pubic arc was less than 5 cm. The composite patch was fixed to the abdominal wall using spiral tacks （Protack） in direct vision. The lower margin of the patch was lower to the pubic arc in 2 cm， and to be fixed to the pubic arc and bilateral pectineal ligament， and it should be extended.
Results 　Laparoscopic repair were successfully performed in all patients without convert to open repair. The max diameter of the hernia ring was 6.1-12.5cm and the average was 9.5 cm. The average operating time was 128 min （ranging from 90 to 180 min）. And the total complication rate was 28% （7/25）， including bladder damage during operation in 1 case， wound seroma upon the patch in 4 cases and cured by aspiration， pain in the operative area and disappeared within one month without intervention in 1 case. Twenty-two patients were followed-up with a follow-up rate of 88%. During a follow-up range of 6-48 months（average 30 months）， one case recurrence occurred in 2 months after the repair with the recurrent rate of 4%.
Conclusions 　Laparoscopic repair of suprapubic incisional hernia is a safe and feasible technique， and the patch should cover and exceed the margin of the defect for 5 cm in all direction. The lower margin of the patch should be fixed to the bilateral pectineal ligament so as to strengthen the fix， and lower the recurrence rate.

Citation： LIU Feide,LI Jiye,YAO Sheng,WANG Shibin,PEI Lijuan,ZHU Yingmei,SHI Xianjie,.. Analysis on Curative Effect of Laparoscopic Repair for Suprapubic Incisional Hernia Using Composite Patch. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2012, 19(4): 401-405. doi: Copy

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7.	Palanivelu C， Rangarajan M， Parthasarathi R， et al. Laparoscopic repair of suprapubicincisional hernias：suturing and intraperitoneal composite mesh onlay. A retrospective study [J].Hernia， 2008， 12(3)：251-256.
8.	Hirasa T， Pickleman J， Shayani V. Laparoscopic repair of parapubic hernia [J]. Arch Surg， 2001， 136(11)： 1314-1317.
9.	Chowbey PK， Sharma A， Mehrotra M， et al. Laparoscopic repair of ventral/incisional hernias [J]. J Minim Access Surg， 2006，2(3)：192-198.
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13.	Mavros MN， Athanasiou S， Alexiou VG， et al. Risk factors for mesh-related infections after hernia repair surgery： a meta-analysis of cohort studies[J]. World J Surg， 2011， 35(11)：2389-2398.
14.	Sanchez VM， Abi-Haidar YE， Itani KM. Mesh infection in ventral incisional hernia repair： incidence， contributing factors，and treatment[J]. Surg Infect (Larchmt)， 2011， 12(3)：205-210.
15.	Leber GE， Garb JL， Alexander AI， et al. Long term complications associated with prosthetic repair of incisional hernia [J].Arch Surg， 1998， 133（4)： 378-382.
16.	Burger JW， Halm JA， Wijsmuller AR， et al. Evaluation of new prosthetic meshes for ventral hernia repair [J]. Surg Endosc，2006， 20(8)：1320-1325.
17.	Schmidbauer S， Ladurner R， Hallfeldt KK， et al. Heavy-weight versus low-weight polypropylene meshes for open sublay mesh repair of incisional hernia [J]. Eur J Med Res， 2005， 10(6)： 247-253.
18.	Klinge U， Junge K， Stumpf M， et al. Functional and morphological evaluation of a low-weight， monofilament polypropylene mesh for hernia repair [J]. J Biomed Mater Res， 2002， 63(2)：129-136.
19.	Klosterhalfen B， Junge K， Klinge U. The lightweight and large porous mesh concept for hernia repair [J]. Expert Rev Med Devices， 2005， 2(1)： 103-117.
20.	Chelala E， Debardemaeker Y， Elias B， et al. Eighty-?ve redo surgeries after 733 laparoscopic treatments for ventral and incisional hernia：adhesion and recurrence analysis [J]. Hernia，2010， 14(2)：123-129.
21.	Dalessandri KM， Bhoyrul S， Mulvihill SJ. Laparoscopic hernia repair and bladder injury [J]. JSLS， 2001， 5(2)：175-177.[ 22] Feliu X， Claveria R， Besora P， et al. A calcified foreign body in the bladder due to： an unusual complication after laparoscopic incisional hernia repair[J]. Surg Laparosc Endosc Percutan Tech， 2011， 21(1)：e28-e30.[ 23] Steinhagen E， Khaitov S， Steinhagen RM. Intraluminal migration of mesh following incisional hernia repair [J]. Hernia， 2010，14(6)：659-662.
22.	Liu F， Li J. Repair of large abdominal wall defects using the Proceed? surgical mesh with open intra-peritonium onlay method [J]. Saudi Med J， 2011， 32 (5)：504-509.
23.	Genç V， Ensari C， Ergul Z， et al. A very late-onset deep infection after prosthetic inguinal hernia repair [J]. Chirurgia (Bucur)，2010， 105(4)： 555-557.

1. 李基业. 欧洲疝学会切口疝分类(2008 年版) 解读 [J]. 外科理论与实践， 2010， 15(6)：665-667.
2. Mudge M， Hughes LE. Incisional hernia：a ten year prospective study of incidence and attitudes [J]. Br J Surg， 1985， 72(1)：70-71.
3. Carbonell AM， Kercher KW， Matthews BD， et al. The laparoscopic repair of suprapubic ventral hernias [J]. Surg Endosc，2005， 19(2)：174-177.
4. Bendavid R. Incisional parapubic hernias [J]. Surgery， 1990，108(5)：898-901.
5. 李基业，邓群，黎沾良. 耻骨上切口疝六例临床分析 [J]. 中华普通外科杂志， 2003，18(4)：251.
6. Varnell B， Bachman S， Quick J， et al. Morbidity associated with laparoscopic repair of suprapubic hernias [J]. Am J Surg， 2008，196(6)：983-988.
7. Palanivelu C， Rangarajan M， Parthasarathi R， et al. Laparoscopic repair of suprapubicincisional hernias：suturing and intraperitoneal composite mesh onlay. A retrospective study [J].Hernia， 2008， 12(3)：251-256.
8. Hirasa T， Pickleman J， Shayani V. Laparoscopic repair of parapubic hernia [J]. Arch Surg， 2001， 136(11)： 1314-1317.
9. Chowbey PK， Sharma A， Mehrotra M， et al. Laparoscopic repair of ventral/incisional hernias [J]. J Minim Access Surg， 2006，2(3)：192-198.
10. Sharma A， Dey A， Khullar R， et al. Laparoscopic repair of suprapubic hernias：transabdominal partial extraperitoneal (TAPE)technique [J]. Surg Endosc， 2011， 25(7)：2147-2152.
11. Biondi A， Tropea A， Monaco N， et al. Laparoscopic treatment of abdominal wall hernias：prosthesis material comparison [J].Minerva Chir， 2011， 66(6)：547-552.
12. Altom LK， Snyder CW， Gray SH， et al. Outcomes of emergent incisional hernia repair [J]. Am Surg， 2011， 77(8)：971-976.
13. Mavros MN， Athanasiou S， Alexiou VG， et al. Risk factors for mesh-related infections after hernia repair surgery： a meta-analysis of cohort studies[J]. World J Surg， 2011， 35(11)：2389-2398.
14. Sanchez VM， Abi-Haidar YE， Itani KM. Mesh infection in ventral incisional hernia repair： incidence， contributing factors，and treatment[J]. Surg Infect (Larchmt)， 2011， 12(3)：205-210.
15. Leber GE， Garb JL， Alexander AI， et al. Long term complications associated with prosthetic repair of incisional hernia [J].Arch Surg， 1998， 133（4)： 378-382.
16. Burger JW， Halm JA， Wijsmuller AR， et al. Evaluation of new prosthetic meshes for ventral hernia repair [J]. Surg Endosc，2006， 20(8)：1320-1325.
17. Schmidbauer S， Ladurner R， Hallfeldt KK， et al. Heavy-weight versus low-weight polypropylene meshes for open sublay mesh repair of incisional hernia [J]. Eur J Med Res， 2005， 10(6)： 247-253.
18. Klinge U， Junge K， Stumpf M， et al. Functional and morphological evaluation of a low-weight， monofilament polypropylene mesh for hernia repair [J]. J Biomed Mater Res， 2002， 63(2)：129-136.
19. Klosterhalfen B， Junge K， Klinge U. The lightweight and large porous mesh concept for hernia repair [J]. Expert Rev Med Devices， 2005， 2(1)： 103-117.
20. Chelala E， Debardemaeker Y， Elias B， et al. Eighty-?ve redo surgeries after 733 laparoscopic treatments for ventral and incisional hernia：adhesion and recurrence analysis [J]. Hernia，2010， 14(2)：123-129.
21. Dalessandri KM， Bhoyrul S， Mulvihill SJ. Laparoscopic hernia repair and bladder injury [J]. JSLS， 2001， 5(2)：175-177.[ 22] Feliu X， Claveria R， Besora P， et al. A calcified foreign body in the bladder due to： an unusual complication after laparoscopic incisional hernia repair[J]. Surg Laparosc Endosc Percutan Tech， 2011， 21(1)：e28-e30.[ 23] Steinhagen E， Khaitov S， Steinhagen RM. Intraluminal migration of mesh following incisional hernia repair [J]. Hernia， 2010，14(6)：659-662.
22. Liu F， Li J. Repair of large abdominal wall defects using the Proceed? surgical mesh with open intra-peritonium onlay method [J]. Saudi Med J， 2011， 32 (5)：504-509.
23. Genç V， Ensari C， Ergul Z， et al. A very late-onset deep infection after prosthetic inguinal hernia repair [J]. Chirurgia (Bucur)，2010， 105(4)： 555-557.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis on Curative Effect of Laparoscopic Repair for Suprapubic Incisional Hernia Using Composite Patch

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