2005 SAGES Abstracts

POSTER ABSTRACTS
SAGES 2005
210 http://www.sages.org/
P317–Hernia Surgery
10 YEARS CONTROLLED STUDYCOMPARING LAPAROSCOPIC
TRANSABDOMINAL PREPERITONEAL TO LICHTENSTEIN
INGUINAL HERNIA REPAIR, O. Avrutis MD, M Dudai, V.
Michalevsky MD,O Sibirsky MD,J. Meshoulam MD,A. Durst
MD, Bikur Cholim Hospital , Jerusalem , Israel
Background: Lichtenstein tension free mesh repair (LTFMR) is
a time - tested, simple, safe and well - understood procedure
with a high success rate. Laparoscopic transabdominal
preperitoneal inguinal hernia repair ( TAPP) is the first established
laparoscopic technique. Few studies have compared
hernia mesh repair of TAPP with LTFMR.
Aim: To compare operative time, complications, postoperative
pain, length of hospital stay, reccurency rate, and time until
return to normal daily activity on long term between LTFMR
and TAPP.
Methods: A prospective study investigated 947 male patients
who underwent LTFMR (n = 449) or TAPP ( n = 498 ) from
February 1992 to December 2001. Four hundred twenty one
patient (93.8 %) in LTFMR group and 466 patients (93.6 %) in
TAPP group still followed ?up until July 2002 with the range of
follow- up from 6 to 125 months.
Results: The mean operative time of LTFMR for unilateral and
for bilateral repair was significantly shorter than in the TAPP
group : 43.3 min vs. 64.4 min and 77.6 min vs. 105 min,
respectively (p = 0.005). There were 23 complications ( 5.5%) in
LTFMR group and 21 complications ( 4.2%) in TAPP group ( p =
NS). The mean postoperative hospital stay after LTFMR and
TAPP was similar: 1.36 day and 1.79 day. There were three
recurrences in the both groups (0.7%/0.6% respectevly, for
TAPP only at the first year). There were not significant differences
in the mean postoperative pain scores, analgesic doses,
and the time until return to the normal daily activity between
compared groups.
Conclusion: This results suggest that TAPP inguinal hernia
repair is comparable with Lichtenstein repair regarding postoperative
pain, complications, reccurrence and time until
return to normal daily activity. Operative time of LTFMR is significantly
shorter than TAPP only at the early experience period.
P318–Hernia Surgery
OUTCOMES OF LAPAROSCOPIC VENTRAL HERNIA REPAIR IN
A TEACHING INSTITUTION, Tamara L Ellis BA, Juliane
Bingener MD,Wayne H Schwesinger MD,Melanie L Richards
MD,Kenneth R Sirinek MD, Dept of Surgery, UTHSCSA
Background and Clinical Significance: Ventral incisional hernia
repairs constitute one of the most frequently performed surgical
procedures in the United States. Recently laparoscopic VIH
repair as been added to the armamentarium of surgical techniques.
Reports of follow up from several specialized centers
are available, however few data about the patient outcome in
the teaching environment. The primary aim of this study is to
retrospectively evaluate the patient outcome after laparoscopic
ventral incisional hernia repair in a teaching hospital.
Secondary aim is to identify potential risk factors for hernia
recurrence.
Study design and methods: Data from patients who underwent
a laparoscopic ventral incisional hernia repair since 1999 were
prospectively collected in a data base and retrospectively
reviewed. Additional data were corroborated through chart
review. Data regarding demographics, co-morbidities, procedure
specific data and outcome variables were collected.
Results: From 1999 to 2004 104 patients underwent laparoscopic
ventral incisional hernia repair; 19 men (18%) and 85
women (82%). The mean age was 51 years, (range 21-71).
Average mesh size was 310 cm2. The majority of the patients
were obese. The VIH repair was assisted by a resident in PGY
year 1 in 2 patients, in PGY year 2 in 13 patients, PGY 3 in 20
patients, PGY 4 in 1 patient and PGY 5 in 68 patients. There
were 10 recurrences (10%). The recurrence rate for patients
who underwent lap VIH repair with the assistance of a junior
resident was 11.5%, for a senior resident it was 8.6% (NS). The
mean estimated blood loss was 33 cc (range 10-300 cc). 27
Patients had complications (25 %). 2 patients (2%) required reoperation.
24 (92%) of the complications were grade 1 (seroma,
urinary retention). No mortality or disabling morbidity was
noted. The complication rate for senior residents was 30%, for
junior residents 17%.The mean follow-up ranged from 1-59
months.
Conclusion: Laparoscopic ventral incisional hernia repair in a
teaching environment is feasible and safe. In selected patients
this advanced laparoscopic procedure can be performed by
junior residents with similar outcomes as their senior colleagues.
P319–Hernia Surgery
COMPOSIX SEPARATION: A REPORT OF THREE CASES,
Andrew G Harrell MD, Kent W Kercher MD,William S Cobb
MD,B. Todd Heniford MD, Carolinas Medical Center
Background: Standard laparoscopic ventral hernia repair
requires the use of a prosthetic mesh. Many of the biomaterials
used in this procedure were developed to allow tissue ingrowth
on the abdominal wall side of the mesh while limiting
adhesions on the intestinal side. A popular concept has been
to combine two materials to form a ?composite? mesh for the
desired effects. Composix mesh combines polypropylene and
expanded polytetrafluoroethylene (ePTFE). Unfortunately,
delamination of the mesh?s components can occur with a subsequent
intra-mesh fluid collection and infection, which
requires surgical resection.
Methods: Patients with Composix mesh infections where the
mesh separated, developed a fluid collection and became
infected were reviewed.
Results: Three patients referred from outside institutions were
identified. They included 1 male and 2 female patients age 52,
39, and 89. Each patient had a laparoscopic ventral hernia
repaired with intraperitoneal placement of the Composix
mesh. The patients presented with abdominal pain and redness
of the abdominal wall at 3 months, 11 months, and 16
months after original implantation. CT imaging demonstrated
the mesh components had separated and the intra-mesh space
contained enhancing fluid collections. All patients required
mesh removal with primary abdominal wall closure.
Staphylococcus aureus was grown from the infected fluid collection
in each case. Subsequent hernia recurrence was noted
in 2 of the 3 patients, and one of the patients has undergone
successful laparoscopic repair.
Conclusion: Despite the improvement in mesh prosthetics,
some complications will occur. This series of patients
describes an unusual and rare event. Prior descriptions of
mesh separation are limited. Successful management of this
problem requires mesh removal, primary closure with possible
recurrent hernia repair in the future.
P320–Hernia Surgery
LAPAROSCOPIC TOTALLY EXTRAPERITONEAL (TEP) REPAIR
OF RECURRENT HERNIA WITH PREVIOUS MESH AND PLUG
REPAIR, Kyung Yul Hur MD, Koo Yong Hahn MD,Jae Young
Jung MD,Sang Hwa Yu MD,Seung Han Kim MD,Yong Geul Joh
MD,Seon Han Kim MD,Dong Keun Lee MD, Laparoscopic
Surgery Center, Department of surgery, Hansol Hospital,
Seoul, Korea
Introduction: We report our experiences of laparoscopic totally
extraperitoneal (TEP) repair for recurrent hernia with previous
mesh and plug repair. Laparoscopic herniorrhaphy is effective
especially for the recurrent hernia that have previously been
repaired using a conventional anterior technique. But in case
of recurrent hernia with previous mesh and plug repair can be
troublesome because of dense scar at the site of the plug with
peritoneum and entire abdominal wall.
Methods: Between December 2000 and July 2004, 221 laparoscopic
hernia repairs were performed. Among them, three
cases of recurrent hernias with previous mesh and plug repair
were managed by laparoscopic TEP repair. Balloon dissector
was not used to avoid unexpected peritoneal tearing.
Result: The average period between the initial operation and
the second operation was 10 months. Two cases were recurrent
indirect hernias after repair for indirect hernia. The hernia
defects were located between inferior epigastric vessels medially
and plug laterally. Mesh prostheses were placed on the
plug and abdominal wall to cover hernia defect and fixed with
stapler. The lateral dissection was not possible due to dense