Comparison of Hybrid and Laparoscopic Incisional Hernia Repair

Comparison of Hybrid and Laparoscopic Incisional Hernia Repair: A Prospective Randomized Multicentre Study

Helsinki University Central Hospital, Kymenlaakso Central Hospital Kotka Finland, Päijät Häme Central Hospital, Seinajoki Central Hospital, Kuopio University Hospital

Study is a prospective, multicenter, randomized trial evaluating two laparoscopic incisional hernia repair methods: basic laparoscopic mesh repair (lap.) and a hybrid repair (laparoscopic mesh and fascial suturation). Patients are recruited prospectively from 10 Finnish Hospitals (Oulu, Jorvi, Hyvinkää, Kotka, Seinäjoki, Valkeakoski, Lahti, Kuopio, Kokkola, Loimaa). Patients are randomized to operative groups (lap. vs hybrid). Follow-up visits are scheduled at 1- and 12-month after surgery. Patients are evaluated for their clinical status and an ultrasound scan is performed. QoL-questionnaire and pain score (VAS) are reported. The primary end-points: clinically and/or radiologically detected seroma in 1 month control clinically and/or radiologically detected recurrent hernia in 1 year control The secondary end-points: peri-and postoperative outcomes/ complications, morbidity, mortality duration of hospital stay pain scale (VAS) Quality of Life (SF/Rand36)

Hypothesis: Using a hybrid method seroma formation and hernia recurrence can be diminished. Patient exclusion criteria: Age< 18 y or > 80 y ASA >4 (the American Society of Anaesthesiologists' classification of Physical Health) BMI> 40 A previous mesh repair of the hernia Hernia defect size <2 or >7 cm Emergency operation Eligible patients are randomized into two operative groups (lap/hybrid). In the laparoscopic group the hernia defect is covered with a Parietex composite mesh (using minimum of 5 cm marginals, Securestrap fixation instrument and four lifting strings. In hybrid group the hernia sack is resected and fascial defect is sutured through a minilaparotomy incision. After this, a mesh repair is performed laparoscopically.

complications are reported perioperatively, during hospital stay, in 1 month control and in 1 year control

Pain scores (VAS) are measured during hospital day (average 3 days), in 1 month control and in 1 year control

patients are asked to fill SF/rand36-questionnaire preoperatively, in 1 month control and in 1 year control

Inclusion Criteria: -Patients with incisional hernia Exclusion Criteria: BMI >40 ASA IV a Prior mesh repair Hernia defect size <2 or >7 cm Emergency operation

Ahonen-Siirtola M, Nevala T, Vironen J, Kossi J, Pinta T, Niemelainen S, Keranen U, Ward J, Vento P, Karvonen J, Ohtonen P, Makela J, Rautio T. Laparoscopic versus hybrid approach for treatment of incisional ventral hernia: a prospective randomised multicentre study, 1-year results. Surg Endosc. 2020 Jan;34(1):88-95. doi: 10.1007/s00464-019-06735-9. Epub 2019 Apr 2.

Ahonen-Siirtola M, Nevala T, Vironen J, Kossi J, Pinta T, Niemelainen S, Keranen U, Ward J, Vento P, Karvonen J, Ohtonen P, Makela J, Rautio T. Laparoscopic versus hybrid approach for treatment of incisional ventral hernia: a prospective randomized multicenter study of 1-month follow-up results. Hernia. 2018 Dec;22(6):1015-1022. doi: 10.1007/s10029-018-1784-2. Epub 2018 Jun 7.