Scoping and Tunneling: Combining Laparoscopy With Minimally Invasive Component Separation for Hernia Repair in Overweight Patients
Erica Y. Xue, M.S., Haripriya S. Ayyala, M.D., Lindsay Weil, B.A., Aziz Merchant, M.D., Jonathan D. Keith, M.D., F.A.C.S..
Rutgers New Jersey Medical School, NEWARK, NJ, USA.
PURPOSE: Minimally invasive component separation (MICS) uses tunnel incisions to spare myocutaneous perforators of the rectus abdominis during ventral hernia repair. MICS has yielded favorable postoperative outcomes compared to open component separation in complex abdominal wall reconstruction; proposed mechanisms of MICS include decreased subcutaneous dead space and preserved vascularity of overlying paramedian skin. A combined laparoscopic and MICS approach uses laparoscopy for initial adhesiolysis and enterolysis, which is then followed by component separation. Studies have not yet explored surgical outcomes in laparoscopically-assisted minimally invasive component separation for ventral hernia repair.
METHODS: A retrospective review of a single, urban hospital’s experience with combined laparoscopic and minimally invasive component separation for hernia repair was performed. Inclusion criteria were overweight and obese BMI patients who underwent elective ventral hernia repair. Charts were reviewed for additional comorbidities and operative details. Surgical outcomes assessed included wound complications, hernia recurrence, and readmission within 30 days of the procedure.
RESULTS: Twelve patients underwent laparoscopically-assisted minimally invasive component separation. The average patient age was 54.3 (32 to 77) years; mean BMI was 32.7 (25.1 to 44.9). Mean length of hospital stay was 8 days, operating time was 420 ± 80 minutes, and hernia defect size was 476 ± 287 cm2, with nine patients requiring mesh placement. There were no differences in hernia defect size, length of hospital stay, or operating time in patients who underwent repair with and without mesh. Average follow-up time period was 7 months. Two patients experienced postoperative wound complications and two patients were readmitted to the hospital within 30 days of the operation. There were no post-operative complications requiring reoperation; to date, none of the patients have experienced hernia recurrence.
CONCLUSIONS: High BMI is a known risk factor for hernia recurrence and return to the operating room after hernia repair; laparoscopically-assisted MICS appears to yield favorable surgical outcomes in this patient population. A combined laparoscopic-MICS approach may better preserve the structural integrity of the peritoneum and decrease postoperative complications in overweight and obese patients. Mesh use did not appear to affect outcomes in laparoscopically-assisted MICS. Further investigation to explore the role of laparoscopy in minimally invasive abdominal wall reconstruction and ventral hernia repair is warranted, especially in the overweight and obese population.
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