Hybrid and laparoscopic techniques equally successful for repairing complex incisional ventral hernias

Hernias commonly occur in elderly or obese individuals who have previously undergone abdominal surgery with suboptimal suturing or experienced wound infections. Hernia repair is the only solution to address the abdominal defect, and it can be performed using either an open or minimally invasive Incisional ventral hernias (IVH) repair, including laparoscopic and robotic assisted technique.

A new meta-analysis in BMC Surgery compared the clinical outcomes of Hybrid Hernia Repair technique (HHR) and Laparoscopic Hernia Repair (LHR) in the management of IVH and found that the HHR technique did not have a greater advantage over LHR in reducing surgical complications, apart from a lower incidence of postoperative seroma.

Incisional ventral hernias (IVH) are ventral (abdominal) hernia is characterized by any protrusion of intestine or other tissue through a weakness or gap in the abdominal wall. Umbilical and incisional hernias are specific types of ventral hernias. Though recently developed HHR, an adaptation of the laparoscopic method, is well known a potential alternative for the treatment of complex Incisional Ventral Hernias (IVH). Only single-arm studies have reported promising outcomes, a comprehensive meta-analysis affirming these benefits is lacking.

Researchers conducted a exhaustive search of the literature, targeting publications in both English and Chinese that compare HHR and LHR up to March 31, 2023. The primary outcomes examined were operation time, blood loss, and intestinal injury. Secondary outcomes included rates of seroma, wound infection, post-operative acute/chronic pain, recurrence, and mesh bulging. The RevMan 5.0 software facilitated the statistical meta-analysis.

The key findings of the study are

• The final analysis incorporated data from 14 studies, encompassing a total of 1158 patients, with 555 undergoing HHR and 603 treated with LHR. Follow-up data, ranging from 12 to 88 months, were available in 12 out of the 14 identified studies.

• The HHR method was associated with a significantly lower risk of seroma (OR = 0.29, P = 0.0004), but a higher risk of wound infection (OR = 2.10, P = 0.04).

• No significant differences were observed between the two techniques regarding operation time, blood loss, intestinal injury, intestinal obstruction, post-operative pain, mesh bulging, and recurrence.

Researchers concluded that “The HHR technique did not demonstrate a clear advantage over LHR in reducing surgical complications, apart from a lower incidence of postoperative seroma. Surgeons with substantial expertise may choose to avoid incidental conversion or intentional hybrid procedures. Further research is needed to clarify the optimal surgical approach for IVH.”

Reference: Wu, Q., Ma, W., Wang, Q. et al. Comparative effectiveness of hybrid and laparoscopic techniques for repairing complex incisional ventral hernias: a systematic review and meta-analysis. BMC Surg 23, 346 (2023). https://doi.org/10.1186/s12893-023-02254-6.