CHIRURGIA LAPAROSCOPICA DEI
LAPAROCELI - IMOLA 28/29 OTTOBRE
Dott. P. Riccio
Ospedale S.Maria della Scaletta – Imola (BO)
U.O. Chirurgia Generale – Dir. S. Artuso
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28-29 OTTOBRE
•US: 2 Millions of laparotomies per year
•Incisional hernia rate: 3-20 %
•90000 ventral hernia annually
•Factors associated with formation of incisional hernia:
•WOUND INFECTION
•IMMUNOSUPPRESSION
•MORBID OBESITY
•PREVIOUS OPERATION
•PROSTATISM
•SURGERY FOR ANEURYSMAL DISEASE
•Abdominal wall defects are typically observed within the
first 5 years
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28-29 OTTOBRE
HERNIA REPAIR METHOD
RECURRENCE
PRIMARY REPAIR WITH SUTURE
41-52 %
HERNIORRHAPHIES WITH PROSTHETIC MESH.
12-24%
Required dissection of wide areas of soft tissue with
increased incidence of wound infections and
wound-related complications
15 %
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28-29 OTTOBRE
MINIMALLY INVASIVE SURGERY:
•SHORTER HOSPITAL STAY
•IMPROVED PATIENTS OUTCOME
•FEWER COMPLICATION
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28-29 OTTOBRE
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28-29 OTTOBRE
OUTCOMES
Complications 112 (13.2%)
Recurrence 35 (4.7%)
Conversion to open technique 31 (4.6%)
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28-29 OTTOBRE
COMPLICATIONS
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28-29 OTTOBRE
COMPLICATIONS
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28-29 OTTOBRE
RECURRENCE
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28-29 OTTOBRE
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28-29 OTTOBRE
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28-29 OTTOBRE
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28-29 OTTOBRE
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28-29 OTTOBRE
OUTCOMES 39 pt
Complications 10 (25.6%)
Recurrence 3 (7.7%)
Conversion to open technique 1 (2.5%)
Operating time 161.8
Hospital stay 5.1
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28-29 OTTOBRE
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28-29 OTTOBRE
Recent experience of laparoscopic incisional
and ventral hernia repair (LVIHR): good
results give value to the procedure
P. Riccio, G. Vetrone, S. Artuso
Imola, 2005 – apr 2010
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28-29 OTTOBRE
Patient Characteristics (147)
Male/Female
51/96
Age (y)
61.7 (15-88)
Body mass index
28.8 (18-45)
ASA classification
2.1 (1-3)
Previous open hernia repair
18 (12.2%)
Max diameter size (cm)
8.4 (2-28)
Operating time (min)
Postoperative hospital stay (d)
Associated procedures
97.5 (25-240)
4.8 (1-27)
6 (5 laparoscopic cholecistectomy, 1 inguinal hernia)
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28-29 OTTOBRE
Type of defect (1)
Laparoscopic Incisional Hernia Repair - LIHR (111)
Median laparotomies: 94
Lateral: 14
Left side 3
Mc Burney 2
Subcostal 8
Right Pararectal 1
Parastomal 3
Laparoscopic Ventral Hernia Repair - LVHR (36)
Umbilical hernia 20
Epigastric hernia 16
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28-29 OTTOBRE
Type of defect (2)
ABDOMINAL BORDER (25)
Subxiphoidal 4
Suprapubic 13
Subcostal 8
Type of defect (3)
Chevrel classification
Small (<= 5 cm)
32 (21.8%)
Medium (6-9 cm)
51 (34.7%)
Large (=> 10 cm)
53 (36.1)
Type of defect (4)
Swess-Cheese
26 (17.6%)
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28-29 OTTOBRE
Type of Prosthesis
30
SEPRAMESH
7 (4.8%)
DYNA-MESH
5 (3.4)
PARIETEX
2 (1.4)
COMPOSIX
33 (22.4%)
PROCEED
97 (66%)
PROLENE
3 (2%)
25
20
COMPOSIX
DYNAMESH
PARIET EX
PROCEED
SEPRAMESH
15
10
5
0
2005
2006
2007
2008
2009apr
2010
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28-29 OTTOBRE
Type of fixation
ABSORBABLE TACK
38 (25.9%)
NON ABSORBABLE TACK
109 (74.1%)
35
30
25
20
ABS.T ACK
15
10
NON ABS.T ACK
5
0
2005
2006
2007
2008
2009apr
2010
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28-29 OTTOBRE
OUTCOMES (147)
Complications 25 (17%)
Recurrence 10 (6.8%)
Conversion to open technique 4 (2.7%)
OUTCOMES (805 pt)
Complications 112 (13.2%)
Recurrence 35 (4.7%)
Conversion to open technique 31 (4.6%)
Ann Surg 2003
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28-29 OTTOBRE
COMPLICATIONS (19)
Prolonged seroma (> 8 wk)
6 (4%)
Prolonged ileus
6 (4%)
Prolonged pain (> 6 months)
4 (2.7%)
Pulmunary Embolism
1 (0.6%)
Myocardial Infarction
1 (0.6%)
Pneumonia + wound infection
1 (0.6%)
Wound infection
1 (0.6%)
RE-OPERATION (5)
Intestinal injury (2 ileus, 1 colon)
3 (2%)
Postoperative bleeding
1 (0.6%)
Trocar site erniation
1 (0.6%)
TOTAL
25 (17%)
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28-29 OTTOBRE
RECURRENCE 10 (6.8%)
Time to recurrence (days): 537 (31-1517)
Treatment of recurrence:
Laparoscopic repair 2
Open repair 3
No repair 5 (small, asypmtomatic)
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28-29 OTTOBRE
CONVERSION TO OPEN TECHNIQUE 4 (2.7%)
Severity of adhesions 3 (2%)
Complete prosthesis detachment 1 (0.6%)
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28-29 OTTOBRE
YEAR
N°
BMI > 30
ASA 3
Age
Chevrel
>=10
Duration
of surgery
Post-operative
hospital stay
Complications
Reoperation
Conversion
to open
technique
Recurrence
2005
30
15 (50%)
11
(36,7%)
63,8
13
(43,3%)
110
5,2
3 (10%)
1 (3.3%)
1
(3.5%)
4
(14%)
2006
32
6
(18,8%)
8
(25%)
60,1
5
(15,5%)
87
5,1
7 (21%)
2 (6%)
1
(3.1%)
3
(9%)
2007
19
1
(5,9%)
2
(10,5%)
63,1
6
(31,5%)
98
4,3
4 (21%)
1 (5%)
0
0
2008
24
14
(58,3%)
11
(45,8%)
65
13
(54,2%)
99
4,9
3 (12.5%)
0
1
(4%)
3
(12.5%)
2009-2010
42
15
(35,5%)
8
(19%)
58
16
(38%)
94
4,4
8 (19%)
1 (2.3%)
1
(3.1%)
0
25
20
% 15
COMPLICATIONS
CONVERSION
10
RECURRENCE
5
0
2005
2006
2007
2008
2009-
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28-29 OTTOBRE
Complications
(25)
Incisional (111)
P
21 (19.1)
Recurrence (10)
9 (8.1%)
0.27
Ventral (36)
4 (11.1)
Year >= 2009 (42)
8 (19.5)
17 (16.2)
BMI > =30 (51)
7 (14)
13 (15.7)
ASA 3 (40)
8 (20)
0.981
1 (2.8)
0
1 (2.4)
0.038
10 (9.5%)
0.87
3 (2.9)
3 (5.9%)
2 (3.9)
0.76
6 (7.2%)
0618
2 (2.4)
5 (12.5%)
0.5
0
0.1
0.211
ASA 1-2 (112)
16 (15.4)
5 (4.8%)
4 (3.8)
SWISS-CHEESE (26)
6 (24)
2 (7.7%)
1 (3.8)
No SWISS-CHEESE
(121)
19 (15.7)
6 (6.6%)
3 (2.5)
Previous repair (18)
1 (5.9)
3 (16.7)
1 (5.6)
No previous repair
(129)
24 (18.6)
7 (5.4)
3 (2.3)
Chevrel large (53)
10 (19.2)
6 (11.3)
2 (3.8)
Chevrel smallmedium (94)
13 (15.7)
3 (3.6)
2 (2.4)
Abdominal border
(25)
6 (24)
2 (8)
1 (4)
NO abdominal border
(122)
19 (15.7)
8 (6.6)
3 (2.5)
Fixation with
absorbable tack (38)
6 (15.8)
1 (2.6)
0
0.316
0.84
0.19
0.64
0.79
0.8
19 (17.6)
0.4
0.07
0.31
Fixation with NON
absorbable tack (109)
0.7
0.07
0.59
0.66
0.236
9 (8.3)
P
3 (2.7)
1 (2.8%)
0.79
BMI < 30 (83)
Conversione
(4)
0.27
0.632
Year < 2009 (105)
P
0.231
4 (3.7)
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28-29 OTTOBRE
Timing (min)
Complications (25)
P
114
Degenza postop (day)
7
0.05
NO Complications (121)
94
No recurrence (137)
95
120
NO Conversion (143)
95
157
Year >= 2009 (42)
94
Year < 2009 (105)
98
BMI > =30 (51)
107
93
ASA 3 (40)
112
4.8
92
No SWISS-CHEESE (121)
92
123
Previous repair (18)
106
10.5
96
Chevrel large (53)
115
88
Abdominal border (25)
109
4.4
95
0.8
8.3
5.2
8.7
0.4
4.7
0.7
8.3
5.8
8.9
0.02
4.4
0.9
8.3
4.7
7.6
0.3
5.4
0.00
11.6
4.7
8.3
0.9
4.8
0.8
8.4
5.1
12.3
0.4
4.6
0.00
5.9
5.5
0.09
NO abdominal border (122)
8.5
0.4
0.00
Chevrel small-medium (94)
0.3
10.5
4.9
0.3
No Previous repair (129)
8.3
0.00
0.00
SWISS-CHEESE (26)
0.09
10.2
4.6
0.01
ASA 1-2 (112)
8.2
0.9
0.07
BMI < 30 (83)
0.9
8.3
4.8
0.6
11
0.27
4.6
P
8.4
4.3
0.03
Conversion (4)
Max diameter
defect size (cm)
0.00
0.07
Recurrence (10)
P
0.00
7.8