MD DrMSc FACS Professor Digestive Disease Center Bispebjerg Hospital University of Copenhagen Denmark When and how to fix the mesh in ventral incisional hernia ID: 1014100
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1. Lars Nannestad Jorgensen MD DrMSc FACS ProfessorDigestive Disease Center,Bispebjerg HospitalUniversity of CopenhagenDenmarkWhen and how to fix the mesh in ventral / incisional hernia repair?
2. DisclosuresEducational activities & speaker’s fee:BARD & Medtronic
3. Open repairIPOMSublayOnlaySublayFixationIPOMLaparoscopic repairPermanent Resorbable Tackers SuturesGlue
4. Optimal fixation preventsrecurrenceacute and chronic painadhesion formationmesh migrationshrinkageinfectionfistulaeseroma
5. FixationIPOMLaparoscopic repairPermanent Resorbable Tackers SuturesGlue
6. SublaySajid MS. Hernia 2013;17:159-66 Tack vs. suture fixationOperative time4-6 weeks postop. painFavors tack Favors sutureFavors tack Favors suture
7. Pain VAS (0 – 100)Wassenaar E. Surg Endosc 2010;24:1296-302
8. SublaySajid MS. Hernia 2013;17:159-66 Perioperative complicationsRecurrence of herniaRecurrence of herniaFavors tack Favors sutureFavors tack Favors sutureFavors tack Favors suture
9. Reynvoet E. Langenbechs Arch Surg 2014;399:55-63Recurrence rates
10. Baker JJ. Br J Surg 2018;105:37-47
11. Baker JJ. Br J Surg 2018;105:37-47SUCRA values 12%93%43%27%73%
12. FixationIPOMLaparoscopic repairPermanent Resorbable Tackers SuturesGlue
13. RecurrenceRCTRCTRCTChronic painRCTRCTKhan RMA. Int J Surg 2018;53:184-92
14. P = 0.007Christoffersen MW. Br J Surg 2015;102:541-7
15. Christoffersen MW. Br J Surg 2015;102:541-7Incidencens of chronic (moderate or severe) pain: 15.3% (abs. tacks) vs. 16.1% (non-abs. tacks)Predictors of chronic painyoung ptshernia recurrence
16. Eriksen JR. Br J Surg 2011;98:1537-45 Tack vs. fibrin sealant fixation
17. The mesh:defect area ratioTulloh & de Beaux. Hernia 2016;20:893-5.Resisting force/displacing force = ”Donut” area/defect area = (πR2 – πr2)/ πr2 ≈ R2/ r2r = 5 cm, R = 20 cm R2/r2 = 16r = 6 cm, R = 24 cm r = 7 cm, R = 28 cmr = 8 cm, R = 32 cm
18. The mesh:defect area ratioHauters P. Surg Endosc 2017;31:3656-63
19. The mesh:defect area ratioHauters P. Surg Endosc 2017;31:3656-63
20. Hernia recurrence and mesh:defect ratioIncidence of recurrence (%)Hauters P. Surg Endosc 2017;31:3656-63Mesh:defect ratio
21. Hernia recurrence and overlapIncidence rate of recurrenceLeBlanc K. Hernia 2016;20:85-9Mesh overlap95 articles, 111 study populations
22. Suture fixation vs. double crown tack: effectiveness , pain Abs. tack fixation: recurrence rate No difference in pain between abs. and non-abs. tack fixationGlue fixation: pain , recurrence Mesh overlap: mesh size 4 times the hernia defect!!!Conclusions
23. DenmarkSweden