Surgical techniques in ventral hernia

Ventral hernia, defined as the protrusion of abdominal contents through a defect in the anterior abdominal wall, is one of the most common problems in general surgery. Primary ventral hernias (umbilical, epigastric, and spigelian) affect up to 20% of the adult population. Midline abdominal incision results in an incisional hernia in 10–30% of patients. Ventral hernias are not only a cosmetic problem, but may lead to significant morbidity, including pain, impaired quality of life, bowel obstruction, and bowel strangulation. Surgery is the definitive treatment for hernias. Numerous techniques have been proposed for various clinical scenarios.

Study I was a long-term (5–10 years) follow-up of a randomized controlled multicentre study comparing laparoscopic incisional hernia repair to hybrid operation. Fascial closure did not reduce hernia recurrences, with a recurrence rate approaching 20% in both groups. Quality of life and pain
scores were also similar.

Study II compared open transversus abdominis release (oTAR) to robotic assisted transversus abdominis release (rTAR) in two European hernia centres in the treatment of large incisional hernias. Duration of postoperative hospital stay was significantly shorter in the rTAR group. Short-term serious complications and surgical site infections were more frequent in the oTAR group.

Study III investigated the results of a preformed hernia patch in the treatment of umbilical hernia. During the follow-up time of 68 months, Ventralex ST hhernia patch placed mostly in the preperitoneal space resulted in a recurrence rate of 2.5% and a re-operation rate of 4.1%.

The use of robotic-assisted surgery in large incisional hernia seems to reduce length of hospital stay and decrease complications. Treatment of small umbilical hernias with a preperitoneal patch produces good results.