State of art in hernia surgery - results of our recent experience

Abstract

Introduction. Minimally invasive surgery (MIS) has gained popularity in all surgical fields, and hernia surgery is one of the most recent. Inguinal, umbilical, and incisional hernias benefit from laparoscopic procedures. Short hospitalization, reduced return-to-work time, and fast recovery after surgery recommend MIS as the new standard for hernia surgery. Methods. In this review, we analyzed our experience in the period 2019-2023, including patients with hernia defects who underwent MIS. The procedures performed were as follows: intraperitoneal onlay mesh (IPOM) and extended total extraperitoneal (eTEP) for umbilical hernias; total extraperitoneal (TEP) and trans-abdominal preperitoneal (TAPP) for inguinal hernias; and eTEP, IPOM, and trans-abdominal retromuscular (TARM) for incisional hernias. Surgeries were performed laparoscopically under general anesthesia. The study included 236 procedures:49 for incisional hernias (20.76%), 52 for umbilical hernias (22.03%), and 135 for inguinal hernias. (57.21%). eTEP was predominant in incisional hernias (61.22%), followed by IPOM (20.42%), and TARM (18.36%). Inguinal hernias were treated using TEP (88.89%) and TAPP (11.12%). Umbilical hernias were operated on using IPOM (23.08%) and eTEP (76.92%). Emergent surgery was performed in 38 cases (16.11%):7 cases of umbilical hernias, 26 cases of inguinal hernias, and 5 cases of incisional hernias. Results: The conversion rate was 5.08% (12 cases), which was related to difficulties in dissection (eTEP) and peritoneal tear (TEP). The complication rate was 11.86% and included 12 hematomas, 10 bleeding events, 3 intestinal fistulas, and 2 bowel obstructions. Of these, 75% required a reoperation. One patient died of postoperative pulmonary thromboembolism. Seromas were observed in 7.2% of patients. Four recurrences (1.7%) have been reported to date. Conclusion: Our results show reduced complication rates, reduced recurrences, and wound-related occurrences and support MIS as a valuable tool in hernia surgery.