New techniques in ventral hernia surgery – an evolution of minimally-invasivehernia repairs

Abstract

Incisional ventral hernia occurs after almost every fourth laparotomy. Still, both simple suturing of the hernia defect and open mesh repair, lead to a high incidence of infections and recurrences. In recent years, we have observed a further evolution of operational techniques used in order to reduce the number of complications. The search for effective repair methods is currently going in two directions: on the one hand, techniques to reduce tissue tension in the suture line are being developed and disseminated (including modifications to the so-called Ramirez technique); on the other hand, minimally invasive techniques are introduced that allow placement of large synthetic meshes without the need for extensive tissue dissection using open repair. In the first group of presented techniques, emphasis is put on basics and access in the following repair method: original Ramirez technique, modified Ramirez technique, anterior component separation with periumbilical perforator-sparing, endoscopic anterior component separation and transversus abdominis release. In the second part of the manuscript, attention is drawn to the following hernia repair techniques: eTEP, reversed TEP, MILOS/eMILOS, stapler repair, TAPP, TARUP, TESLA, SCOLA, REPA, LIRA, IPOM, IPOM-plus. When choosing the optimal technique for a given patient, the surgeon should first of all be guided by technical feasibility, availability of materials, their own experience, as well as the characteristics of the patient and overall burdens. Nevertheless, surgeons undertaking reconstruction of the abdominal wall in the case of hernias should know different surgical accesses and individual spaces of the abdominal integument, in which a synthetic material may be placed. However, it should be emphasized that poor ergonomics of novel techniques, complex anatomy and complicated dissection of space, as well as the need for laparoscopic suturing in a difficult arrangement of tissue layers and in a narrow space, without a full triangulation of instruments, make these operations a challenge even for a surgeon experienced in minimally invasive surgeries.