Perioperatives Management und operative Therapie der Nabelhernie mittels LEESS an einem chirurgischen Zentrum - „Real-World Data“ einer konsekutiven Patientenkohorte im Rahmen einer prospektiven unizentrischen Beobachtungsstudie zur chirurgischen Qualitätssicherung

Introduction The aim was to analyse feasibility and safety, in particular, early postoperative outcome characterized by morbidity (in particular, by intraoperative, specific and general complication rate) and mortality using a novel surgical approach such as laparoscopic extraperitoneal endoscopic staple-based sublay operation (LEESS).

Material and methods The early postoperative outcome results for the first patients are presented here in this systematic clinical uni-center observational study on quality assurance and reflecting daily surgical practice in a consecutive patient cohort (study design) through a defined time period.

Results In total, 93 patients with an umbilical hernia and 1-year follow-up were selected from the “Herniamed Hernia Registry” from 01/01/2016-08/30/2020 (sex ratio, m:f=3:1; mean age, 54 [range, 30-90] years; mean BMI, 33 (19-40) kg/m²; median ASA: 2; mean operating time: 100 min; mean hospital stay: 5 d; mean hernial size, 2.58 cm; mean mesh size, 83 cm. Two out of 93 patients (2.1 %) developed symptomatic subfascial seroma (minor complication), postoperative bleeding, mild wound infection without mesh infection, respectively. One patient (1.1 %) develop ileus with internal herniation and serosa injury of the intestinal wall by a defect in the posterior rectus sheath. There were no surgery-related deaths (in-hospital mortality, 0). The overall 30-d postoperative morbidity rate was 12.3 %.

After a total follow-up of 12 months, 64 patients out of 93 were registered in the registry, 9 out of 64 (14.1 %) reported pain, including pain at rest, three of them (4.6 %) needed medical therapy. In one patient (1.56 %), hematoma was treated with conservative therapy, another patient (1.56 %) developed recurrence, which required redo-surgery with hernial repair, and a further patient (1.56 %) had symptomatic residual hernial sac, which required surgery to remove the sac.

Conclusion The mesh augmentation with LEESS technique is an advanced, minimally invasive, effective and feasible surgical treatment for treating patients with symptomatic umbilical hernia.

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Artikel online veröffentlicht:
07. September 2021