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Minimally invasive component separation technique for large ventral hernia: which is the best choice? A systematic literature review

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Abstract

Background

Aim of the present systematic review is to compare the postoperative outcomes after minimally invasive anterior and posterior component separation technique (CST), in terms of postoperative morbidity and recurrence rates.

Methods

Nine-hundred and fifty-nine articles were identified through Pubmed database. Of these, 444 were eliminated because were duplicates between the searches. Of the remaining 515 articles, 414 were excluded after screening title and abstract. One hundred and one articles were fully analysed, and 73 articles were further excluded, finally including 28 articles. Based on the surgical technique, three groups were created: Group A, endoscopic anterior CST and closure of the abdominal midline by laparotomy; Group B, endoscopic anterior CST and closure of the abdominal midline laparoscopically or robotically; Group C, laparoscopic or robotic posterior CST with transversus abdominal muscle release (TAR).

Results

In group A, B and C, 196, 120 and 236 patients were included, respectively. Surgical and medical complication rates for the three groups were 31.2% and 13.7% in group A, 15.8% and 4.1% in group B, and 17.8% and 25.4% in group C, while recurrence rate was 10.7%, 6.6% and 0.4%, respectively. Statistically significant differences were observed in terms of surgical postoperative complication rate between group A versus B (p = 0.0022) and between group A versus C (p = 0.0015) and of recurrence rate between group A versus C (p = < 0.0001) and B versus C (p = 0.0009).

Conclusions

Anterior CST with midline closure by laparotomy showed the worst results in terms of postoperative surgical complications and recurrence in comparison to the pure minimally anterior and posterior CST. Posterior CST-TAR showed lowest hospital stay and recurrence rate, although the follow-up is short. However, due to the poor quality of most of the studies, further prospective studies and randomized control trials, with wider sample size and longer follow-up are required to demonstrate which is the best surgical option.

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Authors and Affiliations

  1. Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital “Virgen del Rocio”, Seville, Spain

    Andrea Balla, Isaias Alarcón & Salvador Morales-Conde

  2. Department of General Surgery and Surgical Specialties “Paride Stefanini”, Sapienza, University of Rome, Viale del Policlinico 155, 00161, Rome, Italy

    Andrea Balla

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Correspondence to Andrea Balla.

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Dr. Andrea Balla, Dr. Isaias Alarcón and Prof. Salvador Morales-Conde declare that they have no conflict of interest or financial ties to disclose.

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Balla, A., Alarcón, I. & Morales-Conde, S. Minimally invasive component separation technique for large ventral hernia: which is the best choice? A systematic literature review. Surg Endosc 34, 14–30 (2020). https://doi.org/10.1007/s00464-019-07156-4

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