Hybrid laparoscopic repair of complex abdominal wall hernias with transabdominal partially extra-peritoneal (TAPE) mesh fixation: preliminary results

Sarah Mahmood^1,2*Yusuf Moollan¹Sarit S Badiani²Christophe R Berney^1,2

• ¹Bankstown Lidcombe Hospital, Sydney, Australia
• ²Faculty of Medicine, University of New South Wales, Sydney, Australia

Background: There are two conventional approaches to abdominal wall hernia repairs which aim to achieve anatomical restoration. Open approaches have the advantage of complete hernial sac excision with freedom of mesh placement. In comparison, the advantages of the laparoscopic approach involve shorter hospital stays, less post-operative pain and fewer postoperative complications. More recently, the hybrid approach which combines the two techniques has gained popularity as a way to potentially reap the benefits of both. Our aim was to validate if this hybrid approach can achieve the same benefits, irrespective of hernia size, age, and BMI. Primary outcome of interest was hernia recurrence. Secondary outcomes included post-operative complications, pain, and Quality-of-Life (QoL). Method: Medical records of all patients who underwent hybrid laparoscopic hernia repair (HLHR) with transabdominal partially extra-peritoneal (TAPE) mesh fixation from 2017 to 2023 was retrieved from a prospectively maintained institutional database and retrospectively analysed. Intra-and post-operative complications, as well as hernia recurrence was recorded.Results: There were 37 patients (21 females: 56.8%) with a mean age of 66 years and BMI of 34.2 kg/m 2 who underwent hybrid hernia repair. Thirty-four (91.9%) were incisional hernias, of which 50% were recurrent. Mean hernia defect size was 96.8cm 2 . Twelve (32.4%) patients received preoperative chemical component separation with botulinum toxin A (BTA); this group had a significantly higher BMI and hernia size compared to no BTA (37.7 vs 32.5; P=0.048; 174.5cm 2 vs 59.5cm 2 ; P=0.0002). There was no intra-operative, but eight (21.6%) minor postoperative complications. After a mean follow up of 40 months, we recorded one hernia recurrence at 23 months post-surgery (2.7%). Additionally, out of twenty-nine (78.4%) patients assessed for QoL, the median and mean scores were reported as 0 out of 115 and 2.6 out of 115 points scale respectively. Conclusions: HLHR with TAPE mesh fixation is safe with satisfactory mid-to long-term outcomes, irrespective of hernia size and BMI.