Safety and feasibility of concomitant ventral hernia repair and total laparoscopic hysterectomy: A single-centre experience of over 1000 cases.

Introduction: Laparoscopic ventral hernia surgery has become the standard of care for most surgeons, offering improved patient outcomes, shorter hospital stays, and fewer complications compared to open surgeries. However, the benefits of combining Intraperitoneal Onlay Meshplasty (IPOM) with other surgeries are rarely discussed and not commonly practiced. This study examines the safety of placing mesh after Total Laparoscopic Hysterectomy (TLH) based on a single center's retrospective experience of over 1,000 cases spanning 15 years.

Materials and methods: Data of all the patients who underwent concomitant TLH with IPOM were collected retrospectively. Details of the surgery, immediate post-op outcomes, long term follow ups with complications and recurrences were analysed.

Results: Between January 2006 and January 2021, we reviewed 1,273 cases, of which 1,058 met our inclusion and exclusion criteria. There were no open conversions. The mean patient age was 48.23 years with a standard deviation (SD) of 2.19. The mean BMI was 33.21 kg/m² with an SD of 1.83. The average defect size was 5.8 cm with an SD of 1.65. The mean operating time was 231 minutes with an SD of 10.15. The average hospital stay was 3.2 days with an SD of 0.84. There were no 30 day readmissions or mortality. Out of 1,058 cases, 782 patients had a minimum follow-up period of 2 years, conducted through telephone conversations or in-person hospital visits. An additional 155 patients had at least 1 year of follow-up, while 121 patients were lost to follow-up within the first year. The median follow-up duration for all patients was 2.8 years. 52 cases (4.9%) experienced postoperative seroma. We had only one case (0.094%) of mesh infection, which required mesh explantation. There were two instances of recurrence (0.189%): one patient underwent open repair after 24 months, and another underwent eTEP repair 32 months after the initial surgery. Both patients completed 1 year of follow-up post-second procedure and were doing well.

Conclusion: Meshes can be safely placed in a clean, contaminated environment alongside total laparoscopic hysterectomy, with the discretion of the operating surgeon considering his expertise and judgment. We can conclude that combining ventral hernia repairs with TLH is safe and feasible with acceptable morbidity.