Comparison between Dual Layer Intraperitoneal Mesh and Single Layer Mesh for Laparoscopic Ventral and Incisional Hernia Repair

BACKGROUND A hernia is the abnormal exit of tissue or an organ, such as the bowel, through the wall of the cavity in which it normally resides. Hernias come in a variety of forms. The abdomen, specifically the groin, is most frequently involved. Incisional hernias and other ventral hernias are common surgical problems. A prosthetic mesh should always be used in ventral hernia repair (VHR). Now, the polypropylene mesh (PPM) has become the prosthetic mesh of choice in the repair of hernias, including inguinal hernia. Newer meshes are introduced, claiming lesser complication rate, but are invariably costlier than Polypropylene mesh (PPM) by 15 – 20 times. In this study we wanted to evaluate the outcomes of intraperitoneal monofilament and dual layer meshes in laparoscopic incisional and ventral hernia repair. METHODS This is a prospective observational study, with a minimum 30 cases for each type of mesh used. All those patients who had undergone ventral and incisional hernia laparoscopic repair at SRM General Hospital, Chennai between June 2018 and 2021 were included in the study. Data was entered in Microsoft excel for analysis, done by using SPSS software version 23. RESULTS Out of 86 hernias which were repaired laparoscopically, PPM was used in 34 (40 %) and composite meshes in 52 (60 %) cases. Out of 52 composite meshes, 11 cases (21.2 %) turned out with complications whereas out of 34 PPMs (11.8 %), 4 cases turned out with complications. CONCLUSIONS With the composite mesh, complications of intraperitoneal PPM (adhesions, inflammation, intestinal fistulisation, sinus formation, seroma and recurrence) may also occur. The difference between the meshes in the occurrence of these complications is not statistically important. KEY WORDS Hernia, Mesh, Surgery, Intraperitoneal Mesh, Laparoscopic Hernia Repair

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Laparoscopic ventral and incisional hernia repair using intraperitoneal onlay mesh with peritoneal bridging

Hernia ◽

10.1007/s10029-021-02502-9 ◽

2021 ◽

Author(s):

F. Ali ◽

G. Sandblom ◽

A. Wikner ◽

G. Wallin

Keyword(s):

Incisional Hernia ◽

Hernia Repair ◽

Ventral Hernia ◽

Ventral Hernia Repair ◽

Incisional Hernia Repair ◽

Defect Closure ◽

Site Infection ◽

Group 3 ◽

The Mean ◽

Ventral And Incisional Hernia

Abstract Purpose The aim of this study was to assess the feasibility and safety of a novel IPOM procedure with peritoneal bridging (IPOM-pb) for laparoscopic ventral hernia repair, and to compare the outcomes of this procedure with IPOM with- (IPOM-plus) and IPOM without (sIPOM) defect closure. Method A single-centre retrospective study comparing a novel IPOM technique with peritoneal bridging (IPOM-pb) with the two commonly used IPOM techniques, IPOM with defect closure (IPOM-plus) and without defect closure (sIPOM). The intraoperative and postoperative data of patients who underwent laparoscopic IPOM ventral hernia repair were reviewed. Preoperative data, recurrence, and postoperative seroma, surgical site infection, and pain, were compared. Results From January 2017 to June 2020, a total of 213 patients underwent laparoscopic ventral and incisional hernia repair with IPOM technique. The mean length and width of the ventral hernia was 4.4 ± 1.8 cm and 3.6 ± 1.4 cm, respectively, and the mean BMI was 30.1 ± 5.2 kg/m2. The mean operating time was 67 ± 28 min and was longer for IPOM-pb (71 ± 27 min), less for IPOM-plus (63 ± 28 min), and least for sIPOM (61 ± 26 min). The incidence of early postoperative seroma was least in IPOM-pb (1/98, 1%), and similar in the IPOM-plus (4/94, 4%) and sIPOM (1/21, 5%) group. Late postoperative seroma was found only in IPOM-plus (2, 2%). The incidence of early and late postoperative pain was relatively higher in sIPOM (3, 14%; 1, 5%, respectively) compared to IPOM-pb and IPOM-plus in the early (5, 5% and 6, 6%) and late (2, 2% and 1, 1%) postoperative period, respectively. Surgical site infection was higher in sIPOM group (3, 14%), compared to IPOM-pb (1, 1%), and IPOM-plus (3, 3%). Recurrence rates were similar in IPOM-pb group (3/98, 3%) and IPOM-plus (3/94, 3%), and none in sIPOM (0/21). Conclusion IPOM with peritoneal bridging is as feasible and safe as conventional IPOM with defect closure and simple non-defect closure. However, a large randomised controlled trial is required to confirm this finding.

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Intraperitoneal Onlay Mesh in Ventral Hernia Repair Experience in A Tertiary Care Hospital in Bangladesh

BIRDEM Medical Journal ◽

10.3329/birdem.v7i2.32446 ◽

2017 ◽

Vol 7 (2) ◽

pp. 106-109

Author(s):

Md Ezharul Haque Ratan ◽

Hasina Alam

Keyword(s):

Incisional Hernia ◽

Hernia Repair ◽

Ventral Hernia ◽

Ventral Hernia Repair ◽

Tertiary Care ◽

Diabetic Patients ◽

Care Hospital ◽

Intraperitoneal Onlay Mesh ◽

Diabetes Status ◽

Onlay Mesh

Background: Ventral hernias are common problem in surgical practice. Repair of hernia by a prosthetic mesh is a well recognized procedure. But whether the procedure is to be done by open or laparoscopic technique is still a topic of discussion. Laparoscopic intraperitoneal onlay mesh (IPOM) hernioplasty is a newer technique in managing ventral hernia in our country. We are evaluating the usefulness of this procedure as routine operation for ventral hernias.Methods: All patients attending at Bangladesh Institute of Research & Rehabilitation of Diabetes, Endocrine and Metabolic disorders (BIRDEM) outpatient department (OPD) with ventral hernia were approached and counseled for laparoscopic IPOM, but only those who agreed were included in this study. Fifty consecutive patients underwent IPOM by a single surgeon. Preoperative evaluation was done rationally and surgery performed by standard laparoscopic method. Age, sex, diabetes status and additional procedures done were evaluated. Post- operative follow up period was from 3 months to 75 months and any complication or recurrence were noted.Results: We are reporting 50 cases of laparoscopic IPOM, over a time period of 78 months (April 2010- September 2016). Eleven cases were male, 39 female (M: F=1:3.5). 35 (70%) cases were diabetic, 15 (30%) were non-diabetic. Mean age of the patients were 47.7yrs (male 47.7+9.5 yrs, female 47.7- 2.6 yrs, diabetic patients 47.7+ 2.5yrs, non-diabetic patients 47.7-5.9yrs). Indication for IPOM was paraumbilical hernia 29 cases (58%), incisional hernia 14 cases(28%), multiple incisional hernia 2 cases ( 2 large defect in one case, 5 defects of varying size in another patient), umbilical port hernia 2 cases, paraumbilical along with incisional hernia 1 case, epigastric hernia 1 case, lumber hernia 1 case. In 48 cases (96%) polypropylene mesh and only in 2 cases (4%) dual mesh were used. In addition to IPOM procedure, in same sitting laparoscopic cholecystectomy was done in 8 cases, Dilatation & Curettage in 1 case and adhesiolysis in 7 cases. None of the case required conversion to open, neither was there any intra-operative complication. In one case there was recurrence . In another case there was false recurrence due to development of ascites. Four patients developed seroma which were managed conservatively.Conclusion: Laparoscopic intraperitoneal onlay mesh (IPOM) hernioplasty has proved to be an effective surgical procedure for ventral hernia repair. It provides much benefits with low complications and conversion in experienced hands.Birdem Med J 2017; 7(2): 106-109

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