Title: Intraperitoneal Onlay Mesh Repair (IPOM) versus Intraperitoneal Onlay Mesh Repair with Closure of Fascia Defect (IPOM Plus) for Ventral Hernias: Retrospective Analysis of Postoperative Outcomes
Authors: Dr G. Gopalakrishnan, M.B.B.S., M.S., M.CH., Dr V. Selvaraja, M.S.(Gen)., FICS., Dr R. Krishnakumar, M.D (Anaes).
DOI: https://dx.doi.org/10.18535/jmscr/v12i08.02
Abstract
Background: Intra-peritoneal onlay mesh (IPOM) repair, a type of Laparoscopic Ventral Hernia Repair (LVHR), comprises bridging the defect from the peritoneal side with a composite mesh. Recently, IPOM-Plus has become the recommended type of LVHR in which the defect in the fascia is sutured before placing the mesh.
Materials and Methods: This study is a retrospective cohort study conducted at Dharan Hospital, Salem. Patients who had undergone IPOM-Plus or IPOM during January 2020 to June 2021 were selected. Data regarding demographics, intra-operative and post-operative outcomes were collected from medical record section. Patients were followed up for 6 months. Data analysis was performed using SPSS version 26.0 taking a p-value of <0.05 as statistically significant.
Results: A total of 74 patients were included in this study, out of which 34 patients had undergone IPOM (Group A) and 40 patients underwent IPOM-Plus (Group B). In both the groups, there was no statistical difference in demographic variables except more number of umbilical hernia in both the groups compared to epigastric and paraumbilical hernia. Hernia defect size and mean operative time were varied significantly (p-value < 0.05) in both groups. More number of seroma formation (p=0.021), pseudosac at first OPD visit (p=0.020) and pseudosac at 6 months (p=0.027) in Group A compared to Group B.
Conclusions: IPOM plus repair is safe with possible advantages over a standard IPOM repair in patients with ventral hernia in term of postoperative outcomes.
Keywords: Ventral hernia, IPOM, IPOM Plus, Laparoscopy.
References
- Bucknall TE,Cox PJ,Ellis H. Burst abdomen and incisional hernia: a prospective study of 1129 major laparotomies. Br Med J. 1982; 284: 931.
- Lee, B. Mappin-Kasirer, A. Sender Liberman, B. Stein, P. Charlebois, M. Vassiliou, G.M. Fried, L.S. Feldman, High incidence of symptomatic incisional hernia after midline extraction in laparoscopic colon resection, Surg. Endosc. 2012:26: 3180–3185, https://doi.org/10.1007/s00464-012-2311-7.
- Clapp ML, Hicks SC, Awad SS, Liang MK. Trans-cutaneous closure of central defects (TCCD) in laparoscopic ventral hernia repairs (LVHR). World J Surg. 2013 37:42-51.
- Sieda, Bassem M.; Khalil, Osama H. Short-term outcomes of laparoscopic intraperitoneal onlay mesh with facial repair (ipom-plus) for ventral hernia: a randomized controlled trial. The Egyptian Journal of Surgery.2020; 39(3):764-773. | DOI: 10.4103/ejs.ejs_73_20
- Satish Kumar R et al. Comparative Study between Intraperitoneal Onlay Mesh Repair (IPOM) vs Intraperitoneal Onlay Mesh Repair with Closure of Fascial Defect (IPOM PLUS) for Ventral Hernias. SAS J Surg. 2021; 7(11): 708-718.
- Edwards, J. Angstadt, O. Whipple, R. Grau. Laparoscopic ventral hernia repair: postoperative antibiotics decrease incidence of seroma-related cellulitis, Am. Surg.2005: 71: 931–936.
- Tandon, S. Pathak, N.J.R. Lyons, Q.M. Nunes, I.R. Daniels, N.J. Smart. Meta-analysis of closure of the fascial defect during laparoscopic incisional and ventral hernia repair, Br. J. Surg. 2016; 103:1598–1607, https://doi.org/10.1002/ bjs.10268.
- Satish Kumar R, Dhruva HM, Tejasvi KC. Comparative Study between Intraperitoneal onlay Mesh Repair (ipom) vs. Intraperitoneal onlay Mesh Repair with Closure of Fascia Defect (ipom plus) for Ventral Hernias. J Med Imp Surg. 2022; 7: 129.
- Rao ASN, Gupta A, Naik D, Gunasekaran G, Bhandari V, Rajput D. A comparative study between laparoscopic intraperitoneal onlay mesh hernioplasty and open underlay mesh hernioplasty for ventral hernias. Int Surg J. 2015;2: 352-60.