Abstract
BackgroundFor comparison of laparoscopic IPOM versus sublay technique for elective incisional hernia repair, the number of cases included in randomized controlled trials and meta-analyses is limited. Therefore, an urgent need for more comparative data persists.MethodsIn total, 9907 patients with an elective incisional hernia repair and 1-year follow-up were selected from the Herniamed Hernia Registry between September 1, 2009 and June 1, 2016. Using propensity score matching, 3965 (96.5%) matched pairs from 4110 laparoscopic IPOM and 5797 sublay operations were formed for comparison of the techniques.ResultsComparison of laparoscopic IPOM versus open sublay revealed disadvantages for the sublay operation regarding postoperative surgical complications (3.4% vs. 10.5%; p < 0.001), complication-related reoperations (1.5% vs. 4.7%; p < 0.001), and postoperative general complications (2.5% vs. 3.7%; p = 0.004). The majority of surgical postoperative complications were surgical site infection, seroma, and bleeding. Laparoscopic IPOM had disadvantages in terms of intraoperative complications (2.3% vs. 1.3%; p < 0.001), mainly bleeding, bowel, and other organ injuries. No significant differences in the recurrence and pain rates at 1-year follow-up were observed.ConclusionLaparoscopic IPOM was found to have advantages over the open sublay technique regarding the rates of both surgical and general postoperative complications as well as complication-related reoperations, but disadvantages regarding the rate of intraoperative complications.
Highlights
For comparison of laparoscopic intraperitoneal onlay mesh (IPOM) versus sublay technique for elective incisional hernia repair, the number of cases included in randomized controlled trials and meta-analyses is limited
A nationwide study of the Danish Hernia Database on early outcomes after incisional hernia repair observed major complications in 2.8% of open and in 4.8% of laparoscopic repairs with a total morbidity rate of 10.1% in open and 11.8% in laparoscopic repairs [22]. These findings indicate that outcomes after incisional hernia repair, concerning the laparoscopic approach, are unsatisfactory [22]
When comparing laparoscopic IPOM and open sublay approaches in the repair of incisional hernias, the current Propensity score (PS) matching analysis of prospective data obtained from the Herniamed Hernia Registry identified no difference in the proportion of patients experiencing chronic pain or recurrence after 1-year follow-up
Summary
For comparison of laparoscopic IPOM versus sublay technique for elective incisional hernia repair, the number of cases included in randomized controlled trials and meta-analyses is limited. Results Comparison of laparoscopic IPOM versus open sublay revealed disadvantages for the sublay operation regarding postoperative surgical complications (3.4% vs 10.5%; p < 0.001), complication-related reoperations (1.5% vs 4.7%; p < 0.001), and postoperative general complications (2.5% vs 3.7%; p = 0.004). Laparoscopic IPOM had disadvantages in terms of intraoperative complications (2.3% vs 1.3%; p < 0.001), mainly bleeding, bowel, and other organ injuries. Conclusion Laparoscopic IPOM was found to have advantages over the open sublay technique regarding the rates of both surgical and general postoperative complications as well as complication-related reoperations, but disadvantages regarding the rate of intraoperative complications
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