Management of Hernia Defects by a Laparoscopic Repair of Ventral Hernias

Abstract

Introduction: Ventral hernias are a common pathology in the everyday surgical practice. In 1993, LeBlanc and Booth published the first laparoscopic ventral hernia repair cases. Since then, many different modifications of the original technique have been proposed. Despite this diversity, the optimal management of the hernia defect is to be discovered.Aim: The aim of the current study is to compare the laparoscopic ventral hernia repair techniques of primary defect closure, before mesh implantation versus non defect closure, tension free, approach.Materials and Methods: From January, 2012 to December, 2015, 89 laparoscopic ventral hernia repairs were performed. 57 (64%) patients were treated by standard tension-free repair - IPOM, and in the remaining 32 (36%) patients, the hernia defect was closed and the suture line was enforced by intraperitoneal mesh placement - IPOM Plus technique. The patients were followed up for an average of 24.7 months ±13.2 months (1-48). The demographic parameters, operative time, postoperative hospital stay, postoperative pain by VAS score on 24h and on the 7th postoperative day, the intra- and postoperative complications and the recurrence rate were measured.Results: The mean age of the patients was 59 years±14. 37 (41.6%) were male and 52 (58.4%) were female. 27% of the operated patients were obese. The mean operative time in the IPOM group was 42 min. shorter than in the IPOM Plus group (95.61 vs 138.90). vs 1.18±0.39 days. On the 24th hour and 7th day, the pain according to the VAS Score was 6.08 and 2.15, respectively, by IPOM and 6.5 and 2.37, respectively, by IPOM Plus. Complications were observed in 26.31% of the patients in the IPOM group versus 21.87% in the IPOM plus group. The tension-free hernia repair was associated with a 12.5% rate of postoperative seroma formation, while the incidence was two times lower in the IPOM plus reconstruction (6.25%). Abdominal wall bulging was a phenomenon typical only for the tension-free repair group - 4 (7.01%). At the same time, port site hernias were observed in only two of the patients with defect closure.Conclusion: Compared to the standard laparoscopic ventral hernia repair, the IPOM Plus approach is associated with a lower rate of postoperative seroma formation and abdominal wall bulging, longer operative time and similar postoperative stay and pain scores. The port site hernias were typical only for the defect closure group.