Laparoscopic Intraperitoneal Onlay Mesh Repair Research Articles

Epigastric Ventral Hernia Repair Through Vaginal Natural Orifice Transluminal Endoscopic Surgery.

Ventral hernia repair is a commonly performed operation and can be executed by open or laparoscopic approach. The search for even less invasive techniques continues. Natural orifice transluminal endoscopic surgery (NOTES) is a known method of minimally invasive surgery. We performed an epigastric ventral hernia repair through vaginal NOTES during a concurrent hysterectomy and bilateral salpingectomy. We used the access to do a synchronous hernia repair with mesh augmentation. The technique of repair was identical to the laparoscopic intraperitoneal onlay mesh repair (Lap. IPOM). We reported a sufficient hernia repair without intra-operative complications. Also, post-operatively, no problems were encountered. Follow-up after 4 weeks showed a good and strong hernia repair. The complaints of the patient were relieved. CT scan 10 months after operation showed no recurrence nor signs of mesh infection. Ventral hernia repair through vaginal NOTES can be considered a possible new and minimal invasive (scarless) technique for ventral hernia repair but further investigations on a larger scale are needed to confirm feasibility & safety.

Hybrid intraperitoneal onlay mesh repair for incisional hernias: a systematic review and meta-analysis.

Laparoscopic IPOM is technically challenging, especially regarding fascial closure. Hybrid repair has been proposed as a simpler approach. We aimed to compare hybrid and laparoscopic intraperitoneal onlay mesh repair (IPOM) in patients undergoing ventral hernia repair (VHR). We performed a systematic review of Cochrane, Scopus, and MEDLINE databases to identify studies comparing hybrid versus laparoscopic IPOM VHR reporting the outcomes of recurrence, mortality, seroma, postoperative complications, reoperation, surgical site infection, and operative time. Statistical analysis was performed using RStudio 4.1.2 using a random-effects model. We screened 2,896 articles and fully reviewed 22 of them. A total of five studies, encompassing 664 patients were included. Among them, 337 (50.8%) underwent laparoscopic IPOM. All patients had incisional hernias, with a mean diameter varying from 3 to 12.7cm, 60% were women, with a mean BMI varying from 29.5 to 38. The hybrid approach had a lower rate of seroma when compared to the laparoscopic (OR 0.22; 95% CI 0.05 to 0.92; p = 0.038; I²=78%). We found no difference in recurrence, mortality, postoperative complications, reoperation, surgical site infection, and operative time between groups. Hybrid IPOM is a safe and effective method for incisional hernia repair. Moreover, it facilitates fascial defect closure and decreases postoperative seromas.

Laparoscopic intraperitoneal onlay mesh with fascial repair (IPOM plus) for ventral and incisional hernia

Abdominal wall surgery for ventral hernia is one of the commonest procedures performed by the surgeons. The aim of the study is to evaluate short- and long-term outcomes in patients who underwent laparoscopic IPOM plus approach. Materials and methods. This study describes 70 patients who underwent laparoscopic intraperitoneal onlay mesh repair plus (IPOM plus) for ventral and incisional hernia. These were then followed up for a period of a minimum of 12 months and a maximum of 5 years. Results. Of the 70 patients, 8 (11.43 %) linea alba hernias, 28 (40.00 %) umbilical hernias, 34 (48.57 %) had incisional hernias. The distribution based on ASA score: I – 23 (32.86 %) patients, II – 39 (55.71 %), III – 8 (11.43 %). The mean age was 50.21 ± 0.89 years (M ± m). Male to female ratio was 1.19:1.00. Average defect size was 4.77 ± 0.21 cm (M ± m). Mean operating time was 58.27 ± 0.52 minutes (M ± m). Mean post-op hospital stay was 1.84 ± 0.06 days (M ± m). Intensity of pain by VAS pain score was 5.11 ± 0.92, 4.47 ± 0.31, 2.90 ± 0.72, 0.92 ± 0.81 (M ± m) after 6 hours, 24 hours, 1 week, 6 weeks respectively. No conversion to open laparotomy was required. Reported complications were port-site seroma 3 (4.29 %), port-site hematoma 1 (1.43 %) over one year of follow-up. 62 (88.57 %) patients were evaluated over 21 months follow-up period, no complications have been reported. Conclusions. Obtained results showed that the IPOM plus repair is safe and may be used for routine laparoscopic ventral and incisional hernia repair, the closure of fascial defect appears to give chance for good fixation of the mesh and decrease postoperative morbidity.

Prospective, observational study of intraperitoneal onlay mesh repair with defect closure versus SCOLA for primary ventral hernia

Abstract Introduction: The last decade has witnessed several modifications in the laparoscopic techniques for ventral hernia. The aim of this study was to compare an established repair such as laparoscopic intraperitoneal onlay mesh repair with defect closure (IPOM plus) with subcutaneous onlay endoscopic approach (SCOLA) for medium ventral hernia. Patients and Methods: From June 2019 to November 2021, 29 patients undergoing IPOM plus and 22 patients undergoing SCOLA for medium ventral hernia (umbilical and epigastric hernia of size 2–4 cm) were included in the study. A comparative analysis was performed in terms of surgical outcomes and post-operative pain. Results: The two groups were comparable in terms of age and body mass index. The mean operation time of the SCOLA group was higher but not statistically significant. The Visual Analogue Scale score for pain after IPOM plus was significantly higher on post-operative day 1, at discharge and on the first follow-up visit. Around 45.4% of patients in the SCOLA group were discharged with the drain in situ which was later removed on the outpatient visit. However, no drains were placed in the IPOM plus group. The rate of seroma formation was 10.34% in the IPOM plus group and 27.27% in the SCOLA group. The material cost of IPOM plus procedure was significantly higher than that of the SCOLA. At the end of 1 year, there was no recurrence in either group. Conclusion: Our study showed that the post-operative pain after SCOLA is significantly less compared to IPOM plus. SCOLA is feasible for medium midline ventral hernia. However, a study with larger sample size and longer follow-up is warranted to compare the operative morbidity of the two procedures.

Outcomes of recurrent incisional hernia repair by open and laparoscopic approaches: a propensity score-matched comparison.

Recurrent incisional hernias are challenging, and their surgical outcomes have not been well studied. We aimed to analyze the outcomes of recurrent incisional hernia repair in a propensity score-matched cohort study on laparoscopic intra-peritoneal onlay mesh repair (lap. IPOM) versus open sublay repair. All consecutive patients who had undergone open sublay repair and lap. IPOM of recurrent incisional hernia between January 2015 and December 2021 at a tertiary hernia center was identified. One-to-one propensity score matching was used to achieve a balanced exposure groups at baseline. Of 255 patients, 85/95 with open sublay repair were matched to 85/160 with lap. IPOM. Before matching, the open sublay group had significantly larger hernia defects (6.3cm vs. 5.0cm) than the lap. IPOM group. Other major baseline imbalances were also found in body mass index (BMI), obesity and European Hernia Society (EHS) width classification. The pre-match results showed that the lap. IPOM group had significantly shorter operative time (median 75 vs. 95min) and shorter postoperative hospital stay (median 8 vs. 11days) compared with the open sublay group. Wound infection (8.4% vs. 1.9%) and hematoma (5.3% vs. 0.6%) occurred more frequently after open sublay repair. After matching, baseline characteristics were well balanced. The recurrence rate and incidence of complications were comparable between the two groups. However, the post-match analysis still showed that lap. IPOM was associated with decreased length of postoperative stay. The outcomes of recurrent incisional hernia surgery after lap. IPOM and open sublay repair appear similar, except that the former had shorter length of postoperative stay. However, the poor outcomes were more likely associated with the unfavorable risk profiles, such as larger defect size, rather than the procedure technique itself.

Preoperative Abdominal Muscle Elongation Facilitated Laparoscopic Intraperitoneal Onlay Mesh Repair of Complex Ventral Hernia.

Background: Complex ventral hernia remains a challenging situation for any surgeon. In this study, our aim was to analyze the effect of laparoscopic intraperitoneal onlay mesh (IPOM) repair in the treatment of complex abdominal wall hernia, with the assistance of preoperative progressive pneumoperitoneum (PPP) and botulinum toxin A (BTA). Methods: In this retrospective study, we included 13 patients with complex ventral hernia between May 2021 and December 2022. All patients undergoing PPP and BTA protocol before hernia repair. The length of abdominal wall muscles and abdominal circumference were measured from CT scan. All hernias were repaired with laparoscopic or laparoscopic-assisted IPOM. Results: Thirteen patients received PPP and BTA injections. PPP and BTA administration time was over 8.8 ± 2.5 days. Before and after PPP and BTA, imaging showed that the length of lateral muscle on each side increased from 14.3 to 17.4 cm (P < .05). The abdominal circumference increased from 81.8 to 87.9 cm (P < .05). Complete fascial closure was obtained in 13 patients (100%), and no patient experienced postoperative abdominal hypertension and ventilatory support. No patient suffered from recurrent hernia to date. Conclusions: Preoperative PPP combined with BTA injection plays a role similar to component separation technique, avoids the abdominal hypertension after laparoscopic IPOM repair of complex ventral hernia.

Short-term Outcomes After Laparoscopic IPOM Versus Robot-assisted Retromuscular Repair of Small to Medium Ventral Hernias: A Nationwide Database Study.

To examine the short-term outcomes after laparoscopic intraperitoneal onlay mesh (IPOM) compared with robot-assisted retromuscular repair of small to medium-sized ventral hernia. With the introduction of a robot-assisted approach, retromuscular mesh placement is technically more feasible compared with laparoscopic IPOM, with potential gains for the patient, including avoidance of painful mesh fixation and intraperitoneal mesh placement. This was a nationwide cohort study of patients undergoing either laparoscopic IPOM or robot-assisted retromuscular repair of a ventral hernia with a horizontal fascial defect <7 cm in the period 2017 to 2022, matched in a 1:2 ratio using propensity scores. Outcomes included postoperative hospital length of stay, 90-day readmission, and 90-day operative reintervention, and multivariable logistic regression analysis was performed to adjust for the relevant confounder. A total of 1136 patients were included for analysis. The rate of IPOM-repaired patients hospitalized > 2 days was more than 3 times higher than after robotic retromuscular repair (17.3% vs. 4.5%, P < 0.001). The incidence of readmission within 90 days postoperatively was significantly higher after laparoscopic IPOM repair (11.6% vs. 6.7%, P =0.011). There was no difference in the incidence of patients undergoing operative intervention within the first 90 days postoperatively (laparoscopic IPOM 1.9% vs. robot-assisted retromuscular 1.3%, P =0.624). For patients undergoing first-time repair of a ventral hernia, robot-assisted retromuscular repair was associated with a significantly reduced incidence of prolonged length of postoperative hospital stay and risk of 90-day readmission compared to laparoscopic IPOM.

OC-012 NATIONWIDE ANALYSIS OF SHORT-TERM OUTCOMES AFTER LAPAROSCOPIC IPOM VS. ROBOT-ASSISTED RETROMUSCULAR REPAIR OF SMALL TO MEDIUM VENTRAL HERNIA

Abstract Aim With the introduction of a robot-assisted approach, retromuscular mesh placement is technically more feasible compared to laparoscopic IPOM, with potential gains for the patient, including avoidance of painful mesh fixation and intraperitoneal mesh placement. We aimed to examine the short-term outcomes after laparoscopic intraperitoneal onlay mesh (IPOM) compared to robot-assisted retromuscular repair of small to medium sized ventral hernia. Material &amp; Methods This was a nationwide cohort study of all patients undergoing either laparoscopic IPOM or robot-assisted retromuscular repair of a ventral hernia with a horizontal fascial defect &amp;lt;7 cm in the period 2017 to 2022. Outcomes included postoperative hospital length of stay, 90-day readmission, and 90-day operative reintervention, and multivariable logistic regression analysis was performed to adjust for the relevant confounder. Results A total of 2,453 patients were included for analysis, of which 389 patients underwent robot-assisted retromuscular hernia repair and 2,064 laparoscopic IPOM repair. The rate of IPOM repaired patients hospitalized more than 2 days was 4 times higher than after robotic retromuscular repair (18.2% vs. 4.5%, P &amp;lt; 0.001). The incidence of readmission within 90 days postoperatively was significantly higher after laparoscopic IPOM repair (10.9% vs. 6.7%, P = 0.016). There was no difference in the incidence of patients undergoing operative intervention within the first 90 days postoperatively (laparoscopic IPOM 1.8% vs. robot-assisted retromuscular 1.3%, P = 0.579). Conclusions Robot-assisted retromuscular ventral hernia repair was associated with a significantly reduced incidence of prolonged length of postoperative hospital stay and risk of 90-day compared to laparoscopic IPOM.

V-026 LAPAROSCOPIC TAPP REPAIR: IS IT REALLY FEASIBLE IN A RE-RECURRENT HERNIA?

Abstract Aim Describe a step by step laparoscopic transabdominal preperitoneal (TAPP) repair of a re-recurrent incisional lumbar hernia. Material &amp; Methods This is the case of a 72-year-old man who had a previous traumatic right lumbar hernia initially approached by laparoscopic intra-peritoneal onlay mesh repair (IPOM) and its recurrence approached by open onlay mesh repair. CT-scan revealed a lumbar hernia on the right with a neck size of 40 mm. The hernia sac measured 65 mm and contained part of the right colon inside, without signs of incarceration nor dilated intestinal loops. According to the European Hernia Society classification for incisional abdominal wall hernias, the patient had a lateral hernia (L4 W2). Results Lateral incisional hernias are limited by the inguinal region inferiorly, the costal margin superiorly, the lateral margin of the rectal sheath medially and the lumbar region laterally. Due to their low incidence and the resulting lack of expertise in the treatment of this abdominal wall defect, surgical treatment poses a challenge- Conclusion The repair of a recurrent hernia is a daunting task, even more so of a re-recurrent one. By choosing to perform a TAPP repair, we were able to prove a laparoscopic re-do repair is feasible even faced with weakened tissues and distorted anatomy.

Open Retromuscular Sublay Mesh Repair Versus Laparoscopic Intraperitoneal Onlay Mesh Repair for Ventral Hernias-A Randomized Control Trial

Background: The precise treatment of ventral hernias is still a topic of considerable debate. The aim of this study was to compare the methods of open retromuscular sublay versus laparoscopic intraperitoneal onlay mesh repair for ventral hernias. Methods: Following approval by the Institutional Ethics Committee, Rohilkhand Medical College and Hospital, Bareilly, 88 patients were randomly divided into two groups in 1:1 allocation ratio, each compromising 44 patients. Patients characteristics, hernia size and postoperative complications were recorded. Results: Mean operative time was significantly (p= &lt;0.001) lower in the SUBLAY group (55.66±8.34 minutes) than in the IPOM group (68.75±10.44 minutes). The post-operative pain(VAS) was significantly (p=0.001) lower amongst patients of the IPOM group (2.36±0.61) as compared to the sublay (4.52±0.66) group. The hospital stay was significantly (p=0.001) lower among patients of the IPOM group (3.61±2.28 days) than the sublay group (6.50±1.68 days). Conclusion: Laparoscopic repair in medium- and large-sized defects is a feasible and safe approach. IPOM compared to SUBLAY significantly reduces postoperative complications and hospital stay.

Laparoscopic Intra Peritoneal Onlay Mesh Plus (IPOM Plus) repair of Ventral Hernias – Experience in a Tertiary Hospital

Introduction: Laparoscopic Ventral Hernia Repair (LVHR) was first described by Karl Leblanc in 1992 and has increasingly been gaining popularity in this present era of minimal access surgery. Laparoscopic Intraperitoneal Onlay Mesh (IPOM) repair with its modification intraoperative Onlay Mesh Plus (IPOM Plus) repair is now being well-accepted option for the treatment of ventral hernias. Objective: To assess the safety and efficacy of the laparoscopic IPOM plus modality in the management of ventral hernias. Methods: This is a descriptive observational study, carried out on 22 patients who underwent Laparoscopic ventral hernia repair by IPOM Plus technique between January 2017 to December 2018 at CMH Dhaka. Patients who had ventral hernia with a defect size&gt; 2 cm but &lt; 10 cm were included in this study. Primary subcutaneous transfascial suture closure of all ventral hernias with defect size &gt;2 cm were done using prolene 1-0.Optimized composite mesh (ParietexTM) and Polymesh composite partially absorbable mesh were used as prosthesis anchored with four corner sutures and fixed with non absorbable tacking device. Follow up period was one year. Results: A total of 22 patients underwent Laparoscopic IPOM Plus repair of ventral hernias. Intraoperative and postoperative complications were negligible. No seroma, bulging of mesh, intestinal obstruction, mesh infection and recurrence observed in one year follow up time. But one patient developed de novo spigelian hernia on the right side outside the mesh system after one year. One patient (4.5%) developed post operative persisting pain requiring analgesic at 2 months. Conclusion:: Laparoscopic IPOM plus repair of ventral hernia is a safe, effective and well accepted modality. J Bangladesh Coll Phys Surg 2023; 41: 150-155

Peritoneal Bridging Versus Nonclosure in Laparoscopic Ventral Hernia Repair: A Randomized Controlled Trial.

Postoperative seroma and pain are common problems following laparoscopic intraperitoneal onlay mesh (IPOM) repair of ventral hernias. These adverse outcomes may be avoided by dissecting and using the peritoneum in the hernial sac to bridge the hernia defect. This was a patient- and outcome assessor-blinded, parallel-design, randomized controlled trial comparing nonclosure and peritoneal bridging approaches in patients scheduled for elective midline ventral hernia repair. The primary endpoint was seroma volume on ultrasonography. The secondary endpoints were postoperative pain, recurrence, and complications. Between November 2018 and December 2020, 112 patients were randomized, of whom 60 were in the nonclosure group and 52 were in the peritoneal bridging group. The seroma volume in the nonclosure and peritoneal bridging groups were 17 cm3 (6-53 cm3) versus 0 cm3 (0-26 cm3) at 1-month follow-up (P = 0.013). The median volume was zero at the 3-, 6-, and 12-month follow-ups in both groups. No significant differences were observed in early postoperative pain (P = 0.447) and in recurrence rate (P = 0.684). There were 4 (7%) and 1 (2%) perioperative complications that lead to reoperations in simple IPOM (sIPOM) and IPOM with peritoneal bridging (IPOM-pb), respectively. Seroma was less prevalent after IPOM-pb at 1-month follow-up compared with sIPOM, with similar postoperative pain 1 week after index surgery in both groups. At subsequent follow-ups, the differences in seroma were not statistically significant. Further studies are required to confirm these results. Trial registration (NCT04229940).

Laparoscopic Intraperitoneal Onlay Mesh (IPOM): Short- and Long-Term Results in a Single Center

The laparoscopic intraperitoneal onlay mesh repair (IPOM) approach has become the most widely adopted technique in the last decade. The role of laparoscopic IPOM in the last years has been resizing due to several limitations. The aim of the present study is to evaluate short- and long-term outcomes in patients who underwent laparoscopic IPOM. This retrospective single-center study describes 170 patients who underwent laparoscopic IPOM for ventral hernia at the General Surgery Unit of Parma University Hospital from 1 January 2016 to 31 December 2020. We evaluated patient, hernia, surgical and postoperative characteristics. According to the defect size, we divided the patients into Group 1 (Ø &lt; 30 mm), Group 2 (30 &lt; Ø &lt; 50 mm) and Group 3 (Ø &gt; 50 mm). A total of 167 patients were included. The mean defect diameter was 41.1 ± 16.3 mm. The mean operative time was different among the three groups (p &lt; 0.001). Higher Charlson Comorbidity Index, obesity and incisional hernia were related to postoperative seroma and obesity alone with SSO. p &lt; 0.001 Recurrence was significantly higher in larger defects (Group 3) and incisional hernia. p &lt; 0.001. This retrospective study suggests that laparoscopic IPOM is a feasible and safe surgical technique with an acceptable complication rate, especially in the treatment of smaller defects up to 5 cm.

Intraperitoneal onlay mesh versus laparoscopy-assisted ventral hernia patch mesh repair in small primary ventral hernias

Aims: The aim of this study is to compare and evaluate short-term outcomes of laparoscopy-assisted composite patch mesh repair versus laparoscopic intraperitoneal onlay mesh in small primary midline ventral hernias. Materials and Methods: Eighty consecutive patients with small (&lt;2 cm) midline ventral hernia admitted to the Department of General and Laparoscopic surgery at Sir Ganga Ram Hospital, New Delhi, from January 2017 to May 2019 were included in the study and randomised into two groups. Group A included patients who underwent laparoscopic intraperitoneal onlay mesh repair with the classical barrier flat mesh and Group B patients underwent laparoscopy-assisted ventral hernia patch-mesh repair. Parameters assessed at the follow-up were early post-operative pain by Visual Analogue Scale score, wound complications, early recurrence and hospital stay. Results: Early post-operative pain was more in the laparoscopic intraperitoneal onlay mesh group and the difference was statistically significant. Usage of additional analgesia in the post-operative period was required only in the laparoscopic intraperitoneal onlay mesh group. There was a statistically significant difference between the two groups in terms of hospital stay. Conclusion: For primary midline ventral hernia, with defect size &lt;2 cm, laparoscopy-assisted composite patch mesh repair is feasible and safe. It causes less pain and necessitates less usage of additional analgesia enabling patients to be discharged earlier.

Assessment of quality of life using EuraHS-QoL score and postoperative outcome measures following endoscopic video-assisted component separation with laparoscopic intraperitoneal onlay mesh repair in large midline ventral hernia repair

Assessment of quality of life using EuraHS-QoL score and postoperative outcome measures following endoscopic video-assisted component separation with laparoscopic intraperitoneal onlay mesh repair in large midline ventral hernia repair

Predictive value of platelet-related hematological markers in indicating the outcomes after laparoscopic intraperitoneal onlay mesh repair (IPOM).

The predictive value of hematological markers in the outcomes after laparoscopic intraperitoneal onlay mesh repair (IPOM) remains to be investigated. We aim to evaluate the role of platelet-related parameters after laparoscopic IPOM in patients with incisional hernias. The data of 95 patients who underwent laparoscopic IPOM for appendicectomy-related incisional hernias were retrospectively analyzed. The complete blood count analyses were measured preoperatively, and the outcomes were obtained from hospital records and follow-up calls to patients. Platelet-multiple-lymphocyte index (PLM), neutrophil-leukocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), platelet-lymphocyte ratio (PLR) and systemic immune-inflammation index (SII) values were calculated. The patients were grouped based on the recurrence and the postoperative complications after surgery. Using cutoff values acquired by the Youden Index, we found platelet levels < 212.0 × 1000/μl, NLR > 2.33, LMR < 3.17, and PLM < 365.5 were revealed to be statistically significant in the recurrence of hernias based on univariant or multivariant analysis (p = < 0.05). We further divided the patients into two groups based on the cutoff value of PLM and found that a PLM value < 365.5 was significantly associated with the recurrence of incisional hernia (p = 0.018), the occurrence of postoperative seroma (p = 0.044), and there is a tendency that patients with PLM < 365.5 may suffer from other postoperative complications such as cardiopathy, respiratory infection, and hypoproteinemia (p = 0.089). The preoperative hematological values, especially PLM, may indicate the outcomes in incisional hernias after laparoscopic IPOM.

Less postoperative pain and shorter length of stay after robot-assisted retrorectus hernia repair (rRetrorectus) compared with laparoscopic intraperitoneal onlay mesh repair (IPOM) for small or medium-sized ventral hernias.

The optimal repair of ventral hernia remains unknown. We aimed to evaluate the results after robotic-assisted laparoscopic transabdominal repair with retrorectus mesh placement (rRetrorectus) compared with laparoscopic intraperitoneal onlay mesh repair (IPOM) for patients with small- or medium-sized ventral hernia. This was a retrospective cohort study of consecutive patients undergoing elective rRetrorectus or IPOM repair for small or medium-sized primary ventral or incisional hernias. The primary outcome was the postoperative need for transverse abdominis plane (TAP) block or epidural analgesia, secondary outcomes were length of stay and postoperative complications. All patients were followed for 30days postoperatively. A total of 59 patients were included undergoing rRetrorectus (n = 27) and IPOM (n = 32). Patients in the two groups were comparable in terms of age, sex, comorbidities, smoking status, body mass index (BMI), and type of hernia. The median fascial defect area was slightly larger in the rRetrorectus group (9 cm2 vs. 6.2 cm2, P = 0.031). The duration of surgery was longer for rRetrorectus (median 117.2min. vs. 84.4, P = 0.003), whereas the postoperative need for TAP block or epidural analgesia was less after rRetrorectus compared with IPOM (3.7% versus 43.7%, P = 0.002). There were no severe complications or reoperations after either procedure. The length of stay was shorter after rRetrorectus (median 0 vs. 1day, P < 0.001). rRetrorectus was associated with reduced postoperative analgesic requirement and shorter length of stay compared with laparoscopic IPOM. Registration Clinicaltrial.gov: NCT05320055.

WE5.3 Emergency laparoscopic “hybrid” IPOM+ repair of incarcerated umbilical hernia in patient with BMI 62 and small bowel obstruction; a case study

Abstract Background Large abdominal incisions in obese patients are associated with considerable rates of systemic and wound complications. Recently published European Hernia Society guidelines recommend laparoscopic intraperitoneal on-lay mesh (IPOM) repair for large hernia defects and patients at higher risk of wound morbidity, ideally with closure of the defect and a 5 cm overlap. Case Presentation: We report on a 69-year-old, morbidly obese (BMI 62), comorbid woman who presented as an emergency with a 5-day history of vomiting and abdominal pain. A pre-operative computed tomography (CT) scan confirmed small bowel obstruction secondary to a ventral abdominal wall hernia. Operative findings confirmed an obstructed paraumbilical hernia containing small bowel and omentum. A laparoscopic “hybrid” IPOM+ repair was performed, with a generous overlap. She recovered uneventfully with no surgical complications. Discussion: Minimally-invasive surgical techniques are preferred for obese patients with evidence suggesting lower perioperative complications and recurrence rates compared with open repair. However, additional challenges must be taken into consideration including; surgeon expertise, timing of operation, surgeon ergonomics, distortion of surface anatomical landmarks, need for higher pneumoperitoneum pressures and the physiological effects of this on the patient. Conclusion With preoperative planning, our case study demonstrates that IPOM ventral hernia repair remains a viable option for severely obese patients even in emergency presentations. The closure of the defect is recommended whenever feasible. Addition of the hybrid approach (excision of the sac with a limited incision after the laparoscopic closure) reduces the risk of postoperative seromas.

Open versus laparoscopic intraperitoneal on-lay mesh repair: A comparison of outcomes in small ventral hernia

PurposeThe ideal surgical treatment of small ventral hernias (defect less than 4 cm) is still debatable. In our study, we sought to compare the outcomes of open versus laparoscopic intraperitoneal on-lay mesh (IPOM) repair in small ventral hernias. MethodsPatients with a single ventral hernia defect of less than 4 cm undergoing surgical mesh repair between January 2016 and September 2018 were prospectively registered for this study. The minimum follow-up duration was 12 months. Patient demographics, operative findings and regular post-operative follow-up details including recurrence rates and complications were recorded and analysed. Results41 patients underwent laparoscopic IPOM repair and 47 patients underwent open IPOM repair. The mean age for both groups is similar with no significant difference. The mean hernia defect size for the laparoscopic group is 2.8 cm (±0.8) whereas the mean hernia defect size for the open repair group is 2.1 cm (±0.4). The mean surgery duration for open IPOM repair was significantly shorter (59 min (±17) vs 74 min (±26); p = 0.001). There was no significant difference in the incidence of seroma formation and surgical site infections post-operatively. There was also no significant difference in both groups in terms of chronic pain and recurrence at 1-year follow-up. ConclusionOpen IPOM repair for small ventral hernias may be superior to laparoscopic IPOM repair due to the shorter operative duration, single incision, and no additional risk of port-site hernias. There was no difference in chronic pain, wound infection and recurrence rate between the two groups.

Effect of perioperative lignocaine infusion on postoperative pain relief for laparoscopic intraperitoneal onlay mesh repair: A randomized controlled study.

The focus on enhanced recovery after surgery (ERAS) and opioid-free anesthesia has renewed interest in use of lignocaine. We evaluated postoperative pain relief following intravenous (IV) lignocaine administration in patients undergoing laparoscopic intraperitoneal onlay mesh repair (IPOM). Seventy patients were randomized into two groups. Group L patients were administered IV lignocaine infusion (1.5mg/kg) at induction of anesthesia followed by infusion (1.5mg/kg/h), until 1hour in the post-anesthesia care unit (PACU). Group P patients received equal volumes of normal saline IV infusion. We recorded hemodynamics, perioperative analgesic consumption, postoperative visual analog scores (VAS), incidence of postoperative nausea and vomiting (PONV), bowel function, patient satisfaction and length of hospital stay (LOS). The hemodynamics in both groups were maintained. Group L had lower VAS scores as compared to Group P (P < .05). Intraoperative fentanyl consumption in Group L was significantly less than Group P (P=.029). Group L patients scored lower on the Likert scale in comparison to the patients of Group P at 0hour (P=.013). Recovery of bowel function as assessed by time to pass first flatus was significantly shortened by IV lignocaine (P=.001). The perioperative administration of IV lignocaine resulted in decreased postoperative analgesic requirement and greater patient satisfaction scores. Perioperative IV lignocaine infusion provided good pain relief, hemodynamic stability and decreased perioperative analgesic consumption. PONV incidence decreased along with an early return of bowel function, reduced LOS and improved patient satisfaction in patients undergoing laparoscopic IPOM surgery.