Laparoscopic intra-peritoneal onlay mesh plus repair for ventral abdominal wall hernias - is there substance to the hype?

Abstract

Aim: To summarize our experience in laparoscopic intra-peritoneal onlay mesh (IPOM) plus repair for ventral abdominal wall hernias over a 10-year period.

Methods: All patients posted for laparoscopic repair of midline lower abdominal ventral hernia on an intention to treat basis were included in the study. Patients unfit for general anesthesia, patients posted for open repair or a hybrid approach (open reduction and closure of defect followed by laparoscopic IPOM repair) were excluded. Pre-operative patient demographics were noted. Intra-operative and post-operative data was recorded and analyzed.

Results: A total of 278 patients were posted for elective laparoscopic repair of lower midline ventral hernias between January 2007 and January 2017, of which, 56.1% were para-umbilical hernias and 43.9% were incisional hernias. These included 155 female patients. The average body mass index was 27 kg/m². Thirty-five patients were being operated for a recurrent ventral hernia. The average defect width was 1.2 cm for paraumbilical hernias and 2.2 cm for incisional hernias. The mean operating time was 55 min for para-umbilical hernias and 71 min for incisional hernias. In 13.1%, the fascia could not be sutured. There were no conversions to open surgery. Average length of hospital stay was 2.04 days with average follow-up period of 4.6 years. Overall morbidity was 7.9% with 2 recurrences. There was no mortality or mesh infection.

Conclusion: Thus, IPOM plus repair is a safe, feasible and effective technique for the treatment of ventral abdominal wall hernias.

Keywords

Laparoscopic ventral hernia repair / intra-peritoneal onlay mesh plus repair / closure of defect in the fascia / abdominal wall hernia / incisional hernia repair / para-umbilical hernia repair

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