Outcomes of bridging versus mesh augmentation in laparoscopic repair of small and medium midline ventral hernias
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Bridging of the hernia defect in laparoscopic repair (sIPOM) technique does not fully restore the abdominal wall function. Closure of hernia defect in IPOM-plus technique leads to the restoration of abdominal wall function and improved long-term treatment outcomes. Against the expectations, the studies confirm the formation of intraabdominal adhesions to the mesh. Regardless of the above, the search of the proper technique for mesh implantation and fixation is still ongoing. There have also been attempts to identify groups of patients who may still benefit from IPOM procedure.
Materials and methods
Patients with midline abdominal wall hernias up to 10 cm wide were enrolled in the study except for subxiphoid and suprapubic hernias. Between 2011 and 2014 we performed 82 hernia repairs using the laparoscopic technique with Physiomesh. Patients were divided into sIPOM and IPOM-plus groups. The study included 44M and 38F patients aged 27–84 years. After 12-months and again in August 2015 a survey was posted to all patients with questions regarding potential recurrence.
After 12 months, eight patients (20 %) in sIPOM group reported subjectively perceived recurrence and none in IPOM-plus group (p = 0.002). Six patients (14.3 %) in sIPOM group reported suspected recurrence, as compared to three patients (7.1 %) in IPOM-plus group (p = 0.13). These patients were invited for a follow-up physical examination and sonography. Eventually, four cases of hernia recurrence were confirmed in sIPOM group (10 %) and none in IPOM-plus group (p = 0.018). Other patients presented with mesh bulging.
Laparoscopic ventral hernia repair is generally safe and is associated with the low recurrence rate. Closure of fascial defects before mesh insertion offers better treatment outcomes. Non-closure of fascial defects with only bridging of the hernia defect (sIPOM) causes more frequent recurrence and bulging. As a result, patient satisfaction with treatment is lower, and they are concerned about hernia recurrence.
KeywordsHernia repair Mesh IPOM Bridging Suturing Physiomesh
Compliance with ethical standards
Kryspin Mitura, Marzena Skolimowska-Rzewuska and Karolina Garnysz have no conflict of interest.
- 3.Jenkins ED, Yom V, Melman L, Brunt LM, Eagon JC, Frisella MM, Matthews BD (2010) Prospective evaluation of adhesion characteristics to intraperitoneal mesh and adhesiolysis-related complications during laparoscopic reexploration after prior ventral hernia repair. Surg Endosc 24:3002–3007CrossRefPubMedGoogle Scholar
- 8.Rickert A, Kienle P, Kuthe A, Baumann P, Engemann R, Kuhlgatz J, von Frankenberg M, Knaebel HP, Büchler MW (2012) A randomised, multi-centre, prospective, observer and patient blind study to evaluate a non-absorbable polypropylene mesh vs. a partly absorbable mesh in incisional hernia repair. Langenbecks Arch Surg 397(8):1225–1234CrossRefPubMedPubMedCentralGoogle Scholar
- 11.Suwa K, Okamoto T, Yanaga K (2015) Closure versus non-closure of fascial defects in laparoscopic ventral and incisional hernia repairs: a review of the literature. Surg Today. doi: 10.1007/s00595-015-1219-y
- 17.Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E, Dietz UA, Eker HH, El Nakadi I, Hauters P, Pascual MH, Hoeferlin A, Klinge U, Montgomery A, Simmermacher RK, Simons MP, Smietański M, Sommeling C, Tollens T, Vierendeels T, Kingsnorth A (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13(4):407–414CrossRefPubMedPubMedCentralGoogle Scholar
- 21.Pascual G, Sotomayor S, Rodríguez M, Bayon Y, Bellón JM (2015) Tissue integration and inflammatory reaction in full-thickness abdominal wall repair using an innovative composite mesh. Hernia. doi: 10.1007/s10029-015-1383-4
- 23.Bittner R, Bingener-Casey J, Dietz U, Fabian M, Ferzli GS, Fortelny RH, Köckerling F, Kukleta J, LeBlanc K, Lomanto D, Misra MC, Morales-Conde S, Ramshaw B, Reinpold W, Rim S, Rohr M, Schrittwieser R, Simon Th, Smietanski M, Stechemesser B, Timoney M, Chowbey P (2014) Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society [IEHS])—Part 2. Surg Endosc 28:353–379CrossRefPubMedGoogle Scholar
- 28.Chelala E, Baraké H, Estievenart J, Dessily M, Charara F, Allé JL (2015) Long-term outcomes of 1326 laparoscopic incisional and ventral hernia repair with the routine suturing concept: a single institution experience. Hernia. 21 June 2015. [Epub ahead of print]Google Scholar
- 31.Muysoms FE, Antoniou SA, Bury K, Campanelli G, Conze J, Cuccurullo D, de Beaux AC, Deerenberg EB, East B, Fortelny RH, Gillion JF, Henriksen NA, Israelsson L, Jairam A, Jänes A, Jeekel J, López-Cano M, Miserez M, Morales-Conde S, Sanders DL, Simons MP, Śmietański M, Venclauskas L, Berrevoet F, European Hernia Society (2015) European Hernia Society guidelines on the closure of abdominal wall incisions. Hernia 19(1):1–24CrossRefPubMedGoogle Scholar