A study to compare outcomes in patients undergoing intraperitoneal onlay mesh plus and eTEP repair for ventral wall and incisional hernia

Authors

  • Hussain Arish Department of Surgical Gastroenterology, Global Hospitals Group, Hyderabad, Telangana, India
  • Faisal A. Masudi Department of Surgical Gastroenterology, Global Hospitals Group, Hyderabad, Telangana, India

DOI:

https://doi.org/10.18203/2349-2902.isj20232988

Keywords:

eTEP, IPOM plus, Intraperitoneal onlay, Ventral wall hernia, Incisional hernia

Abstract

Background: The introduction of minimally invasive surgery in the early 1990s enabled the possibility of laparoscopic ventral or incisional hernia repair in 1993. At present IPOM Plus (intraperitoneal onlay mesh) is the most frequent technique used for laparoscopic ventral hernia repair, and the mesh is placed just under the peritoneum and enhanced view totally extraperitoneal repair. A relatively new approach based on TEP repair for inguinal hernia has also shown to be safe and effective. our study is primarily aimed at assessing and comparing outcomes of lap IPOM plus and eTEP, in terms of operative time, postoperative pain, length of hospital stay.

Methods: This is a retrospective cohort study. Data were collected from successive patients who have undergone minimally invasive ventral hernia repair from January 2020 to June 2022, in Global hospital Hyderabad). Data were entered into a prospectively maintained database and retrospectively analysed. Pateints were distributed into two groups IPOM plus and eTEP. Perioperative data were analysed using statistical tests.

Results: In this study, a total of 76 patients with ventral and incisional hernias were included, with 40 patients undergoing IPOM plus repair and 36 patients undergoing eTEP repair. Both groups were similar in terms of risk factors, types of hernias, defect size. The duration of surgery was significantly shorter in the IPOM plus group (85.6 minutes) compared to the eTEP group (121.6 minutes). Postoperative pain, according to the VAS score at postoperative day 1 and 3, was significantly higher in the IPOM plus group (7.5 and 5.6, respectively) compared to the eTEP group (3.8 and 1.6, respectively). However, at day 30, pain scores in both groups were not statistically significant (IPOM plus-1.2 vs. eTEP 1.1). The mean length of hospital stay in the IPOM plus group (5.3 days) was significantly longer than in the eTEP group (3.1 days).

Conclusions: The eTEP technique exhibits significantly lower postoperative pain and results in a reduced length of hospital stay. However, it is worth noting that the eTEP procedure does require a longer operative time compared to IPOM Plus.

References

Smith J, Parmely JD. Ventral hernia. Treasure Islands: Stat Pearls Publishing; 2021.

Veilleux E, Lutfi R. Obesity and Ventral Hernia Repair: Is There Success in Staging?. J Laparoendosc Adv Surg Tech. 2020;30(8):896-899.

LeBlanc KA, Booth WV. Laparoscopic repair of incisional abdominal hernias using expanded polytetrafuoroethylene: preliminary fndings. Surg Laparosc Endosc 1993;3(1):39-41.

Park Y, Chung M. Laparoscopic Ventral Hernia Repair. J Minimal Invas Surg. 2017;20(3):93-100.

Belyansky I, Daes J, Radu VG, Balasubramanian R, Reza ZH, Weltz AS, et al. A novel approach using the enhanced-view totally extraperitoneal (eTEP) technique for laparoscopic retromuscular hernia repair. Surg Endosc. 2011;32(3):1525-32.

Baig SJ, Priya P. Extended totally extraperitoneal repair (eTEP) for ventral hernias: Short-term results from a single centre. J Minim Access Surg. 2019;15(3): 198-203.

Malik S, Wijerathne S. Laparoscopic Intraperitoneal Onlay Mesh (IPOM) and IPOM Plus. In: Lomanto D, Chen WTL, Fuentes MB, eds. Mastering Endo-Laparoscopic and Thoracoscopic Surgery. Singapore: Springer. 2011.

Basukala S, Tamang A, Rawal SB, Malla S, Bhusal U, Dhakal S, Sharma S. Comparison of outcomes of laparoscopic hernioplasty with and without fascial repair (IPOM-Plus vs IPOM) for ventral hernia: A retrospective cohort study. Ann Med Surg. 2022;80: 104297.

Jamry A, Jałyński M, Piskorz L, Brocki M. Assessment of adhesion formation after laparoscopic intraperitoneal implantation of Dynamesh IPOM mesh. Arch Med Sci. 2013;9(3):487-92.

Domen A, Stabel C, Jawad R, Duchateau N, Fransen E, Vanclooster P, de Gheldere C. Postoperative ileus after laparoscopic primary and incisional abdominal hernia repair with intraperitoneal mesh (DynaMesh®-IPOM versus ParietexTM Composite): a single institution experience. Langenbecks Arch Surg. 2021; 406(1):209-18.

Bansal VK, Asuri K, Panaiyadiyan S, Kumar S, Subramaniam R, Ramachandran R, et al. Comparison of Absorbable Versus Nonabsorbable Tackers in Terms of Long-term Outcomes, Chronic Pain, and Quality of Life After Laparoscopic Incisional Hernia Repair: A Randomized Study. Surg Laparosc Endosc Percutan Tech. 2016;26(6):476-483.

Salido FS, Fraile VM, Osorio SI, Georgiev HT, Bernar de OJ, González-Ayora S, et al. Extended Totally Extraperitoneal (eTEP) Approach for Ventral Hernia Repair: Initial Results. Cir Esp. 2020;98(5):260-6.

Choi YY, Kim Z, Hur KY. Learning curve for laparoscopic totally extraperitoneal repair of inguinal hernia. Can J Surg. 2012;55(1):33-6.

Downloads

Published

2023-09-28

Issue

Section

Original Research Articles