Comparison of Results of the sIPOM and the IPOM-Plus Techniques for Small and Medium-Sized Primary Midline Abdominal Wall Hernias

Abstract

Abstract Aims: To compare the results of the standard intraperitoneal onlay mesh (sIPOM) and intraperitoneal onlay mesh-plus (IPOM-Plus) techniques for the repair of small and medium-sized primary midline abdominal wall hernias (PMAWHs). Material and Method: A prospectively documented data of 82 patients who underwent the sIPOM and IPOM-Plus approach between January 2016 and December 2021 was retrospectively evaluated. Forty-one patients with PMAWH repaired with sIPOM (18) and IPOM-Plus (23) were included in the study. Median follow-up for the sIPOM and IPOM-Plus was 73 and 51 months (mean 73.83±7.81vs. 47.43±19.22), respectively. Results: Both groups had no difference in demographics, comorbidities, and smoking habits. The mesh area (MA) and the mesh-to-defect ratio (MDR) were not significant (p=0.083 and p= 0.30, respectively); however, the defect area (DA) was higher in the sIPOM group (p= 0.005). The IPOM-Plus group had a longer operative time and length of hospital stay (LOHS) and higher early postoperative pain than the IPOM group (p = 0.002, p = 0.049 and p <0.001). Seroma developed in 4 (22.2%) and 2 (8.6%) patients in the sIPOM and IPOM-Plus groups, respectively, with no significant difference (p=0.477). There was two (11.1%) recurrence in the sIPOM group, while no recurrences were observed in the IPOM-Plus group (p = 0.196). Conclusions: The IPOM-Plus approach has similar seroma and recurrence rates to sIPOM in small and medium-sized PMAWH, but with higher postoperative pain and longer LOHS. More randomized controlled studies (RCTs), meta-analyses, and multi-center studies with large samples are needed for more valuable results.

Keywords

• sIPOM
• IPOM-Plus
• Primary abdominal wall hernia
• Laparoscopic hernia repair

Küçük ve Orta Büyüklükteki Primer Ortahat Karın Duvarı FıtIklarında sIPOM ve IPOM-Plus Tekniklerinin Sonuçlarının Karşılaştırılması

Abstract

Öz Amaç: Küçük ve orta büyüklükteki primer orta hat karın duvarı fıtıklarının (PMAWH) onarımında standart intraperitoneal onlay mesh (sIPOM) ve intraperitoneal onlay mesh-plus (IPOM-Plus) tekniklerinin sonuçlarının karşılaştırılması amaçlandı. Gereç ve Yöntem: Ocak 2016 ile Aralık 2021 arasında sIPOM ve IPOM-Plus yaklaşımı uygulanan 82 hastanın prospektif olarak belgelenmiş verileri retrospektif olarak değerlendirildi. Çalışmaya sIPOM (18) ve IPOM-Plus (23) ile onarılan 41 PMAWH hastası dahil edildi. sIPOM ve IPOM-Plus için ortanca takip süresi sırasıyla 73 ve 51 (ortalama 73.83±7.81vs. 47.43±19.22) aydı. Bulgular: Her iki grupta demografik özellikler, eşlik eden hastalıklar ve sigara içme alışkanlığı açısından fark yoktu. Mesh alanı (MA) ve mesh-defekt oranı (MDR) istatistiksel olarak anlamlı değildi (sırasıyla p=0,083 ve p=0,30); ancak defekt alanı (DA) sIPOM grubunda daha yüksekti (p= 0,005). IPOM-Plus grubunda ameliyat süresi ve hastanede kalış süresi (LOHS) daha uzundu ve erken ameliyat sonrası ağrı daha fazlaydı (p = 0,002, p=0,049, p <0,001). sIPOM ve IPOM-Plus gruplarında sırasıyla 4 (%22,2) ve 2 (%8,6) hastada seroma gelişti, anlamlı fark yoktu (p=0,477). sIPOM grubunda iki (%11,1) nüks görülürken, IPOM-Plus grubunda nüks gözlenmedi (p = 0,196). Sonuç: IPOM-Plus yaklaşımı, küçük ve orta büyüklükteki PMAWH'de sIPOM ile benzer seroma ve nüks oranlarına sahiptir, ancak ameliyat sonrası ağrı daha yüksek ve LOHS daha uzundur. Daha değerli sonuçlar için daha fazla randomize kontrollü çalışmaya (RKÇ), meta-analizlere ve geniş örneklemli çok merkezli vaka kontrol çalışmalarına ihtiyaç vardır.

Keywords

• sIPOM
• IPOM-Plus
• Primer karın duvarı fıtığı
• Laparoskopik fıtık tamiri

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