Laparoscopic management of ventral hernia repair using intraperitoneal synthetic mesh: A 10-year retrospective observational study

Objective

Ventral hernia is an anterior abdominal wall hernia, with an incidence of 2%–13%. Laparoscopic ventral hernia repair is the preferred method worldwide with all the advantages of the laparoscopic technique proven to be an effective treatment option. This study aims to assess the long-term outcomes of laparoscopic management of ventral hernia repair using intraperitoneal onlay mesh (IPOM) or intraperitoneal onlay mesh with defect closure (IPOM PLUS) technique with the usage of variety of synthetic meshes intraperitoneally.

Methods

A retrospective study of 821 patients of a single institution for a decade was conducted. Long-term outcomes such as pain, mesh infections, enterocutaneous fistula, bowel adhesions and recurrence were assessed.

Results

There were 801 primary, 12 incisional, and 8 recurrent hernia cases, including 532 females and 289 males with a mean age of 45.62±9.37 years. IPOM PLUS were underwent in 674 (82.10%) cases. Polypropylene, dual, titanium, composite meshes were applied in 473 (57.61%), 208 (25.33%), 82 (9.99%), and 58 (7.06%) cases respectively. Intraoperative bleeding occurred in 3 (0.37%) cases, seroma in 8 (0.97%), wound infection in 4 (0.49%), stitch abscess in 2 (0.24%). Recurrence was found in 8 (0.97%) cases, with 5 used polypropylene mesh and 3 used dual mesh. Mesh infections were discovered in 6 (2.88%) cases used dual, and foreign body sensation in 4 (0.85%) cases used polypropylene. Three (0.37%) patients had suture site hernia, and 3 (0.37%) had chronic sinus.

Conclusion

IPOM or IPOM PLUS holds good in small or medium sized ventral hernias. The safety and efficacy of intraperitoneal polypropylene mesh is comparable to that of other synthetic meshes. A mesh overlap of minimum 5 cm beyond defect edge is must to minimise hernia recurrence. Absorbable suture can be considered as alternative to tackers.