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

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.

Anahtar Kelimeler:

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

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

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,

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[1] K A LeBlanc, W V Booth. Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: preliminary findings. Surg Laparosc Endosc 1993;3:39–41.
[2] Franklin JE, Gonzalez JJ, Glass JL, Manjarrez A. Laparoscopic ventral and incisional hernia repair: An 11-year experience. Hernia 2004;8:23–7. https://doi.org/10.1007/s10029-003-0163-8.
[3] Sauerland S, Walgenbach M, Habermalz B, Seiler CM, Miserez M. Laparoscopic versus open surgical techniques for ventral or incisional hernia repair. Cochrane Database of Systematic Reviews 2011. https://doi.org/10.1002/14651858.cd007781.pub2.
[4] Agarwal BB, Agarwal S, Gupta MK, Mishra A, Mahajan KC. Laparoscopic ventral hernia meshplasty with "double-breasted" fascial closure of hernial defect: A new technique. Journal of Laparoendoscopic and Advanced Surgical Techniques 2008;18:222–9. https://doi.org/10.1089/lap.2007.0112.
[5] Liang MK, Subramanian A, Awad SS. Laparoscopic Transcutaneous Closure of Central Defects in Laparoscopic Incisional Hernia Repair. Surg Laparosc Endosc Percutan Tech 2012;22:e66–70. https://doi.org/10.1097/SLE.0b013e3182471fd2.
[6] Orenstein SB, Dumeer JL, Monteagudo J, Poi MJ, Novitsky YW. Outcomes of laparoscopic ventral hernia repair with routine defect closure using "shoelacing" technique. Surg Endosc 2011;25:1452–7. https://doi.org/10.1007/s00464-010-1413-3.
[7] Chelala E, Thoma M, Tatete B, Lemye AC, Dessily M, Alle JL. The suturing concept for laparoscopic mesh fixation in ventral and incisional hernia repair: Mid-term analysis of 400 cases. Surgical Endoscopy and Other Interventional Techniques 2007;21:391–5. https://doi.org/10.1007/s00464-006-9014-x.
[8] Bittner R, Bingener-Casey J, Dietz U, Fabian M, Ferzli GS, Fortelny RH, et al. Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS) - Part 1. Surg Endosc 2014;28:2–29. https://doi.org/10.1007/s00464-013-3170-6.
[9] Muysoms F. IPOM: history of an acronym. Hernia 2018;22:743–6. https://doi.org/10.1007/s10029-018-1804-2.
[10] Kroese LF, Gillion JF, Jeekel J, Kleinrensink GJ, Lange JF. Primary and incisional ventral hernias are different in terms of patient characteristics and postoperative complications - A prospective cohort study of 4,565 patients. International Journal of Surgery 2018;51:114–9. https://doi.org/10.1016/j.ijsu.2018.01.010.
[11] Bittner R, Bain K, Bansal VK, Berrevoet F, Bingener-Casey J, Chen D, et al. Update of Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS))—Part A. Surg Endosc 2019;33:3069–139. https://doi.org/10.1007/s00464-019-06907-7.
[12] Köckerling F, Schug-Paß C, Adolf D, Reinpold W, Stechemesser B. Is Pooled Data Analysis of Ventral and Incisional Hernia Repair Acceptable? Front Surg 2015;2. https://doi.org/10.3389/fsurg.2015.00015.
[13] Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E, et al. Classification of primary and incisional abdominal wall hernias. Hernia 2009;13:407–14. https://doi.org/10.1007/s10029-009-0518-x.
[14] Earle D, Roth JS, Saber A, Haggerty S, Bradley JF, Fanelli R, et al. SAGES guidelines for laparoscopic ventral hernia repair. Surg Endosc 2016;30:3163–83. https://doi.org/10.1007/s00464-016-5072-x.
[15] Sajid MS, Bokhari SA, Mallick AS, Cheek E, Baig MK. Laparoscopic versus open repair of incisional/ventral hernia: a meta-analysis. Am J Surg 2009;197:64–72. https://doi.org/10.1016/j.amjsurg.2007.12.051.
[16] Bernardi K, Olavarria OA, Holihan JL, Kao LS, Ko TC, Roth JS, et al. Primary Fascial Closure during Laparoscopic Ventral Hernia Repair Improves Patient Quality of Life: A Multi-center, Blinded Randomized Controlled Trial. Ann Surg 2020;271:434–9. https://doi.org/10.1097/SLA.0000000000003505.
[17] Basukala S, Tamang A, Rawal SB, Malla S, Bhusal U, Dhakal S, et al. Comparison of outcomes of laparoscopic hernioplasty with and without fascial repair (IPOM-Plus vs IPOM) for ventral hernia: A retrospective cohort study. Annals of Medicine and Surgery 2022;80. https://doi.org/10.1016/j.amsu.2022.104297.
[18] Olmi S, Millo P, Piccoli M, Garulli G, Nardi MJ, Pecchini F, et al. Laparoscopic treatment of incisional and ventral hernia. Journal of the Society of Laparoendoscopic Surgeons 2021;25. https://doi.org/10.4293/JSLS.2021.00007.
[19] Saijo F, Tokumura H, Narushima Y, Matsumura N, Sato K, Okazaki Y. The quality of life after laparoscopic ventral and incisional hernia repair with closure and non-closure of fascial defect. Surg Today 2019;49:942–7. https://doi.org/10.1007/s00595-019-01834-5.
[20] Gómez-Menchero J, Balla A, Fernández Carazo A, Morales-Conde S. Primary closure of the midline abdominal wall defect during laparoscopic ventral hernia repair: analysis of risk factors for failure and outcomes at 5 years follow-up. Surg Endosc 2022;36:9064–71. https://doi.org/10.1007/s00464-022-09374-9.
[21] Christoffersen MW, Westen M, Rosenberg J, Helgstrand F, Bisgaard T. Closure of the fascial defect during laparoscopic umbilical hernia repair: a randomized clinical trial. British Journal of Surgery 2020;107:200–8. https://doi.org/10.1002/bjs.11490.
[22] Martin-del-Campo LA, Miller HJ, Elliott HL, Novitsky YW. Laparoscopic ventral hernia repair with and without defect closure: comparative analysis of a single-institution experience with 783 patients. Hernia 2018;22:1061–5. https://doi.org/10.1007/s10029-018-1812-2.
[23] Tandon A, Pathak S, Lyons NJR, Nunes QM, Daniels IR, Smart NJ. Meta-analysis of closure of the fascial defect during laparoscopic incisional and ventral hernia repair. British Journal of Surgery 2016;103:1598–607. https://doi.org/10.1002/bjs.10268.
[24] Chelala E, Baraké H, Estievenart J, Dessily M, Charara F, Allé JL. Long-term outcomes of 1326 laparoscopic incisional and ventral hernia repair with the routine suturing concept: a single institution experience. Hernia 2016;20:101–10. https://doi.org/10.1007/s10029-015-1397-y.