Comparative Patient Reported Outcomes in Laparoscopic Intraperitoneal Onlay Mesh Repair for Ventral Hernia with or Without Defect Closure - A 9-year Follow Up Case Controlled Study

Comparative Patient Reported Outcomes in Laparoscopic Intraperitoneal Onlay Mesh Repair for Ventral Hernia with or Without Defect Closure – A 9-year Follow Up Case Controlled Study

Objective of Study
Intra-peritoneal onlay mesh (IPOM) is the gold standard technique of laparoscopic ventral hernia repair (LVHR), a ‘standard of care’ day care procedure. We have reported vest over pant closure of defect (VOPCOD) preceding IPOM in LVHR raising debate of anatomical restoration for functional compliance versus compromise with the ‘tension free repair’ principle. Hence we compared the clinical patient reported outcomes of LVHR with IPOM versus IPOM+VOPCOD
Methods and procedures
From January2000 – December 2004 unselected consecutive non smoking candidates for day care LVHR were operated (general-anesthesia) by either IPOM( control) or IPOM+VOPCOD(study) according to informed consent based patient preference. A dual surface e-polytetrafluoroethylene prosthesis was used.

End Point		Measuring Scale
Nausea	0-no nausea; 1-some; 2-moderate; 3-severe; 4-vomiting
Pain	No pain-0 to worst pain-100@100 point visual analog scale(VAS)
Local Stiffness		No stiffness to maximum stiffness 0-100 point VAS
Contour Restoration		Worst shape to best shape 0-100 point VAS
Prospective Data-Day1 (D1), Day3 (D3), 3rd week (W3),3rd month (M3) & Year(Y) 1…9.

Results
Study (n=30) & Control (n=41) were well matched for demographic, co-morbidity & hernia content profile. There was no visceral injury, technical difficulty, conversion, any adverse event or failure to discharge from daycare. There was no loss in follow up.

Demographics & Per-operative Data

Group	Age		Defect Length(cms)		Defect number		Mesh Size used(cms)			Operating Time(min)
	Mean	Range	Mean	Range	=1	>1	10×15	10×20	15×20	Mean	Range
Control	46	21-67	5	3-10	29	12	0	0	41	70	55-115
Study	49	32-74	5.7	3-10	26	4	20	10	0	90	75-110

Mean Scores of Patient Reported Outcomes

Group	Pain				Nausea			Stiffness			Contour
	D1	D3	W3	M3	D1	D2	D3	W3	M3	Y1	W3	M3	Y1
Control	80	80	34	18	3	2.6	1	80	64	26	17	25	44
Study	84	85	26	16	3	2.4	1	80	58	16	68	90	100
Seroma	Noticed at W3 in Study but less pronounced than Controls where they were apparent from D1 but resolved in all by M3
Recurrence	None reported or clinically detected in either of the groups during a follow-up of 9 years (minimum being 5 years).

Mean Mass of the Implanted Prosthesis reduced by 50 %

Control	300 sq.cm./Patient	60 sq.cm./Cm. of Defect Length per patient
Study	167 sq.cm./Patient	29.5 sq.cm./Cm. of Defect Length per patient

Conclusions:
Anatomical defect closure in IPOM based LVHR reduces the implanted prosthetic mass thus improving all patient reported outcomes without additional risk of recurrence. This needs to be studied with better designed studies for larger hernia defects with addition of Component Part Separation.

Session: Poster

Program Number: P472