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.
| 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 |
| 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). | ||||||||||||
| 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
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