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

View Poster

« Return to SAGES 2010 abstract archive