Om Prakash, Shardool Vikram Gupta, Virinder Kumar Bansal, Subodh Kumar, Asuri Krishna, M. C. Misra. AIIMS, New Delhi
Introduction: The literature continues to be ambiguous on the type of mesh to be used in laparoscopic incisional/ventral hernia repair. This study presents non randomised comparison of pure propylene and covered mesh in laparoscopic incisional and ventral hernia repair.
Material and Methods: Patients undergoing laparoscopic incisional or ventral hernia repair in a single surgical unit from 2004 to 2015 were studied. The data was collected from a prospectively maintained database and analysed retrospectively.These patients were divided into two groups depending on the type of mesh used i.e. pure polypropylene (PP group) mesh or covered mesh (CM group).Laparoscopic repair of incisionaland ventral hernia was done following a standard protocol.A mesh of appropriate size was used to overlap all the defects with a margin of at least 4-5 cm in all directions. Mesh fixation was done with a 5mm non absorbable or absorbable fixation device in double crown fashion along with 4 corners transfascial sutures.Patients were followed up in the follow up clinic at 1 week, 6 weeks, 3months, 6months and yearly thereafter.
Results: Eight hundred eighty patients underwent incisional and ventral hernia repair during this period. Laparoscopic repair was performed in 500 patients. Conversion to open repair was done in 30 patients because of dense adhesions. Pure polypropylene mesh was used to repair the hernia in 174 patients (PP group) and covered mesh was used in 326 patients (CM group).Commonest index surgery of incisional hernia was lower section Caesarean section. Seroma formation difference was not statistically significant between the two groups. Wound infection was comparable in both groups (4.6 % in PP and 5.2% in CM). Post operative pain scores were similar in both groups. Three patients in both groups required relaparoscopy for unsettled abdomen. Six patients (3.4%) in PP group and 8 patients (2.5%) in CM group had prolonged ileus. Sixteen patients(9.2%) in PP group while 28 patients(8.6%) in CM group required readmission for various reasons.Subacute intestinal obstruction was seen in 12 patients(6.9%) in PP group while in 18 patients(5.5%) in CM group. There were 28 recurrences, 11(5.9%) in pure polypropylene group and 17 (4.9%) in covered mesh group.The median duration of recurrence was 2 years with a range of 16 to 48 months.
Conclusion: Outcomes with pure polypropylene mesh are comparable to covered mesh for laparoscopic ventral and incisional hernia repair with regards to postoperative pain, complications and recurrence rates.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94352
Program Number: P564
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster