Laparoscopic Intra-peritoneal Mesh Repair combined with clean contaminated surgeries – Feasibility and safety.

C Palanivelu, MS, FACS, P Praveen Raj, MS, P Senthilnathan, MS, R Parthasarathi, MS, M K Ganesh

GEM Hospital & Research Centre

Since the first report of laparoscopic ventral hernia repair in 1992, this procedure has gained popularity with benefits of shorter hospital stay, improved patient outcome and fewer complications than the traditional open procedures. Many at times patients will have multiple surgical problems and laparoscopy offers the ability to tackle these problems in the same sitting. In this novel paper we try to study the safety of combining laparoscopic intraperitonial mesh repair (IPOM) with clean contaminated surgeries like cholecystectomy and hysterectomy. We hereby report the technical details and immediate post-operative result of such procedures.

Material and methods
Between 2006 and 2011 we did 246 cases of laparoscopic IPOM in combination with clean contaminated surgeries. Out of that 126 were hysterectomies and 120 were cholecystectomies. The details of these surgeries and the immediate postoperative out comes were collected in retrospective as well as in a prospective manner and analysed.

Results
Indications for combined procedure were Hysterectomy for non-malignant causes and Cholecystectomy for symptomatic stones with non- inflamed gall bladder associated with Incision hernia. The commonest surgery associated with incisional hernia was Caesarean section. Mean operating time for laparoscopic IPOM with cholecystectomy was 136 minutes (112 – 172 minutes) and 224 minutes (196 – 285 minutes) for laparoscopic IPOM with hysterectomy. The average hospital stay were 4.3 days (3 – 7 days) for laparoscopic IPOM with hysterectomy and 2.73 days (range: 1– 5 days) for laparoscopic IPOM with cholecystectomy. We had 36 cases (14.6 %) of seroma, for which 16 patients (6.5%) warranted aspiration. We had a single mesh infection. The complication rates were comparable to our results of Intra-peritoneal mesh repair when performed alone.

CONCLUSION
Laparoscopic intra peritoneal onlay mesh can be performed simultaneously with selected clean contaminated surgeries with acceptable morbidity. The infective complications of combined procedures are not different from IPOM performed alone. Combining certain selected clean contaminated surgeries does not alter the outcome of the procedure.

Session: Podium Presentation

Program Number: S101