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Post operative pain following Mesh fixation of ventral hernia repair: Comparison of transfascial with intracorporal suture fixation

Manoj K Choudhury, MS, FMAS, Kaushik Baruah, MS. Nemcare Superspeciality Hospital

Objective: Fixation of mesh is the most important step of ventral hernia repair. Transfascial mesh fixation has been the most accepted of all the methods, but the significant pain during early post operative period following fixation is still a cause of concern. In search of reducing the post operative pain, the intracorporal suture fixation has been carried out in our centre. So the study is undertaken to determine the post operative pain following  intracorporal suture fixation of mesh in ventral hernia repair and to compare the severity and duration of pain with transfascial fixation method.

Method & Procedures: 81 cases are taken up for study during the period from august,2015 to july, 2018.

Cases were admitted after clinical diagnosis and complete evaluation. Ultrasonography was the routine diagnostic investigation specially to measure the defect. CT scan was done in selected cases of complex hernias. Transfascial and intracorporal suture for mesh fixation were done in 33 and 47 cases respectively for the comparative study.

One 10 mm and two 5 mm trocars were introduced after CO2 insufflation. Abdominal cavity was examined and adhesiolysis was done to carry out the release of hernia content. Defect/s were cleared and prepared for mesh fixation with or without closure of the defect. Size of the composite mesh was determined by the size of the defect/s. 2-0 polypropylene was used to centralize the mesh with the centre of the hernia defect. Mesh was aseptically introduced through the 10 mm trocar and fixed with the centralizing suture. Fixation of the mesh was done either by transfascial sutures or by intracorporal sutures to fix the mesh with the abdominal wall. Ports were closed after completion of mesh fixation.

Post operative pain was recorded as per visual analog score 0- 10 (0- no pain, 10- most severe pain) and  compared the severity on day 0,2,7,14,30 and 60.

Results: Average age of the patients was between 35 and 65 years and was mostly female (83.75%). Comparative study of severity and duration of pain were found to be significantly less with intracorporal method  in comparison to transfascial method.. Day 0 ( t-value 5.201, p<0.01)  Day 2 (t-value 7.693, p<0.01), Day 7 (t-value-9.738, p<0.01), Day 14 (t-value 9.571, p<0.01).

Conclusion: Intracorporal mesh fixation is a technically demanding technique in comparison to transfascial method. But the study has shown significant reduction of post operative pain with intracorporal technique in comparison to transfascial.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 95929

Program Number: P579

Presentation Session: Poster Session (Non CME)

Presentation Type: Poster

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