Page 10 - World Journal of Laparoscopic Surgery
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Comparison of Types of IPOM
            realized that the placement and fixation of the mesh were more   Comparable single-institution case series and one multicenter
            crucial in determining the outcome of the repairs.   randomized study reported recurrence rates as low as 0–2.5%. 13–17
               The placement of the mesh in the preperitoneal, retromuscular   Our study showed no significant relation between mesh
            position with a wide overlap of at least 5 cm over hernia defect in all   fixation by use of suture passer with transfascial sutures and
            directions was introduced in the late 1980s. The extensive dissection   nonabsorbable tackers and recurrence of the hernia, which is
            in open procedure accounted for most of its complications   consistent with the existing literature. 14,15  There has been a recent
               Omphalocele,  gastroschisis,  and  divarication  of  rectus   focus on the use of glue for mesh fixation, particularly in areas
            abdominis account for a congenital visceral hernia. Latrogenic   such as the subcostal margins and close to the xiphisternum and
            factor accounts for incisional hernias. The faulty technique of closing   pelvis. Other studies have emphasized that mesh fixation using
            the 10 mm port after surgery can also account for incisional hernias.   fibrin glue in patients with a ventral hernia is associated with less
            Systemic and other comorbid conditions can also account for the   postoperative pain. 18–20
            development of incisional hernia such as cough, steroid intake,
            wound infection, cancer, morbid obesity, nutritional imbalance,   conclusIon
            and wound infection. These reduce collagen synthesis and wound
            healing.                                           Intraperitoneal Onlay Mesh is an acceptable technique. In our study,
               Other factors include duration of the operation, crossing   even though PPV is shown to be associated with a significantly
            incisions, ineffective wound drainage, and excessive wound tension.   higher incidence of adhesion-related intestinal obstruction, it is
            Two other important variables include nutritional aspects as well as   still feasible to use because intestinal obstruction resulting from its
                            4
            the presence of cancer  which overall reduces the ability for wound   usage easily gets relieved by simple conservative treatment as can
            healing and collagen deposition in the wound. Three to thirteen   be seen in our cases. Also, this study will further promote its usage
            percent of laparotomy patients develop incisional hernias. Multiple   as can be seen in the lower incidence of recurrence, seroma, and
            defects (Swiss cheese hernias) are best done by laparoscopy as all   hematoma formation as compared to the composite mesh and also
            defects unlike in the open approach get directly visualized and   for the fact that it is cheaper than composite mesh. The composite
            appropriately covered by a single mesh.            mesh, however, can equally be used if the patients can afford it,
               Contraindication of laparoscopic repair of ventral hernia is very   especially in a resource-poor setting such as ours. However, for the
            Large hernia with huge protrusion of skin which is thin enough,   newer meshes such as proceed and the biological meshes (surgisis
            and skin fold is necessary to correct by abdominoplasty. Dense   and alloderm), more studies should be done.
            intra-abdominal adhesions are also a relative contraindication of
            laparoscopic repair of ventral hernia.             references
               Clinical evidence suggests that omental adhesion is common,     1.  Korenkov M, Paul A, Sauerland S, et al. Classification and surgical
            but bowel adhesion is not common and as such usage of PPV is safe. 5  treatment of incisional hernia. Results of an experts meeting.
               Incisional hernias mostly become clinically manifest between 2   Langerbecks Arch Surg 2001;386(1):65–73. DOI: 10.1007/
                                                                    s004230000182.
            and 5 years after surgery, and studies have shown that the process     2.  Zhang Y, Zhou H, Chai Y, et al. Laparoscopic versus open incisional
            starts within the first postoperative month. They are said to occur   and ventral hernia repair: a systematic review and meta-analysis
            as a result of the biochemical failure of the acute fascial wound   World J surg 2014;38(9):2233–2240. DOI: 10.1007/s00268-014-2578-z.
            coupled with clinically relevant impediments to acute tissue repair     3.  Cassar K, Munro A. Surgical treatment of incisional hernia. Br J Surg
            and normal support function of the abdominal wall. Our findings   2002;89(5):534–545. DOI: 10.1046/j.1365-2168.2002.02083.x.
            suggest that there were related complications with the use of both     4.  Anthony T, Bergen PC, Kim LT, et al. Factors affecting recurrence
            meshes.                                                 following incisional herniorrhaphy. World J Surg 2000;24(1):95–101.
               In our series, PPV was associated with a significant incidence of   DOI: 10.1007/s002689910018.
            bowel obstruction caused by adhesion and this has been proven     5.  Berger D, Bientzle M, Muller A. Post operative complications after
                                                                    Laparoscopic incisional hernia repair. Incidence and treatment. Surg
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            histologicallyl.  Various experimental modes and studies suggest   Endosc 2002;16(12):1720–1723. DOI:  10.1007/s00464-002-9036-y. 
            decreased adhesion formation with the use of composite mesh 7–11      6.  Fortenlny RH, Petter-Puchner AH, Glaser KS, et al. Adverse effects
            with most questioning that coated meshes perform better with   of polypropylene fluoride-coated poly propylene mesh used for
            less adhesion formation. There may be individual idiosyncrasies   laparoscopic intraperitoneal onlay repair of incisional hernia. Br J
            to these meshes. However, more work has to be done to elucidate   Surg 2010;97(7):1140–1145. DOI: 10.1002/bjs.7082.
            these variations. A higher rate of seroma/hematoma formation      7.  Burger JW, Halm JA, Wijsmuller AR, et al. Evaluation of new prosthetic
            24% was noted in the composite group in our study. Coated   meshes for ventral hernia repair. Surg Endosc 2006;20(8):1320–1325.
            meshes that are commonly used in intraperitoneal mesh repairs   DOI: 10.1007/s00464-005-0706-4.
            are typically associated with seroma formation because of the     8.  Mc Ginty JJ, Hogle NJ, Mc carthy H, et al. A comparative study of
                                                                    adhesion format-ion and abdominal wall ingrowth after Laparoscopic
            resulting impaired drainage of fluid due to the barrier coating.   ventral hernia in a porcine model using multiple types of mesh. Surg
            There may be other contributing factors such as the number   Endosc 2005;19(6):786–790. DOI:  10.1007/s00464-004-8174-9.
            and size of the defects, the difficulty of dissection, mesh fixation     9.  Kayaoglu HA, Ozkan N, Hazinedaroglu SM, et al. Comparison of adhesive
            technique, and operation time.                          properties of five different prosthetic materials used in hernioplasty.
               Titanium-coated lightweight mesh versus standard composite   J Invest Surg 2005;18(2):89–95. DOI: 10.1080/08941930590926357.
            mesh comparison showed no differences in recurrence rate but     10.  Schreinemacher MH, Van Barneveld KW, Dikmans RE, et al. Coated
            a lower incidence of pain-related complications in the titanium-  meshes for hernia repair provide comparable intraperitoneal
                           12
            coated mesh group.                                      adhesion prevention. Surg Endosc 2013;27(11):4202–4209. DOI:
                                                                    10.1007/s00464-013-3021-5.
               In our study, a significant recurrence rate of 15% was noted in     11.  Deeken CR, Faucker KM, Mathews BD. A review of the composition,
            the composite mesh group as compared to 10% in the PPV group.   characteristics and effectiveness of barrier mesh prostheses utilized

            106   World Journal of Laparoscopic Surgery, Volume 15 Issue 2 (May–August 2022)
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