Page 53 - World Journal of Laparoscopic Surgery

RESEARCH ARTICLE
Laparoscopic Ventral Hernia Repair: Intraperitoneal Onlay

Mesh Repair vs Transabdominal Retromuscular Repair

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Selmy Sabry Awad , Ashraf Shoma , Ahmed El-Khouli , Waleed Althobiti , Shaker Alfaran , Saleh Alghamdi , Saleh Alharthi ,
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Khaled Alsubaie , Soliman Ghedan , Rayan Alharthi , Majed Asiri , Azzah Alzahrani , Nawal Alotaibi , Ahmed Negm ,
Mohamed Samir Abou Sheishaa 15
AbstrAct
Background: Ventral hernia repair has changed over the past years by the introduction of laparoscopy and prosthetic materials. The laparoscopic
approach is now broadly done because it offers its advantages for the patients. The broad acceptance of laparoscopic surgery has afforded an
alternative to open repair of incisional hernia.
Objective: To compare the intraperitoneal onlay mesh (IPOM) repair vs the transabdominal retromuscular (TARM) repair as regards the
periprocedural data.
Patients and methods: This prospective study was conducted on 60 patients with a ventral hernia in the period from May 2018 to August 2019.
All eligible fit cases, who were 18-year-old and on with non-complicated ventral hernia (the size defect, ≤60 mm), were included. They were
simply randomized between the two techniques to compare operative time, intraoperative complications, postoperative pain, postoperative
hospital stay, postoperative complications, and cosmetic results.
Results: The IPOM repair (1st group) was done in 24 patients, while TARM repair was completed in 36 patients. The operative time of group I was
significantly shorter than that of group II. The repair in group I was cheaper than that in the other one. There was no significant injury to viscera
or vessel and no recurrence in either group. The hospital stay was shorter for both groups (28.0 ± 9.2 vs 26.0 ± 6.93 hours; p = 0.527) as well
as return to normal daily activity. More wound infection occurred in group II (16.7%) than in the other group (8.3%) (p = 0.511). No important
difference statistically was observed between the two groups regarding postoperative pain (p = 0.885).
Conclusion: Laparoscopic hernia repair by either of both techniques has less postoperative pain, shorter hospital stays, faster return to normal
daily activity, a lower rate of postoperative complications as regard wound infection, and ileus. The TARM repair technique is more time-consuming
than the other technique, but early results indicate that it can be performed as a cheaper alternative to the other one.
Keywords: Intraperitoneal onlay mesh, Laparoscopic, Transabdominal retromuscular, Ventral.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1524
IntroductIon 1,14 Department of General Surgery, Faculty of Medicine, Mansoura
Defects in the abdominal wall results in a ventral hernia. They are University, Mansoura, Egypt
routinely identified and called by location and etiology. Ventral 2,3,15 Department of General Surgery, Mansoura University Hospital,
abdominal hernias can develop spontaneously or at a site of Damietta, Damietta Governorate-Egypt, Egypt
previous scar as an incisional hernia. Incisional hernias form the 4–13 Department of General Surgery, King Faisal Hospital, Taif, Saudi
major group of ventral abdominal hernias and they are the most Arabia
challenging to reconstruct. Trocars insertion for laparoscopic Corresponding Author: Selmy Sabry Awad, Department of General
surgery may also cause defects in the abdominal wall fascia which Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt,
is called port sites hernia. 1 Phone: +20 055-646-6097, e-mail: selmysabry2007@yahoo.com
Abdominal wall hernias in adults are mostly acquired in How to cite this article: Awad SS, Shoma A, El-Khouli A, et al.
origin. Postoperative incisional hernias, a long-term complication Laparoscopic Ventral Hernia Repair: Intraperitoneal Onlay Mesh
of abdominal incisions, are commonly seen with the incidence Repair vs Transabdominal Retromuscular Repair. World J Lap Surg
of 3–13% after laparotomy. The incidence can increase up to 2022;15(2):149–156.
20–40% if the case had considerable surgical site infection (SSI) Source of support: Nil
postoperatively. 2–4 Conflict of interest: None
The incidence of incisional hernias is lower in tiny slit incisions;
therefore, it seems to be much less common following laparoscopic
port sites than that following large midline abdominal surgeries. There is no definite clue that defines that the suture type at
At least one-third of incisional hernias will appear within 5–10 years the index surgery causes hernia occurrence. Patient-associated
postoperatively. The surgical site infection and open abdomen are risk factors contributed to the formation of ventral hernia involve
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the most significant causative factors of the incisional hernia. There male sex, older age, prostatism, obesity, emphysema, and sleep
are many nonsurgical possible causes like uncontrolled diabetes apnea, it has been claimed that all of these risk factors which are
mellitus (DM), smoking, obesity, immunosuppressive therapy, associated with collagen damage in the lung allied to diminish
malnutrition, use of steroids, and old age. 7 healing of the wound, with a rising incidence of hernia formation. 8

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