Page 58 - World Journal of Laparoscopic Surgery

Laparoscopic Ventral Hernia Repair
between IPOM and TARM techniques. This likely stems from the In this study, only two patients in the IPOM group and two
distribution of cases who required extensive adhesolysis (>30 patients in the TARM group showed postoperative recurrence of
minutes) (7.7% in IPOM vs 3.8 in TARM). 31 the ventral hernia with no significant difference between the two
In this study, intraoperative complications in both groups, groups. All of those four cases were repaired within 6–12 months
minor bleeding from adhesolysis accounted for 12.5% in group postoperatively by open approach.
I and 16.7 % in group II, six cases in group II (16.7%) show tearing The previous studies reported that the total recurrence rate
of peritoneum, small intestine serosal tear occur in group II in two of LVHR (IPOM) is 3.8–5.6%. 35,36 Chowbey et al. observed in their
patients that managed by vicryl suturing of the serosal tear, also series of 34 cases who underwent LVHR with TARM approach that
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retromuscular hematoma occurs in group II in two patients and the recurrence rate was 2.5%. However, other study reported no
managed intraoperatively by aspiration and control of bleeders. recurrence rates in the two groups of cases included in their study
Three cases in TARM repair were converted to IPOM technique due either those underwent IPOM or TARM. 38
to tearing of the peritoneum, Neither vascular injuries nor intestinal In this study, there is no significant difference between the
injuries were observed in both groups. periods of hospital stay of the two groups. Most of the hospital
In a previous research, two cases in TARM procedures had stay durations in both groups did not exceed 48 hours and only a
an omental bleed while doing adhesolysis, which was controlled few cases stayed in the hospital for 72 hours. Return to normal daily
laparoscopically with the placement of a drain for one postoperative activity with a short period for both techniques with no significant
day. One case in the IPOM group had an inferior epigastric vessel difference between both of them.
injury that was managed by clip application. None had any Prasad et al. showed that the mean of the hospital stay was
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intraoperative complications in IPOM. Prasad et al. reported 1.5–0.6 days in TARM group and 1.4–0.7 days in the IPOM group
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that bleeding occurred in only one patient (1.4%) with TARM while with no significant difference between the two groups. In
serosal injury occurred in two patients (2.9%) in TARM group, and another study, the mean postoperative hospital stay was 2.8 ±
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five patients (2.3%) in the IPOM group. 29 1.02 days in the TARM group vs 3.4 ± 1.3 days in the IPOM group.
Hematomas were more frequent in the IPOM group of another Gokcal et al. showed that the median length of postoperative
research as well. One possible explanation for this may be stemmed hospital stay was 0 days (IQR = 0–0) for both groups (range, 0–7
from the more extensive mesh fixation in IPOM repairs, increasing days in IPOM vs 0–4 days in TARM). They reported that a very
the likelihood of inadvertently injuring perforating vessels. 31 large majority of patients are discharged on the same day of the
Regarding the postoperative complications of the cases within surgery. 31
the two groups, 12 cases (50%) had complications in the IPOM In this current study, the 60 cases were given postoperatively
repair group while in the TARM group, postoperative complications one dose of analgesic in the form of IM injection of NSAIDs.
appeared in 21 cases (58.3%). seroma formation was the most Moreover, 12 cases from group I and 16 cases from group II
commonly reported complication in IPOM and TARM groups received extra doses of analgesics with no important difference
(33.3% vs 41.6%, respectively) with no significant difference. All statistically. The mean postoperative pain score in the IPOM repair
cases of seroma were managed conservatively with no need for group was 3.42 ± 0.51 vs 3.44 ± 0.51 in the TARM group. There was
surgical interference. no significant difference between the two groups regarding the
It has been reported that the most commonly noticed postoperative pain.
complication of LVHR is the formation of seroma. The majority of Similar results were reported by previous research. There
the seromas occur anterior to the mesh and within retained hernial was no statistically significant difference in the pain VAS score
sac. 32,33 This came in agreement with a previous study which stated between the cases who underwent IPOM or TARM hernia repair
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that seroma was the most frequent complication in both groups at 12 and 24 hours. This came in agreement with Prasad et al.
underwent LVHR enrolled in their research (5.8% in the TARM (2011) who revealed by comparison of the VAS pain score in both
group and 8.3% in the IPOM group) with no significant difference of the groups included in their study that there was no statistically
between the two groups. 29 significant difference between the two groups either in the first day
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The fundamental principles of the retromuscular (preperitoneal) postoperatively or after 30 days. The recent research conducted
repair, described by Stoppa and Rives, that entail placing the mesh by Gockal et al. who did not find a difference in early postoperative
in this preperitoneal planes have many advantages. It is a highly pain scores between the two groups. 31
vascular plane; hence, it is protective against infection, and, From our initial experience of these 36 cases done by TARM
moreover, any SSI occurring in the subcutaneous planes does not repair, we feel it may be better to reduce mesh size to 12 cm × 15 cm
reach the mesh, as the mesh is retromuscular in a different deeper with 12 cm placed laterally so that lateral nerves are not unduly
plane. 34 irritated and to reduce postoperative pain.
This coincided with our results where mesh infection in the Transfascial sutures used in IPOM may result in increased
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studied patients was only one case in the second group. Five postoperative pain. Another a possible contributing factor to a
patients developed wound infection—two in the IPOM group and difference in the perception of pain or discomfort in IPOM cases
three in the TARM repair group. The minimal surgical interference relates to a potential inflammatory reaction which resulted from
was needed without the need for mesh removal. One case in the the placement of a foreign body within the peritoneal cavity. 39
IPOM group and two cases in the TARM group had postoperative However, although shortened operation time due to minimal
paralytic ileus and they were managed conservatively. dissection with IPOM repair, the economic calculation including
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On the contrary, Gokcal et al. showed that the rate of mesh costs is significantly higher. In regard to the analysis of
development of seromas, hematomas, and SSI, was significantly hospital cost of the case of each technique, it was found also that
higher in the IPOM group, though when taken individually, these higher hospital costs were observed in IPOM ($3,080) than the costs
complications did not reach significance. 31 of TARM ($2,210).The difference was statistically so significant due

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