Page 7 - World Journal of Laparoscopic Surgery

ORIGINAL RESEARCH
Comparison of Different Types of Mesh in Intraperitoneal

Onlay Mesh Ventral Hernia Surgery

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George Chilaka Obonna , Martin Chibuike Obonna , Rajneesh K Mishra 3
AbstrAct
A ventral hernia does occur on the anterior abdominal wall, and a substantial number are iatrogenic from surgical incisions. Surgical treatment
has progressed over the decades using mesh to correct the laxity in the anterior abdominal wall. The Intraperitoneal Onlay Mesh (IPOM)
method uses a mesh inserted into the peritoneal space to repair the abdominal defect. The best mesh is the ideal mesh, least associated with
complications of mesh implantation such as hematoma formation, mesh failure, and discomfort to the patient.
Materials and methods: We evaluated patients who had IPOM in our center from January 2013 to January 2020 prospectively. Polypropylene
polyvinylidene fluoride (PPV) mesh and the composite mesh were put under study. Other biological meshes have been used but not assessed.
Factors assessed included intestinal obstruction, recurrence rates, and incidence of seroma. Both laparoscopic and open techniques were the
procedures adopted in placing the meshes.
Results: We had 100 patients under study. Seventy patients presented with primary hernia, while 30 patients presented with incisional hernia. All
the patients were followed up for 48 months (2 years). Forty (80%) patients in the PPV group had intestinal obstruction secondary to adhesion,
while no patient in the composite group had intestinal obstruction (p = 0.0001). No patient in the PPV group had seroma/hematoma, while 12
(24%) patients in the composite group had seroma/hematoma (p = 0.0001). Five (10%) of patients in the PPV group had recurrence, while 15%
of patients in the composite group had recurrence (p = 0012).
Conclusion: Mesh hernioplasty by IPOM is currently a procedure of choice and more preferable than ordinary suture closure of hernia. None
of the mesh types are free from possible postoperative complications. A significant drawback in the use of PPV was intestinal obstruction from
adhesion formation, but there was no incidence of seroma/hematoma and a much lower incidence of recurrence compared with the composite
mesh. Therefore, none can be said to be superior to the other on the mesh type of choice in IPOM hernioplasty for ventral hernias.
Keywords: Composite, Intraperitoneal Onlay Mesh, Laparoscopy, Polypropylene polyvinylidene fluoride, Ventral hernia.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1505

IntroductIon
1 Department of Surgery, University of Medical Science Teaching
A ventral (abdominal) hernia occurs when viscera projects through Hospital, Ondo, Nigeria
a gap in the wall of its containing cavity. Examples include 2 Department of Anatomy, College of Medicine, Abia State University,
epigastric, paraumbilical, umbilical, and iatrogenic (incisional) Uturu, Nigeria
hernias. Ventral hernias can get larger and worsen with time. They 3
Department of Minimal Access Surgery, World Laparoscopy Hospital,
cannot get better on their own, and surgery is the way to go by Gurugram, Haryana, India
repairing them. Untreated hernias can become difficult to repair
and can lead to terrible complications, such as strangulations Corresponding Author: George Chilaka Obonna, Department of
Surgery, University of Medical Science Teaching Hospital, Ondo,
of parts of the gut. Clinical examination or imaging can discern Nigeria; Phone: +2348038584310, e-mail: obonnadr@gmail.com
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a ventral hernia. Open mesh placement is an option and so is
laparoscopic mesh implant, though laparoscopic repair benefits the How to cite this article: Obonna GC, Obonna MC, Mishra RK.
Comparison of Different Types of Mesh in Intraperitoneal Onlay Mesh
patient more in the fact that patient leaves the hospital in time and Ventral Hernia Surgery. World J Lap Surg 2022;15(2):103–107.
is minimally invasive with less pain and reduced wound infection Source of support: Nil
2,3
rate. Laparoscopic repair gives between 0 and 9% recurrence rate,
and incisional hernias complicate 2–10% of abdominal surgeries. Conflict of interest: None
Suture repair of ventral hernia has been shown to be associated
with high recurrence rate up to 54%. This justifies the use of mesh in this case, the hernia orifice is suture closed. What this means is
implant. Intraperitoneal Onlay Mesh is a way of mesh placement. that in the open technique direct closure is done after placing the
In the treatment of incarcerated hernia, combined open and mesh intraperitoneally. In the laparoscopic approach, the mesh is
laparoscopic approach in the hybrid IPOM plus method is relevant. placed intraperitoneally, and the use of tackers or trasfascial sutures
In this case, the hernia orifice is sutured, and this helps in reducing peripherally reinforces the mesh. Methods of fixation include tackers
the recurrence rate. and suture glue.
Intraperitoneal Onlay Mesh which can be by open or Polypropylene polyvinylidene fluoride is a noncoated, 100%
laparoscopic approach involves placing a mesh into the abdominal synthetic two-component textile structure. Composite mesh is
cavity to cover the hernia orifice. Operative complication rates made from a composite structure of monofilament polyester textile
and recurrence rates are higher in open IPOM. Thus, open IPOM on one side and a hydrophilic absorbable collagen film on the other
without a bridging scenario will reduce the recurrence rate, since side which is the side that abuts on the viscera.

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