Page 10 - World Journal of Laparoscopic Surgery

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
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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.
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12
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106 World Journal of Laparoscopic Surgery, Volume 15 Issue 2 (May–August 2022)