Page 57 - World Journal of Laparoscopic Surgery

Laparoscopic Ventral Hernia Repair
Table 2: The postoperative complications of the study population
IPOM (N = 24) TARM (N = 36)
Group I Group II
No % No % χ 2 p
Seroma 8 33.3 15 41.6 0.201 0.654
Wound infection 2 8.3 3 8.3 0.433 0.511
Mesh infection 0 0.0 1 2.7 0.690 0.406
Recurrence 2 8.3 2 5.6 0.062 0.804
Bowel injury 0 0.0 0 0.0
Ileus 1 4.2 2 5.6 0.675 0.421
Vascular complications 0 0.0 0 0.0

Table 3: Postoperative follow-up data of both groups
IPOM (N = 24) TARM (N = 36)
(mean ± SD) Group I Group II T p
Postoperative pain 3.42 ± 0.51 3.44 ± 0.51 0.145 0.885
Hospital stay (hours) 26.0 ± 6.93 28.0 ± 9.2 0.640 0.527
Return to normal activity (days) 3.08 ± 1.0 3.39 ± 1.61 0.584 0.564

Table 4: Analysis of hospital cost of the case of each procedure and clinical researches, it was concluded that TARM placement of
prolene mesh is a cost-effective available option and has a reduced
Variables IPOM ($) TARM ($) p
rate of postoperative formation of adhesions. 27,28
Equipment cost 1,900 1,000 0.001 This current study was conducted to assess and compare the
Theater cost 250 250 – outcomes of two laparoscopic procedures of LVHR composing of
TARM and IPOM placement of mesh. The cases were randomly
Ward cost/night 650 650 –
divided into two groups; group I patients were operated by IPOM
Cost of anesthesia 280 310 0.23 procedure and group II patients were operated by TARM placement
The mean cost of the inpatient 3,080 2,210 0.041 of mesh.
In this study, the ventral hernia with defect size 39.31 ± 20.23
mm represented in the cases of both groups. Epigastric hernias were
dIscussIon true hernias with defect size in the range of 20–60 mm in diameter
The ventral hernias are a group of hernias affecting the abdominal. with no significant difference statistically between the two groups.
Repair surgeries of these hernias stay one of the most frequently Prasad et al. reported that there was no difference in the mean
performed operations with more than 350,000 achieved/year in the fascial defect size (30.8 cm ± 24.4 cm vs 29.9 cm ± 22.0 cm, p = 0.78)
US. These hernias carry the risk of bowel ischemia and strangulation, and the mean size of mesh (237.8 cm ± 66.8 c, vs 240.3 cm ± 98.2
which can lead to serious consequences, In addition to the aesthetic cm, p = 0.84) used in both techniques. 29
detriment of the hernia. 22 In the study between our hands, the mean operative time of
Laparoscopic ventral hernia repair has many advantages over LVHR by IPOM was (82 minutes) which was significantly shorter
the open approach mainly due to reduced wound complication than that of laparoscopic TARM repair (115 minutes) (p = 0.002,
rates and faster recovery. Laparoscopic ventral hernia repair uses statistically significant). The explanation for the longer duration
different prosthetic meshes, which are put either intraperitoneally associated with TARM is the need for the creation of peritoneal flaps
IPOM or in retromuscular space TARM. Laparoscopic ventral hernia in the retromuscular space and closure over the mesh by resuturing
repair is growing rapidly to be a standard technique worldwide due of the flaps after mesh fixation. Inspite of higher operating time,
to the low rate of recurrence and all the advantages of laparoscopic TARM procedure is economical because of the use of cheap prolene
surgery. 23,24 mesh, but IPOM procedure involves the use of expensive composite
In spite of the marvelous results of LVHR, many experimental meshes.
29
and clinical researches have noticed complications resulting from This came in agreement with a study who reported that the
the procedure of IPOM when using prolene mesh. It had a rising rate operative time is longer in TARM group was statistically significant
of complications which were a statistically significant issue. They longer than in IPOM group (p = 0.001). This also came in accordance
included formation of adhesions, small intestinal obstruction, and with Shetty et al. who showed that the mean operative time in the
fistula formation. 25,26 TARM group was 105 ± 19.8 minutes vs 89.5 ± 26.4 minutes in the
The omental interface can diminish or prevent the adhesion of IPOM group with statistically significant difference between the
viscera to prolene mesh. However, in the case series of reoperated two groups. 30
patients, they revealed that one-third of the cases had dense On the other hand, Gokcal et al. showed that there was no
adhesion to prolene mesh. Depending on the results of experimental difference in terms of operative times in their cohort studies

World Journal of Laparoscopic Surgery, Volume 15 Issue 2 (May–August 2022) 153