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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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