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.
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