sIPOM vs pIPOM in Incisional Hernia Patients
Condition: Incisional Hernia
MeSH terms: Hernia; Incisional Hernia
Study type: Observational [Patient Registry]

Summary: 
      Nowadays, two intraperitoneal mesh approaches are commonly used in Laparoscopic Ventral
      Hernia Repair (LVHR): the simple intraperitoneal onlay mesh repair (sIPOM) and the
      intraperitoneal onlay mesh reinforcement with defect closure before placement of mesh
      (pIPOM). The pIPOM has been introduced to reduce adverse events in incisional hernia (IH)
      surgery (i.e., seroma formation, recurrences etc ) associated to laparoscopic hernia repair,
      and satisfactory outcomes has been reported in several studies. In details, sequelae such
      mesh bulging seems to be less associated to pIPOM than sIPOM, even if the latter topic is
      matter of intense debate. The pIPOM has been introduced in the guidelines for the
      laparoscopic treatment of ventral and incisional abdominal wall hernias published by the
      International Endohernia Society (IEHS) in 2014. Despite prospective studies on the quality
      of IPOM-Plus are available, the evidence level for the statements in these guidelines remains
      low. The aim of this prospective analysis is to compare the postoperative outcomes of
      patients treated for Incisional hernia (IH) with sIPOM and pIPOM after 36 months follow-up in
      terms of recurrence and wound events.
    


Intervention name(s): Intraperitoneal onlay mesh reinforcement with defect closure before placement of mesh (pIPOM); Standard intraperitoneal onlay mesh repair (sIPOM)
Intervention type(s): Procedure; Procedure
Intervention description(s): The pneumoperitoneum (12-15 mmHg) was built up with Veres in the Palmer'point. The primary optical trocar was set in the left upper abdomen, two other trocars were set in the left middle and lower abdomen. If necessary, adhesiolysis was firstly performed. The hernia gap was deperitonealized in order to prevent a seroma formation and, if possible, all hernia sac was removed to facilitate the healing of the hernia defect after the laparoscopic suture. This also included the transection of the ligamentum teres hepatis. We reduced the intraabdominal pressure to approx. 5 mmHg and measured the hernia gap through an intraperitoneal graduated mark. The choice of mesh size was done with an overlap of more than 5 cm. The laparoscopic closure of the hernia defect was performed with non-reabsorbable detached stitches of prolene 1/0 suture at a distance of 1.5 cm from stich to stich using a Reverdin' needle. The final fixation of the mesh took place with a non-resorbable tacks.; The pneumoperitoneum (12-15 mmHg) was built up with Veres in the Palmer'point. The primary optical trocar was set in the left upper abdomen, two other trocars were set in the left middle and lower abdomen. If necessary, adhesiolysis was firstly performed. The hernia gap was deperitonealized in order to prevent a seroma formation and, if possible, all hernia sac was removed to facilitate the healing of the hernia defect after the laparoscopic suture. This also included the transection of the ligamentum teres hepatis. We reduced the intraabdominal pressure to approx. 5 mmHg and measured the hernia gap through an intraperitoneal graduated mark. The choice of mesh size was done with an overlap of more than 5 cm. In sIPOM, the defect was not closed. The final fixation of the mesh took place with a non-resorbable tacks.
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Patients referring to the Departments of General Surgery of 3 Tertiary Hospitals (the "A.
        Rizzoli" Hospital, in Lacco Ameno Naples, the University of Campania "Luigi Vanvitelli" of
        Naples and the AORN "A. Cardareli" of Naples) for Incisional Hernia