Page 173 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

3. Laparoscopic repair
In the last decade the laparoscopic repair with intraperitoneal mesh (IPOM) has been gaining popularity ( gure 5). In the included studies the mesh was positioned bridging the defect with an overlap ranging between at least 2 and 5 cm. In 8 studies a total of 483 LIH were repaired using laparoscopy(74-81). No patients were de ned as complex LIH. During repair non-absorbable ePTFE, PE- or PP-composite meshes were used.
Postoperative wound complications were reported in 8% of patients; 6% of patients developing prolonged seroma (>6-8 weeks) and in 2 patients (0.4%) mesh infection was reported. The complication trocar site hernia was described by Ferrari in 2 out of 36 patients(74). Conversion to an open procedure due to dense adhesions, problems with xation or enterotomy occurred in 5% of laparoscopic repair. Ji et al. describe a technique of adhesiolysis through an additional small (5-10cm) incision in case of dense adhesions as an alternative to complete conversion with good results.(79) The recurrence rate of laparoscopic LIH repair with intraperitoneal mesh was 5.6% after 14-62 months follow-up.
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Table 3. Overview of recurrence hazards per year using GLM
Review treatment large IH
Technique #
Open without mesh
CST(9, 11, 31-35) 219 Aponeuroplasty(10, 36, 37) 195 Langenskiöld(38) 46 Open with mesh
Sublay(10, 39-48) 762 Aponeuroplasty + IPOM(49, 50) 630 IPOM (bridging)(11, 15, 46, 51-57) 514 MCST(47, 58-64) 511 Onlay(53, 65-69) 454 Sandwich(53, 70-73) 131 Laparoscopy
IPOM (bridging) (74-81) 483
Hazard (a) Std error
0.00392 0.00253 0.00468 0.00251 0.00771 0.00265
0.00043 0.00069 0.00039 0.00053 0.00211 0.00093 0.00212 0.00155 0.00288 0.00101 0.00028 0.00273
0.00265 0.00181
Recurrence hazard per year (%)
4.6 5.5 8.8
0.5 0.5 2.5 2.5 3.4 0.3
3.1
4. Generalized linear model (GLM) of recurrence rates
The hazards (a) for the di erent repair techniques are shown in table 3 and gure 7. The open repair techniques without mesh have a recurrence hazard
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