COMPARISON BETWEEN OUTCOMES OF IPOM AND SUBLAY MESH HERNIOPLASTY FOR VENTRAL HERNIA

Abstract

Introduction:

Abdominal wall hernia is a common condition encounter in surgical OPD. There is 2% chance of developing hernia in lifetime wheres umbilical / paraumbilical hernia accounts for 10-14% of all the hernias. Ultimate treatment of abdominal wall hernia is surgery and mesh placement. Early surgery can avoid multiple complications including incarceration of intestine. Multiple patient factors that can cause recurrence of hernia or development of incisional hernia laprotomy incorporate age, male sex, COPD ,diabetes mellitus, somking and obesity. Multiple operative modalities are present for ventral hernias, commonest being laproscopic IPOM and Open sublay. Different meta-analysis recommends that laproscopic hernia repair is best in defect size not more than 10cm.

Objective: 

objective of this study was to compare the efficacy of intra-peritoneal (IPOM) mesh repair with open sublay mesh repair for PUH in terms of operative time, post operative pain, hospital stay and recurrence.

Material and Methods:

This study was done in department of surgery at surgical unit III , Lahore General Hospital starting from january 2018 till january 2019. Patients presenting with paraumbilical hernia were admitted from SOPD. An aggregate of 50 participants were included in this study. Majority of patients were females (46 in number) with age ranging from 26 years to 55 years. Rests of patients were males (04 in number) with age ranging from 40 years to 60 years. Patients undergoing open surgery were placed under O-group and patients undergoing laproscopic repair were placed under L-group. Patients were followed up on 10th post-op day, 4 weeks, 6 month and 1 year interval. Inclusion criteria: All patients of both sexes with para umbilical hernia presenting in the SOPD was included in the study. Exclusion criteria: All patients with obstructed, strangulated PUH were excluded in the study. Patients with co-morbid conditions like diabetes mellitus (DM), COPD (Chronic obstructive pulmonary disease), IHD (Ischemic Heart  Disease) were also excluded.

Results:

50 participants included in this study had age ranging from 26 years to 60 years. Mean duration of operation in L-group was 81 ± 13 minutes while in O-group, duration of operation was 89 ±19 minutes. Hernia defect size in both groups was approximately same. mean size defect was 13.3 ± 2.6 cm2 for L-group and 13.1 ± 2.9 cm2 in O-group. Post-operative Duration of Hospital atay for L-group was 36-60 hours while hospital stay in O-group was 48 to 72 hours. Recurrence rate after 1 year in L-group was 01 while in O-group;recurrence was seen in 02 patients. 

Conclusion:

IPOM is a better option in management of paraumbilical / umbilical hernia in terms of operation duration, hospital stay, post-operative pain and recurrence outcomes as compared to open sublay technique.