Laparoscopic ventral hernia repair: does IPOM plus allow to increase the indications in larger defects?

• Published in: Hernia : the journal of hernias and abdominal wall surgery Vol. 26; no. 2; pp. 525 - 532
• Main Authors: Toffolo Pasquini, M., Medina, P., Mata, L. A., Cerutti, R., Porto, E. A., Pirchi, D. E.
• Format: Journal Article
• Language: English
• Published: Paris Springer Paris 01.04.2022; Springer Nature B.V
• Subjects: Abdominal Surgery; Hernia; Hernia, Ventral - surgery; Hernias; Herniorrhaphy - methods; Humans; Laparoscopy; Laparoscopy - methods; Medicine; Medicine & Public Health; Original Article; Patients; Prospective Studies; Recurrence; Statistical analysis; Surgical Mesh; Treatment Outcome; Laparoscopic repair; Incisional hernia; Ventral hernia; IPOM; IPOM plus
• ISSN: 1265-4906; 1248-9204
• DOI: 10.1007/s10029-021-02506-5

Purpose The laparoscopic ventral hernia repair (LVHR) may have a limit of effectiveness, especially in defects greater than 80 cm 2 , with a higher recurrence rate which contraindicates this technique. The purpose of this study is to analyze the indication of LVHR determining and comparing the recurrence rate according to defect size in two series. Methods We analyzed all patients who underwent LVHR between 2007 and 2017. Patients were divided according to the ring size: <  o  ≥ 80 cm 2 into group one (G1) and group two (G2) respectively. In both groups, all three techniques were used: intraperitoneal onlay mesh (IPOM), IPOM with closure of the defect (IPOM plus), and IPOM plus + anterior videoscopic component separation (AVCS). Results A total of 258 patients underwent LVHR. Mean recurrence rate was 13% in G1 and 24% in G2. A statistically significant difference was found when comparing the IPOM technique among both groups, with a higher recurrence rate when ring size was ≥ 80 cm 2 ( p  < 0.5). However, when comparing recurrence rate in IPOM plus and IPOM plus + AVCS between both groups, no significant differences were observed, yielding a p of 0.51 and 0.63, respectively. Conclusion The IPOM technique has shown a limit of effectiveness in large ventral hernia defects. The combination of techniques (ring closure and AVCS) may be useful to expand the indication for this surgery to larger defects and to reduce the recurrence rate. Prospective randomized studies are required to confirm this trend.