Laparoscopic Hernioplasty For Abdominal Wall Incisional Hernia:a Report Of 94 Cases And Literature Review

Background:Abdominal wall incisional hernia is a common complication after abdominal operation.It can not be self-healing and has trend of increasing in size with age growing.In addition to the patients with contraindication,abdominal wall incisional hernia need to take active surgical treatment.Meshe has irreplaceable position in laparoscopic hernioplasty for abdominal wall incisional hernia.With the development of research,different characteristics,advantages and disadvantages of various meshes are constantly being discovered and recogized.So surgeons in hernia surgery are expected to know how to choose mesh properly.Objective:The objective of this applied research was to summarize the experiences in selecting meshes in laparoscopic hernioplasty for abdominal wall incisional hernia by analyzing the operation related index and reviewing the related literatures.It could also help surgeons to choose the most appropriate mesh for higher surgery effectiveness.Methods:One hundred and nine cases in laparoscopic hemioplasty for abdominal wall incisional hernias were analyzed retrospectively,which including the cases from June 2011 to January 2017 in QiLu Hospital Affiliated to ShanDong University.All operative types are intraperitoneal onlay mesh(IPOM)and all meshes were fixated 2 turns by auto-suture tacks on the edge.Patients were divided into three groups based on different meshes.Operative time,intraoperative blood loss,body temperature,hemogram,exhaust and defecaration time,infection of incision or punctures,drainage days,daily drainage,hospitalization days,expense,seroma,infection of mesh,intestinal fistula,chronic pain and recurrence were observed and analyzed.Results:This article includes 94 cases of abdominal incision hernia,including 28cases of Composix E/X group,28 cases of Composite Parietex group,38 cases of Sepramesh group.No significant difference is found in age,gender,weight,size of hernial ring in three groups.Higher incidence of complication and seroma are found in Composix E/X group(P<0.01).Longer drainage days、higher total volume of drainage and higher expense in hospital are found in Sepramesh group and Composite Parietex group(P<0.01)..No significant difference is found in operative time,intraoperative blood loss,body temperature,exhaust,defecaration time,hemogram and incidence of infection of incision or punctures,infection of mesh,chronic pain,intestinal fistul and recurrence(P>0.05).Conclusions:Intraperitoneal onlay mesh(IPOM)is safe and effective in the treatment of abdominal wall incisional hernia.Complications associated with meshes include seroma,infection of mesh,intestinal fistula and chronic pain.However,patient’s condition,family financial status,surgeon’s technic and experiences should be considered when choosing meshes.Appropriate mesh can improve treatment efficacy.Individualized treatment should also be taken into serious consideration.