A Clinical Comparative Study On Three Operative Methods For Ventral Incisional Hernia

Background Ventral incisional hernia is a frequent complication of abdominal surgery. If incisional hernia happens, the only effective choice is surgical repair. Recently, as the development of repair technology and artificial patch, the repair of incisinal hernia has undergone revolutionary changes. But how to choose the surgical methods for incisional hernia, yet have not formed a "gold standard", surgeons still depend on their traditions and customs.Objective The objective of this thesis was to comparatively analysis the surgery effect of Onlay, Sublay, and IPOM repair method and direct clinicians to choose the best proposal of the operation.Methods From January 2006 to December 2010,53 patients with incisional hernia underwent laparotomy hernia repair in the Naikai Hospital of Tianjin and relative materials were retrospectively analyzed. All patients were followed up. We had comparatively analyzed multiple clinical parameters of three groups (group Onlay, group Sublay and group IPOM),among them,the measurement indicators include the average operation time,the mean hospital stay,costs and bowel function recovery time. The count indicators include wound hematoma,seroma, pulmonary infection, intestinal obstruction,wound discomfort and pain, urinary retention and hernia recurrence. The student's t-test was applied to determine the significance of difference between continuous variables by the SPSS 17.0 statistic soft ware pack. For the count data, we choose chi square test. All tests of significance were at the 5% level.Result l.The measurement indicators:the mean hospital stay of group Onlay were 12.3 days, less than other two groups (p<0.05).The average operation time and bowel function recovery time of Onlay all were shorter other two groups (p< 0.05).The cost of hospitalization of group IPOM was 22596.2 yuan, more than other two groups(p<0.05).Between group Sublay and group IPOM, the time of operation, postoperative bowel function recovery and the mean hospital stay aren't statistics meanings (p>0.05).2. The count data, wound hematoma occurred in 2 patients, seroma occurred in 3 patients, wound discomfort and pain occurred in 7 patients, pulmonary infection occurred in 4 patients, intestinal obstruction occurred in 1 patient, urinary retention occurred in 1 patient. The total incidence rate of complication of Onlay group is 50%(9/18), Sublay group is 41.2%(7/17), IPOM group is 11.1% (2/18). The total incidence rate of complication of IPOM group lower than other groups (p<0.05),the other groups were no significant difference (p>0.05).The recurrence rate of Onlay group is 22.2%(4/18), the other groups haven't recurrent cases. The recurrence rate of Olay group higher than other groups (p<0.05)Conclusions Onlay group is with shorter operative time, rapid recovery, low-cost advantages, but high complications and recurrence rate. It's applied to medium and small incisional hernia with severe abdominal adhesions and infection. IPOM is with less trauma and low complications and recurrence rate, but the high cost. We hold that IPOM is the better method, if patients don't care the money. Although Sublay group is with lower cost and recurrence rate, but it is with more trauma and high complications. It's applied to large or giant incisional hernia with abdominal infection. So we can choose individualized treatment plan to repair incisional hernia by each patient's charcteristics, as long as we master the charcteristics of different repair methods.