Лапароскопска наспроти отворена херниопластика кај вентрални хернии со техника на интраперитонеално пласирање на мрежа (IPOM – intraperitoneal onlay mesh) – ран клинички исход

Abstract

Introduction: In everyday surgical practice, ventral hernia repair is one of the most commonly performed surgeries worldwide. Ventral hernioplasty can be performed either with open or laparoscopic approach and in this study both approaches use the IPOM technique of mesh placement. From the clinical experience so far, the laparoscopic approach is characterized by a lower rate of early postoperative complications, shorter hospital stay and a period of convalescence. The aim of the study was to compare early postoperative complications (infections,seroma, hematoma), postoperative pain, duration of hospital stay between patients undergoing open and laparoscopic access with IPOM ventral hernioplasty. Secondary aims of the study include a comparison of the duration of the operation, the occurrence of postoperative ileus, recurrence in the first year in both methods, occurrence of port hernia in laparoscopic approach and convalescence period between these two methods. Material and methods: The study was designed as a randomized, prospective, comparative study of 63 patients who met the inclusion criteria, operated by IPOM technique and divided into two groups: open access to 32 patients and laparoscopic access to 31 patients. In both groups were compared early postoperative complications, postoperative pain- which was compared at eight time intervals during rest and activity, quantified using VAS and also was made comparison for duration of surgery, hospital stay, recurrence in the first year and convalescence. Statistical processing and data analysis was performed in the statistical programme SPSS version 23.0. Values of p <0.05 were taken as statistically significant . Results: Regarding the early postoperative complications, it was found that the occurrence of seroma is more common in the laparoscopic group (p = 0.013), while in open hernioplasty the number of surgical site infections is significantly higher (p = 0.03). Results of comparison of postoperative pain at rest and activity, patients in both groups had significantly different pain intensities on the day of the intervention, the first and second day after the intervention (p<0.0001). At these time points, the intensity of pain was significantly stronger in patients undergoing laparosopic hernioplasty. On the third and seventh postoperative days, as well as one and six months after the intervention, there was no significant difference in pain intensity between the two methods during rest and activity. The hospital stay expressed in days is longer in open hernioplasty (p = 000001). Regarding the duration of the operation (p = 0.8) and the period of convalescence (p = 0.28), there is no statistically significant difference between the two groups. Discussion: The results shown by our experience shows that laparoscopic ventral IPOM hernia repair is characterized by lower rates of SSI, a shorter hospital stay, but without statistical significant benefit in terms of a period of convalescence, duration of surgery and recidive rate in the first year. About postoperative pain, the general clinical experience confirmed in our study is that patients after laparoscopic ventral hernioplasty suffer from severe pain in the early postoperative period and it is the biggest challenge and problem after these operations. Conclusion: Тhe choice of treatment and access should be based according to individual patient characteristics and principles of evidence based surgery. A laparoscopic approach, due to its minimal invasiveness, should be more common in ventral hernioplasty. Due to the higher intensity of postoperative pain in the laparoscopic approach, further research in the future should focus on developing new non-traumatic methods for mesh fixation (Fibrin Glue) and studies that will analyse in detail the impact of postoperative pain on quality of life.