LAPAROSCOPIC INGUINAL HERNIA REPAIR “IPOM” WITH DUAL-MESH

Abstract

The authors report their experience on laparoscopic hernioplasty using the Intraperitoneal Onlay Mesh Repair (IPOM) in 56 patients. 34 patients had a bilateral hernia, 6 of which were recurrent and 22 had a monolateral hernia, of which 9 had recurrent hernia. Overall, a total of 90 hernias were treated.

The hernia repair was performed utilizing “GORE-TEX® DualMesh Plus biomaterial with holes” in the first 32 cases and the latest “...Corduroy” type in the remaining 24 cases. The prostheses were fixed with titanium spiral tacks (Protack®, AutoSuture, Tyco Healthcare).

No intraoperative complications occurred and no conversion was necessary. Five minor post-operative complications (5.5%), 2 seromas and 3 transient paresthesias, were observed. Four patients (7.1%) needed analgesics after the first 24 hours. Mean hospital stay was 36 hours, with a minimum of 24 and a maximum of 48. Mean resumption of normal activity was 8 days with return to work within two weeks.

At an average 18 months follow-up, 3 recurrences were recorded (3.3%).

The results of this study as well as the meta-analysis of the series presented in the Literature, indicate that the IPOM may be a feasible, safe and effective procedure in the treatment of recurrent and bilateral hernias or when a hernia repair is performed during other laparoscopic procedures. The IPOM has infact been shown to be faster and easier than the other more commonly performed laparoscopic hernioplasties (TAPP and TEP).

These data may also suggest utilizing this technique in particular cases of primitive hernia such as very active young males or heavy duty workers. However, the limited series and the short follow-up ask for randomized prospective long term studies to definitely ascertain the true incidence of recurrence and therefore the effectiveness of this attractive procedure.