THE ANALYSIS OF THE RESULTS OF SURGICAL TREATMENT OF VENTRAL AND POSTOPERTIVE HERNIAS WITH THE USE OF LAPAROSCOPIC IPOM TECHNOLOGY

Introduction. The aim of this work is to study the immediate and long-term results of treatment of ventral and incisional hernias using the laparoscopic IPOM technology.
Materials and methods. A comparative retrospective-prospective cohort study of the results of surgical interventions using minimally invasive laparoscopic IPOM (intraperitoneal onlay mesh) plasty and open Sublay plasty was performed in 144 patients who sought medical help for ventral hernia, with a hernia orifice size up to 130 cm2. All patients were employed between the ages of 22 and 56 years. Of these, 63% are women and 37% are men. The average age of the patients was 46±7.3 years.
Discussion. An ultrasound examination of the anterior abdominal wall at the preoperative stage made it possible to avoid vascular damage during the operation and, as a consequence, hematomas in the early postoperative period. The study showed that the use of laparoscopic hernioplasty reduces the number of seromas in comparison with the control group by half, significantly reduces the risk of hematomas and infiltrates. The use of IPOM plastic statistically significantly reduces the duration of the operation, the time of restoration of the intestinal motor-evacuation function. There was a significant decrease in the duration of taking analgesics and the length of hospital stay. The analysis of the restoration of working capacity was carried out depending on the method and dimensions of the hernial defect. The ability to work was restored in all cases. It is noteworthy that there was no significant difference in the timing of mental and light work. Performing work of moderate severity was possible after 2.5–3 weeks in patients of the first group, and heavy work after 1.5 months. In the patients of the control group, moderate and hard work was possible only by 2–2.5 months.
Conclusions. 1. The use of the modified method of intraperitoneal laparoscopic hernioplasty, IPOM, is a safe method of treating patients with ventral and incisional hernias with hernial orifice sizes W1-W2; it can reliably reduce the risk of postoperative seroma formation by almost 2 times, as well as the formation of anterior abdominal wall hematomas and infiltrates. The use of laparoscopic technologies makes it possible to reduce postoperative pain syndrome, avoid hematomas of the anterior abdominal wall, reduce the length of hospital stay, and reduce the need for the administration of parenteral analgesics (p <0.05).
2. The most significant advantages of IPOM hernioplasty over «open» hernioplasty in rehabilitation and restoration of labor activity in people engaged in moderate and hard work (p <0.0001). No significant changes in the timing of the recovery of mental and light labor were found.

1. Agaev B. A., Rustamov E. G., Rustamov G. A. Laparoskopicheskaya plastika bryushnoj stenki pri posleoperacionnyh ventral’nyh gryzhah [Laparoscopic abdominal wall repair in postoperative ventral hernia], Hirurgiya, 2009, No. 9, рр. 74–78. (In Russ.)

2. Antadze A.A., Lomidze N.B. Khirurgiya posleoperatsionnykh ventral’nykh gryzh, [Postoperative ventral hernia surgery] Herniology Bulletin, 2009, No. 2, рр. 26–28. (In Russ.)

3. Vavilova O.G. Sovremennyy podkhod k khirurgicheskomu lecheniyu obshirnykh i gigantskikh posleoperatsionnykh ventral’nykh gryzh [Modern approach to the surgical treatment of extensive and giant postoperative ventral hernias], 2011, рр. 133. (In Russ.)

4. Zhukovsky V.A Polimernyye endoprotezy dlya gernioplastiki [Polymer endoprosthesis for hernioplasty], 2011, 14–54 р. (In Russ.).

5. Romanov R.V. Sovremennoe sostoyaniye problemy intraperitoneal’noy plastiki bryushnoy stenki sinteticheskimi endoprotezami. [The Current state of the problem for intraperitoneal abdominal wall plasty with synthetic endoprosthesis]. Modern techniques in Medicin, 2012, No. 4, рр. 161–170. (In Russ.)

6. Khitaryan А.G., Kislyakov V.N., Veliev K.S., Kovalev S.А. Zavgorodnyaya R. N., Orekhov А.А., Mezhunts A.V. Analiz rezul’tatov khirurgicheskogo lecheniya gryzh u patsiyentov s izbytochnoy massoy tela s ispol’- zovaniyem laparoskopicheskoy tekhnologii IPOM. [Analysis of the results of sugical treatment of hernias in patients with overweight using the laparoscopic IPOM technology]. Tavricheskiy Mediko-biologicheskiy vestnik, 2017, No. 3, рр. 262–267. (In Russ.)

7. Rustamov E.G. Vybor sinteticheskogo proteza i sposoba yego fiksatsii pri laparoskopicheskoy plastike peredney bryushnoy stenki po povodu gryzhi. [Choise of the synthetic prosthesis and the method of its fixation in laparoscopic plastic surgery of the anterior abdominal wall hernia]. Surgery, 2010, No. 8, рр. 76–79. (In Russ.)

8. Ahonen-Siirtola M., Rautio T., Ward J. Complications in Laparoscopic Versus Open Incisional Ventral Hernia Repair. A Retrospective Comparative Study. World Journal of Surgery, 2015, 39(12), рр. 2872–2877. https://doi.org/10.1007/s00268-015-3210-6

9. Caruso F, Ciccarese F, Cesana G. Massive Incisional Hernia Repair with Parietex: Monocentric Analysis on 500 Cases Treated with a Laparoscopic Approach. Journal of Laparoendoscopic & Advanced Surgical Techniques, 2017, 27(4), рр. 388–392. https://doi.org/10.1089/lap.2016.0623:

10. Chelala E., Baraké H., Estievenart J. Long-term outcomes of 1326 laparoscopic incisional and ventral herniarepair with the routine suturing concept: a single institution experience. Hernia, 2016, 20, рр. 101–110. https://doi.org/10.1007/s10029-015-1397-y

11. Klein F., Ospina C., Rudolph B. Formation of a chronic pain syndrome due to mesh shrinkage after laparoscopic intraperitonealonlay mesh (IPOM)]. Surgical Laparoscopy Endoscopy & Percutaneous Technique, 2012, 22, рр. 288–290. https://doi.org/10.1097/SLE.0b013e31825efc3c

12. Kouhia S., Vironen J., Hakala T. Open Mesh Repair for Inguinal Hernia is Safer than Laparoscopic Repair or Open Non-mesh Repair: A Nationwide Registry Study of Complications. World Journal of Surgery, 2015, 39(8), рр. 1878–1884. https://doi.org/10.1007/s00268-015-3048-y

13. Light D., Bawa S. Trans-fascial closure in laparoscopic ventral hernia repair. Surgical Endoscopy, 2016, 30(12), рр. 5228–5231. https://doi.org/10.1007/s00464-016-4868-z

14. Mercoli H., Tzedakis S., D’Urso A. [Postoperative complications as an independent risk factor for recurrence after laparoscopic ventral hernia repair: a prospective study of 417 patients with long-term follow-up. Surgical Endoscopy, 2017, 31, рр. 1469–1477. https://doi.org/10.1007/s00464-016-5140-2