Is fascial defect closure with intraperitoneal onlay mesh superior to standard intraperitoneal onlay mesh for laparoscopic repair of large incisional hernia?

Abstract

For large incisional hernia repair, IPOM-Plus seems to be more effective than sIPOM in terms of reducing mesh bulging.

Complete intracorporeal defect closure using unidirectional barbed suture in laparoscopic incisional hernia repair: Preliminary experience with short‐term follow‐up

“…We limited the maximum diameter of the defect to 6 cm to avoid excessive tension after the fascial closure. In recent studies, intracorporeal defect closure was preferably indicated for defects less than or equal to 10 cm, whereas extracorporeal closure, with relaxing incision or the endoscopic anterior component separation, was performed for larger defects (greater than 10 cm) . Accordingly, we may be able to extend the application of our technique to defects up to 10 cm.…”

“…Laparoscopic incisional hernia repair (LIHR) has generally been supported by the recent literature (1)(2)(3). Defect closure during LIHR has also been advocated to reduce seroma, mesh bulge, and hernia recurrence (2)(3)(4)(5)(6)(7)(8)(9). Using barbed suture (BS) is considered beneficial because of improved tissue approximation, even distribution of tissue length, and reduced strangulating force (10,11).…”

Laparoscopic and percutaneous repair of a large midline incisional hernia extending to the bilateral subcostal region: A case report

“…It took 1 month for discontinuing analgesic agents. Although a meta-analysis demonstrated that postoperative pain with defect closure appeared to be transient [6] , a recent study showed that 14% of patients with IPOM-plus had pain at 3 months whereas those with sIPOM did not experience such pain [12] . Defect closure inevitably oppose to the ‘tension-free concept’ in hernia surgery.…”

“…In addition, fascial defect closure has been advocated for reduction of seroma [6] , [9] , mesh bulge [6] , [10] , and recurrence rates [9] , [10] , although conflicting reports have also been published [11] , [16] . A recent study showed that defect closure with intraperitoneal onlay mesh (IPOM-plus) was more effective than standard intraperitoneal onlay mesh (sIPOM) in terms of reducing mesh bulge, for large hernias (greater than 10 cm in diameter) [12] . In the present case, the defect size was 14 cm (longitudinal) × 10 cm (horizontal).…”

“…In addition, fascial defect closure can be performed either extracorporeally or intracorporeally, that potentially reduces the mesh bulge, seroma formation, or hernia recurrence [8] , [9] , [10] , [11] . Recent studies have advocated defect closure for a large midline incisional hernia, which is typically defined as transverse diameter of equal to or greater than 10cm [8] , [12] .…”