POSTOPERATIVE PAIN AFTER VENTRAL HERNIA REPAIR: A PROSPECTIVE COMPARISON OF OPEN VERSUS LAPAROSCOPIC WITH INTRAPERITONEAL ONLAY MESH (IPOM) TECHNIQUE
Laparoscopic ventral hernioplasty has many advantages over the open access hernioplasty, but patients suffer severe pain in the first few days.Objectives of this study was comparison of early postoperative pain in Open and Laparascopic approach in IPOM hernioplasty and whether there was statistically significant difference in the intensity of postoperative pain during resting and activity.63 patients who met the inclusion criteria were included in a randomized, prospective, comparative study and were operated with the IPOM technique. They were divided into two groups: open and laparascopic access (32 and 31 patient, consequently). In both groups, postoperative pain was compared at eight time intervals during rest and activity, quantified using VAS. The statistical analysis was done in the statistical programme SPSS version 23.0.Patients undergoing laparoscopic hernioplasty had significantly higher pain intensities on the day of the intervention, the first and second day after the intervention (p<0.0001). 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.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. This originates from transfascial sutures for mesh fixation in both groups and additionally multiple lesions of the parietal peritoneum in the laparoscopic method due to the numerous mesh fixations with tackers.
Keywords: Laparoscopic IPOM, open IPOM, postoperative pain
2.DeMaria EJ, Moss JM, Sugerman HJ. Laparoscopic intraperitoneal polytetrafluoroethylene (PTFE) prosthetic patch repair of ventral hernia. Surg Endosc. 2000;14:326 –329.
3. Carbajo MA, Martin del Olmo JC, Blanco JI, et al. Laparoscopic treatment vs open surgery in the solution of major incisional and abdominal wall hernias with mesh. Surg Endosc. 1999;13:250 –252.
4. Heniford B, Park A, Ramshaw BJ, Voller G. Laparoscopic ventral and incisional hernia repair in 407 patients. J Am Coll Surg. 2000;190:645– 650.
5.Eid GM, Prince JM, Mattar SG, Hamad G, Ikrammudin SI, Schauer PR. Medium-term follow-up confirms the safety and durability of laparoscopic ventral hernia repair with PTFE. Surgery. 2003;143:599 – 604.
6.MR Langenbach, D. Enz. Mesh fixation in open IPOM procedure with tackers or sutures? A randomized clinical trial with preliminary results, Hernia, The World Journal of Hernia and Abdominal Wall Surgery, 2020 Feb;24(1):79-84.
7. Forbes SS, Eskicioglu C, McLeod RS et al. Meta-analysis of randomized controlled triales comparing open and laparoscopic ventral and incisional hernia repair with mesh. Br J Surg 2009; 96:851-8.
8. McGreevy JM, Goodney PP, Birkmeyer CM, Finlayson SRG, Laycock WS, Birkmeyer JD. A prospective study comparing the complication rates between laparoscopic and open ventral hernia repairs. Surg. Endosc. 2003; 17:1778-1780.
9. Merskey H (Eds.) and International Association for the Study of Pain Subcommittee on Taxonomy. Classification of chronic pain syndromes and definitions of pain terms. Pain Suppl 1986; 3: S1–226.
10.Scott, J. and Huskisson, E.C., Graphic representation of pain, Pain, 2 ,1976; 175-184.
11.Misra MC, Bansal VK, Kulkarni MP et al. Comparison of laparoscopic and open repair of incisional and primary ventral hernia: results of a prospective randomized study. SurgEndosc 2006; 20: 1839-45.
12.Barbaros U, Asoglu O, Seven R et al. The comparison of laparoscopic and open ventral hernia repairs: a prospective randomized study. Hernia 2007;11:51-6
13. Asencio F, Agulió J, Peiró S et al. Open randomized clinical trial of laparoscopic versus open incisional hernia repair. SurgEndosc 2009;23: 1441-8.
14. Jones, Daniel B, Master Techniques in Surgery: Hernia, Lippincott Williams & Wilkins (LWW), 1st Ed, 2012, p.245-385.
15.Köckerling F and Lammers B. Open Intraperitoneal Onlay Mesh (IPOM) Technique for Incisional Hernia Repair. Front. Surg.2018; 5:66. doi: 10.3389/fsurg.2018.00066
16.Karl A. LeBlanc, MD. Current Considerations in Laparoscopic Incisional and Ventral Herniorrhaphy, JSLS. 2000 Apr-Jun; 4(2): 131–139
17.Gillian GK, Geis WP, Grover G. Laparoscopic incisional and ventral hernia repair (LIVH): an evolving outpatient technique. JSLS. 2002;6:315–322.
18. Carbajo MA, Martin delOlmo JC, Blanco JI et al.Laparoscopic approach to incisional hernia. Lessons learned from 270 patients over 8 years. Surg. Endosc. 2003;17:118-122.
19.Wassenar E, Schoenmaeckers E, Raymakers J, et al. Mesh-fixation method and pain and quality of life after laparoscopic ventral or incisional hernia repair: a randomized trial of three fixation techniques. Surgendosc 2010;24(6):1.296-302.
20.Muysoms F, Vander Mijnsbrugge G, Pletinckx P, et al. Randomized clinical trial of mesh fixation with “double crown” versus “sutures and tackers” in laparoscopic ventral hernia repair. Hernia 2013;17(5): 603-12.