IPOM PLUS – AN EFFECTIVE METHOD IN TREATMENT OF VENTRAL HERNIA
Journal
Macedonian Journal of Anaesthesia
Date Issued
2020
Author(s)
Mitevski, A
Markov P
DOI
616.381-007.43-089.819
Abstract
ABSTRACT
Introduction: Abdominal wall surgery for ventral hernia is one of the commonest procedures performed by surgeons. Hernias that occur after previous abdominal surgery - incisional
hernias - appear in 11% to 20% of the cases, and the recurrence of ventral hernia is related to
the presence of abdominal rectus muscle diastasis.
Case: A patient who had two previous operations for ventral hernia with prosthesis was
admitted. Hernia bulging and partially reducing content of the hernia sac when pressure applied
was present. Intraoperative, a recurrent hernia was observed and pseudohernia – bulging out of
the previous implanted prosthesis was noted, cephalic from the clinically diagnosed defect. Also
a rectus muscle diastasis was present caudally.
Discussion: The laparoscopic IPOM repair is associated to a high incidence of post-operative bulging or eventration of mesh, seromas, recurrences and non-restoration of abdominal
muscle function. To overcome these problems, sutured closure of the defect in the fascia with
intra-peritoneal mesh reinforcement has been described, known as the IPOM plus repair. This
repair is the recommended procedure in the guideline of International Endohernia Society.
Conclusion: In patients who are presented with diastasis of the abdominal rectus muscles
in addition to the ventral hernia, plication of the diastasis can be done in order to help support
of the ventral hernia and improve outcomes or can be sutured with transfascial non-absorbable
single sutures along the diastasis. It brings considerable esthetic advantages and reduces the
recurrence of hernias.
Introduction: Abdominal wall surgery for ventral hernia is one of the commonest procedures performed by surgeons. Hernias that occur after previous abdominal surgery - incisional
hernias - appear in 11% to 20% of the cases, and the recurrence of ventral hernia is related to
the presence of abdominal rectus muscle diastasis.
Case: A patient who had two previous operations for ventral hernia with prosthesis was
admitted. Hernia bulging and partially reducing content of the hernia sac when pressure applied
was present. Intraoperative, a recurrent hernia was observed and pseudohernia – bulging out of
the previous implanted prosthesis was noted, cephalic from the clinically diagnosed defect. Also
a rectus muscle diastasis was present caudally.
Discussion: The laparoscopic IPOM repair is associated to a high incidence of post-operative bulging or eventration of mesh, seromas, recurrences and non-restoration of abdominal
muscle function. To overcome these problems, sutured closure of the defect in the fascia with
intra-peritoneal mesh reinforcement has been described, known as the IPOM plus repair. This
repair is the recommended procedure in the guideline of International Endohernia Society.
Conclusion: In patients who are presented with diastasis of the abdominal rectus muscles
in addition to the ventral hernia, plication of the diastasis can be done in order to help support
of the ventral hernia and improve outcomes or can be sutured with transfascial non-absorbable
single sutures along the diastasis. It brings considerable esthetic advantages and reduces the
recurrence of hernias.