Comparison of the Intensity of Postoperative Pain Between Open and Laparoscopic Access of Ventral Hernioplasty with IPOM (Intraperitoneal Onlay Mesh) Technique
Journal
Journal of Health, Medicine and Nursing
Date Issued
2020-09
Author(s)
Panikj Katarina
Mladenovic Dragoslav
Nanceva Jasminka
DOI
10.7176/JHMN/80-08
Abstract
Introduction: Despite the numerous advantages of laparoscopic ventral hernioplasty over the open access
hernioplasty, described in the literature, the general clinical experience is that patients have severe pain in the
first few days, hence early postoperative pain is a challenge in this procedure.The aim of this study was to
compare early postoperative pain and whether there was statistically significant difference in the intensity of
postoperative pain among patients operated with open and laparoscopic approach with IPOM hernioplasty during
resting and activity.Material and methods: A randomized, prospective, comparative study was performed on 63
patients who met the inclusion criteria, operated with the IPOM technique and divided into two groups: open
access in 32 patients and laparoscopic approach in 31 patients. In both groups, postoperative pain was compared
at eight time intervals during rest and activity, quantified using VAS. The statistical processing and analysis of
the data was done in the statistical programme SPSS version 23.0.Results: The results of the study showed that
at rest and activity, patients in both groups had significantly different pain intensities on the day of the
intervention, the first and second day after the intervention (p<0.0001). At these time points, the intensity of pain
was significantly stronger in patients undergoing laparosopic hernioplasty. 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.Discussion: The general clinical experience
confirmed in our study is that 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. The explanation is that it
is the result of transfascial sutures for mesh fixation in both groups and additionally multiple lesions of the
parietal peritoneum in the laparoscopic method due to the numerous fixations of the mesh with tackers. Future
research should focus on developing new non-traumatic methods for mesh fixation (Fibrin Glue) and studies that
will analyse in detail the impact of postoperative pain on quality of life.
hernioplasty, described in the literature, the general clinical experience is that patients have severe pain in the
first few days, hence early postoperative pain is a challenge in this procedure.The aim of this study was to
compare early postoperative pain and whether there was statistically significant difference in the intensity of
postoperative pain among patients operated with open and laparoscopic approach with IPOM hernioplasty during
resting and activity.Material and methods: A randomized, prospective, comparative study was performed on 63
patients who met the inclusion criteria, operated with the IPOM technique and divided into two groups: open
access in 32 patients and laparoscopic approach in 31 patients. In both groups, postoperative pain was compared
at eight time intervals during rest and activity, quantified using VAS. The statistical processing and analysis of
the data was done in the statistical programme SPSS version 23.0.Results: The results of the study showed that
at rest and activity, patients in both groups had significantly different pain intensities on the day of the
intervention, the first and second day after the intervention (p<0.0001). At these time points, the intensity of pain
was significantly stronger in patients undergoing laparosopic hernioplasty. 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.Discussion: The general clinical experience
confirmed in our study is that 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. The explanation is that it
is the result of transfascial sutures for mesh fixation in both groups and additionally multiple lesions of the
parietal peritoneum in the laparoscopic method due to the numerous fixations of the mesh with tackers. Future
research should focus on developing new non-traumatic methods for mesh fixation (Fibrin Glue) and studies that
will analyse in detail the impact of postoperative pain on quality of life.
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