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Hernia. 2020 Feb 25. doi: 10.1007/s10029-020-02143-4. [Epub ahead of print]

What is the outcome of the open IPOM versus sublay technique in the treatment of larger incisional hernias?: A propensity score-matched comparison of 9091 patients from the Herniamed Registry.

Author information

1
Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany. ferdinand.koeckerling@vivantes.de.
2
Department of Surgery I - Section Coloproctology and Hernia Surgery, Lukas Hospital, Preussenstr. 84, 41464, Neuss, Germany.
3
University Clinic for Visceral Surgery, Pius Hospital Oldenburg, Georgstraße 12, 26121, Oldenburg, Germany.
4
Wilhelmsburger Hospital Groß-Sand, Groß-Sand 3, 21107, Hamburg, Germany.
5
Marien Hospital Düsseldorf, Rochusstraße 2, 40479, Düsseldorf, Germany.
6
StatConsult GmbH, Halberstädter Strasse 40 a, 39112, Magdeburg, Germany.
7
Vivantes Humboldt Hospital, Am Nordgraben 2, 13509, Berlin, Germany.
8
Immanuel Hospital Rüdersdorf, Seebad 82/83, 155562, Rüdersdorf, Germany.

Abstract

INTRODUCTION:

In an Expert Consensus guided by systematic review, the panel agreed that for open elective incisional hernia repair, sublay mesh location is preferred, but open intraperitoneal onlay mesh (IPOM) may be useful in certain settings. This analysis of data from the Herniamed Registry aimed to compare the outcomes of open IPOM and sublay technique.

METHODS:

Propensity score matching of 9091 patients with elective incisional hernia repair and with defect width ≥ 4 cm was performed. The following matching variables were selected: age, gender, risk factors, ASA score, preoperative pain, defect size, and defect localization.

RESULTS:

For the 1977 patients with open IPOM repair and 7114 patients with sublay repair, n = 1938 (98%) pairs were formed. No differences were seen between the two groups with regard to the intraoperative, postoperative and general complications, complication-related reoperations and recurrences. But significant disadvantages were identified for the open IPOM repair in respect of pain on exertion (17.1% vs. 13.7%; p = 0.007), pain at rest (10.4% vs. 8.3%; p = 0.040) and chronic pain requiring treatment (8.8% vs. 5.8%; p < 0.001), in addition to rates of 3.8%, 1.1% and 1.1%, respectively, occurring in both matched patients. No relationship with tacker mesh fixation was identified. There are only very few reports in the literature with comparable findings.

CONCLUSION:

Compared with sublay repair, open IPOM repair appears to pose a higher risk of chronic pain. This finding concords with the Expert Consensus recommending that incisional hernia should preferably be repaired using the sublay technique.

KEYWORDS:

Chronic pain; Incisional hernia; Open IPOM; Postoperative complications; Recurrence; Sublay

PMID:
32100213
DOI:
10.1007/s10029-020-02143-4

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