Background

To clarify the optimum mesh-tack ratio MTR (mesh area in cm² divided by the number of fixation tacks) in laparoscopic ventral and incisional hernia repair, we compared IPOM Plus procedures with more intensive mesh fixation to those with standard mesh fixation.

Methods

In a retrospective cohort study, 84 patients (mean hernia width 6.6 ± 4.4 cm) intraoperatively received an intensive mesh fixation I-IPOM Plus with MTR ≤ 4:1 (e.g. ,150 cm² mesh fixed by 50 tacks) and 74 patients (mean hernia width 6.7 ± 3.4 cm) received a standard mesh fixation S-IPOM Plus with MTR > 4:1 (e.g., 150 cm² mesh fixed by 30 tacks) at a community hospital between 2014 and 2017. Outcomes in recurrence rates, immediate and chronic postoperative pain, as well as long-term functionality of the abdominal wall were then evaluated.

Results

After a mean follow-up time of 34 months, a 2.3% recurrence rate in I-IPOM Plus patients and a 13.5% recurrence rate in S-IPOM Plus patients were recorded (p = 0.018). The recurrence was associated with large hernia > 10 cm (OR 3.7, 95% CI 1.3–5.4) and MTR > 5 (OR 2.4, 95% CI 1.1–3.8) in the multivariate analysis. There was a positive correlation between immediate postoperative pain intensity measured on day 7 and number of fixation tacks placed (I-IPOM Plus: mean 4.5 ± 2.5 VAS versus S-IPOM Plus: mean 2.7 ± 2.0 VAS, p = 0.001). However, there were no outcome differences in terms of length of immediate postoperative pain experience, sick leave duration, chronic pain rate and long-term abdominal wall functionality between these two groups.

Conclusion

For ventral and incisional hernia patients with multiple recurrence risk factors, a mesh-tack ratio MTR ≤ 4:1 should be applied in laparoscopic IPOM Plus procedures.

中文翻译：

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腹腔镜腹侧和切口IPOM Plus疝修补术中理想的网眼面积与固定钉数目的比值评估

背景

为了阐明腹腔镜腹侧和切口疝修补术中的最佳网状钉比MTR（以cm ²为单位的网状面积除以固定钉的数量），我们将IPOM Plus手术与标准网状固定的比较，将IPOM Plus手术的强度更高。

方法

在一项回顾性队列研究中，有84例患者（平均疝宽6.6±4.4厘米）在术中接受了MTR≤4：1的强化网状固定I-IPOM Plus（例如，由50个大头钉固定的150厘米²网状）和74例患者（平均疝宽度为6.7±3.4厘米）在2014年至2017年之间在社区医院接受了MTR> 4：1的标准网状固定S-IPOM Plus（例如，通过30个大头钉固定了150厘米^2的网状）。复发率，即刻和然后评估慢性术后疼痛以及腹壁的长期功能。

结果

在平均随访34个月后，I-IPOM Plus患者的复发率为2.3％，S-IPOM Plus患者的复发率为13.5％（p  = 0.018）。在多变量分析中，复发与大疝气> 10 cm（OR 3.7，95％CI 1.3-5.4）和MTR> 5（OR 2.4，95％CI 1.1-3.8）相关。在第7天测得的术后即时疼痛强度与固定钉的数量之间呈正相关（I-IPOM Plus：平均4.5±2.5 VAS与S-IPOM Plus：平均2.7±2.0 VAS，p  = 0.001）。然而，两组之间在术后立即疼痛经历的时间长度，病假持续时间，慢性疼痛率和长期腹壁功能方面没有结果差异。

结论

对于具有多种复发危险因素的腹侧和切口疝患者，应在腹腔镜IPOM Plus手术中应用网状比MTR≤4：1。