Retrospective Study Of Three IPOM Techniques In The Treatment Of Abdominal Incisional Hernia

Introduction:Retrospective study of three IPOM technology(open surgery,laparoscopic surgery and hybrid completely)used to treat the clinical effect of incision hernia of abdominal wall,to analyze the feasibility of hybrid surgery in abdominal hernia repair,to discuss IPOM technology security problems.Methods:The clinical data of 79 patients with abdominal incisional hernia admitted to the department of gastrointestinal/hernia surgery of the first affiliated hospital of China Medical University from February 2012 to September 2017 were retrospectively analyzed(excluding patients transferred to the emergency department due to incarcerated hernia and excluding patients with primary abdominal hernia caused by non-abdominal surgery).Among the included patients,44 underwent open surgery,23 underwent full laparoscopic surgery,and the remaining 12 underwent hybrid surgery.There were 41 patients aged 60 years or older,23 males,22 patients with hypertension,9 patients with diabetes,and 12 patients with recurrent incisional hernia.Meanwhile,the abdominal wall defect diameter(cm),operation time(min),length of stay(d)and hospitalization cost(￥)were also included in this study.Statistical methods were used to compare the differences of the above factors in IPOM technology.To investigate the clinical efficacy of three IPOM techniques in the treatment of abdominal incisional hernia,postoperative complications were counted in this study: postoperative surgical site infection(SSI)in 12 patients,seroma in 4patients,and dyspnea in 2 patients,postoperative fever,pelvic effusion and urinary retention occurred in 1 patient each,and no serious postoperative complications(intestinal fistula and intestinal obstruction)were found..Statistical software was used to analyze the statistical data,analysis of variance was used for the measurement data,and χ2 test was used for the counting data.P<0.05 was considered statistically significant.Results:There was no statistically significant difference in age(P=0.86),hypertension(P=0.13),diabetes(P=0.11),or recurrent hernia(P=0.15)between the three IPOM techniques for incisional hernia repair.The operative time of the three kinds of operations(P=0.39)showed no significant statistical difference.Postoperative hospitalization days(P=0.01),hospitalization costs(P=0.01)and abdominal wall defect diameter(P=0.02)showed significant statistical differences.In terms of postoperative hospitalization days,total laparoscopic surgery was significantly shorter than open surgery group(P=0.001)and hybrid surgery group(P=0.049).In terms of the diameter of abdominal wall defect,the abdominal wall defect in hybrid surgery was significantly larger than that in laparoscopic surgery(P=0.01).In terms of postoperative complications,9 patients in the open surgery group had postoperative surgical site infection(SSI),1 patient in the open surgery group had complete laparoscopy,and 2 patients in the hybrid surgery group.There was no significant difference in surgical site infection(P=0.16)between the three operations.No significant statistical difference was found in postoperative complications of the three types of surgery,such as seroma(P=0.87),fever(P=0.55),dyspnea(P=0.33),pelvic effusion(P=0.55)and urinary retention(P=0.55).In addition,no intestinal fistula and intestinal obstruction caused by intestinal tube injury were found in the three groups of patients,and no incisive hernia recurrence was found postoperatively.Conclusions:Compared with open surgery,laparoscopic incisional hernia can effectively reduce the trauma of patients and significantly shorten the postoperative hospitalization days.Hybrid surgery can take the advantages of the two methods by combining open surgery and laparoscopic surgery.The diameter of the abdominal wall defect of hybrid surgery patients is significantly larger than that of laparoscopic surgery patients.Therefore,for patients with large incisional hernia,hybrid surgery is preferred.In terms of postoperative complications,IPOM technology did not cause any intestinal injury or postoperative intestinal obstruction caused by mesh contact in the separation of abdominal adhesion,so the safety of IPOM technology is worth affirming.