This case report discusses a rare complication of small bowel obstruction occurring in the early course following Intraperitoneal Onlay Mesh (IPOM) repair for an incisional hernia. The bowel obstruction, which failed to respond to conservative measures, was caused by band adhesions resulting from the presence of a loose intraperitoneal migrated surgical tack. This was successfully managed laparoscopically resulting in complete recovery. We present the clinical and radiological findings and review the relevant literature in this area.

BACKGROUND: Laparoscopic IPOM is technically challenging, especially regarding fascial closure. Hybrid repair has been proposed as a simpler approach. We aimed to compare hybrid and laparoscopic intraperitoneal onlay mesh repair (IPOM) in patients undergoing ventral hernia repair (VHR).
METHODS: We performed a systematic review of Cochrane, Scopus, and MEDLINE databases to identify studies comparing hybrid versus laparoscopic IPOM VHR reporting the outcomes of recurrence, mortality, seroma, postoperative complications, reoperation, surgical site infection, and operative time. Statistical analysis was performed using RStudio 4.1.2 using a random-effects model.
RESULTS: We screened 2,896 articles and fully reviewed 22 of them. A total of five studies, encompassing 664 patients were included. Among them, 337 (50.8%) underwent laparoscopic IPOM. All patients had incisional hernias, with a mean diameter varying from 3 to 12.7 cm, 60% were women, with a mean BMI varying from 29.5 to 38. The hybrid approach had a lower rate of seroma when compared to the laparoscopic (OR 0.22; 95% CI 0.05 to 0.92; p = 0.038; I²=78%). We found no difference in recurrence, mortality, postoperative complications, reoperation, surgical site infection, and operative time between groups.
CONCLUSIONS: Hybrid IPOM is a safe and effective method for incisional hernia repair. Moreover, it facilitates fascial defect closure and decreases postoperative seromas.

OBJECTIVE: The purpose of the study was to evaluate the results of using fluoropolymer-coated mesh during intraperitoneal onlay mesh hernia repair in patients with primary ventral hernias.
METHODS: The multicenter, non-randomized, controlled clinical study included 88 patients of both sexes who were operated on using a laparoscopic approach using the IPOM technique for a primary ventral hernia. The duration of observation ranged from 3 to 12 months. In the main group, 48 patients received fluoropolymer-coated meshes (Ftorex). A comparison was made with a retrospective group of 40 patients who were treated with anti-adhesive collagen-coated meshes (Parietene composite, Parietex Composite, Symbotex).
RESULTS: The number of early and late postoperative complications in the groups did not have significant differences, at the same time, their number was lower in the group of patients in whom fluoropolymer-coated meshes were used. Most of the complications corresponded to Clavien-Dindo class I and II and did not pose a significant threat to health. There were no recurrences of hernias observed in patients included in the study. There were slightly more adhesions in the fluoropolymer-coated mesh group (35.4% vs. 25.0% in the collagen-coated mesh group). The quality of life of patients in the study groups did not differ.
CONCLUSIONS: In laparoscopic IPOM hernia repair fluoropolymer-coated meshes are not inferior in effectiveness and safety to traditionally used collagen-coated meshes and can be recommended for use in patients with primary ventral hernias.
UNASSIGNED: Оценка результатов использования эндопротезов с фторполимерным покрытием при герниопластике IPOM у пациентов с первичными вентральными грыжами.
UNASSIGNED: В многоцентровое нерандомизированное контролируемое клиническое исследование были включены 88 пациентов обоего пола, оперированных из лапароскопического доступа по методике IPOM по поводу первичной вентральной грыжи. 48 пациентам основной группы были установлены эндопротезы с фторполимерным покрытием (ФТОРЭКС), 40 пациентам ретроспективной группы - протезы с антиадгезивным покрытием из коллагена (Parietene Composite, Parietex Composite, Symbotex). Длительность наблюдения составила от 3 до 12 месяцев.
UNASSIGNED: Число ранних и поздних осложнений в группах не имело достоверных различий, но в основной группе у пациентов осложнений оказалось меньше. Бóльшая часть осложнений соответствовала классу I и II по Clavien—Dindo и не представляла значимой угрозы здоровью. У пациентов обеих групп рецидивов грыж не отмечено. Спаек было несколько больше в группе, где использовали протезы с фторполимерным покрытием (35,4% против 25,0% в группе с протезами с покрытием из коллагена). Качество жизни пациентов в исследуемых группах не отличалось.
UNASSIGNED: При лапароскопической герниопластике IPOM эндопротезы с фторполимерным покрытием по эффективности и безопасности не уступают традиционно используемым протезам с покрытием из коллагена и могут быть рекомендованы для применения у пациентов с первичными вентральными грыжами.

OBJECTIVE: To review the first robotic hernia repairs performed at the Ilyinsky Hospital, evolution of this technology, learning curve and early outcomes.
METHODS: There were 17 procedures at the Ilyinskaya Hospital between 2021 and 2023 (13 men and 4 women). Mean age was 60 years, body mass index 28 kg/m2. ASA grade 1 was observed in 1 patient, grade 2 - 14 ones, grade 3 - 2 patients. Ventral, inguinal and umbilical hernias were diagnosed in 7, 8 and 2 cases, respectively. Ventral hernias required IPOM+ procedure in 3 cases, eTEP-RS procedure in 2 cases and eTEP-RS-TAR procedure in 2 cases. Patients with inguinal hernia underwent transabdominal preperitoneal hernia repair. In case of umbilical hernia, TARUP procedure was performed in 1 case and vTAPP procedure in 1 case.
RESULTS: Mean surgery time was 2 hours 38 min (min 1 hour 35 min, max 10 hours 11 min). There was one intraoperative complication (bleeding from epigastric artery). The follow-up period ranged from 3 months to 3 years. There were no recurrent hernias. Postoperative complications were noted in 2 cases. One patient was diagnosed with epididymitis after TAPP, 1 patient - with seroma after eTEP-RS procedure. All complications were relieved by conservative treatment. Bleeding from a. epigastrica inferior was diagnosed after removal of the trocar at the end of surgery. This event required suturing.
CONCLUSIONS: Robotic hernia repair appears to be technically feasible and safe. This approach provides favorable results regarding quality of life and recurrence rate.
Минимально инвазивная герниопластика имеет доказанные преимущества перед открытыми операциями, включая сниженный болевой синдром и более раннюю активизацию пациентов. Часть экспертов считает, что результаты операций можно улучшить, используя роботические хирургические комплексы, за счет улучшенной эргономики, трехмерной оптики высокого разрешения и изгибающихся инструментов, которые способны преодолеть ограничения лапароскопического доступа. Настоящий обзор первых 17 роботизированных герниопластик, выполненных в Ильинской больнице, описывает эволюцию технологии, кривую обучения и первые результаты пациентов.
UNASSIGNED: Продемонстрировать безопасный способ внедрения новой технологии, робота Da Vinci, в устоявшуюся лапароскопическую практику.
UNASSIGNED: В период с 2021 по 2023 г. в Ильинской больнице было выполнено 17 операций. Из 17 пациентов 13 больных были мужчины и 4 женщины. Средний возраст — 60 лет. Средний индекс массы тела 28 кг/м2. Большинство больных имели хороший физический ASA 1 — 1, ASA 2 — 14, у 2 пациентов — ASA 3. Из них оперированы по поводу вентральной грыжи в 7 случаях, паховой грыжи — в 8 случаях, пупочной грыжи — в 2 случаях. При вентральной грыже выполнены следующие операции: IPOM+ — в 3 случаях, 2 операции выполнены по методике eTEP-RS и в 2 случаях — eTEP-RS-TAR. При паховых грыжах пациенту выполняли трансабдоминальную преперитонеальную герниопластику ТАРР. При пупочных грыжах выполнили в 1 случае TARUP и в 1 случае vTAPP.
UNASSIGNED: Среднее время операции составило 2 ч 38 мин, минимальное время операции было 1 ч 35 мин, максимальное — 10 ч 11 мин. Интраоперационное осложнение было в одном случае — кровотечение из надчревной артерии. Сроки наблюдения пациентов составили от 3 мес до 3 лет. Ни в одном случае не выявлено рецидива грыж. Послеоперационные осложнения отмечены в 2 случаях, у одного пациента диагностирован эпидидимит после ТАРР и у 1 пациента отмечена серома после eTEP-RS, все осложнения купированы консервативным лечением. Интраоперационные осложнения были в 1 случае — кровотечение из a. epigastrica inferior, — диагностированное после удаления троакара в конце операции и остановленное прошиванием кровоточащего сосуда.
UNASSIGNED: Наши результаты подтверждают, что роботизированная герниопластика представляется технически осуществимой и безопасной в опытных руках с хорошими результатами, обеспечивающими высокое качество жизни, связанное со здоровьем, и низкую частоту рецидива в краткосрочной и долгосрочной перспективе.

Objectives Laparoscopic intraperitoneal onlay mesh hernioplasty (IPOM) for ventral hernias has been used for a long time. However, there have been some issues associated with it, thereby leading to the introduction of a new technique that involves laparoscopic closure of the fascial defect with suture followed by intraperitoneal onlay mesh placement (IPOM-Plus). We carried out this study to compare the outcome of laparoscopic IPOM with fascial defect closure versus without defect closure in midline ventral hernia repair in terms of recurrence. Methodology This comparative study was carried out in the Department of Surgery, Services Hospital, Lahore, from October 16, 2020, to April 15, 2022. A total of 84 patients of both genders, aged between 18 and 70 years, presenting with midline ventral hernia were included in the study. Patients with recurrent hernia, unstable cardiopulmonary conditions, neurological or psychiatric diseases, chronic renal disease, congestive cardiac failure, and chronic obstructive pulmonary disease (COPD) were excluded from the study. Patients were assigned to two groups. Group 1 underwent IPOM with the closure of the defect, and Group 2 underwent IPOM without the closure of the defect. Patients were observed for immediate postoperative complications. Patients were monitored for one year to assess recurrence through clinical evaluation and ultrasonography. Results In this study, seroma formation was found in 3 (7.14%) patients for laparoscopic IPOM with fascial defect closure and 10 (23.81%) in those undergoing laparoscopic IPOM without defect closure (P-value = 0.035). Recurrence was identified in 2 (4.76%) patients undergoing laparoscopic IPOM with fascial defect closure and 9 (21.43%) in those undergoing laparoscopic IPOM without defect closure (P-value = 0.024). Conclusions This study concluded that the frequency of recurrence is less after laparoscopic IPOM with fascial defect closure in midline ventral hernia repair than after laparoscopic IPOM without fascial defect closure.

BACKGROUND: Intraperitoneal onlay mesh (IPOM) placement for small to medium-sized hernias has garnered negative attention due to perceived long-term risk of mesh-related complications. However, sparse data exists supporting such claims after minimally invasive (MIS) IPOM repairs and most is hindered by the lack of long-term follow-up. We sought to report long-term outcomes and mesh-related complications of MIS IPOM ventral hernia repairs.
METHODS: Adult patients who underwent MIS IPOM ventral hernia repair at our institution were identified in the Abdominal Core Health Quality Collaborative database from October 2013 to October 2020. Outcomes included hernia recurrence and mesh-related complications or reoperations up to 6 years postoperatively.
RESULTS: A total of 325 patients were identified. The majority (97.2%) of cases were elective, non-recurrent (74.5%), and CDC class I (99.4%). Mean hernia width was 4.16 ± 3.86 cm. Median follow-up was 3.6 (IQR 2.8-5) years. Surgeon-entered or patient-reported follow-up was available for 253 (77.8%) patients at 3 years or greater postoperatively. One patient experienced an early small bowel obstruction and was reoperated on within 30 days. Two-hundred forty-five radiographic examinations were available up to 6 years postoperatively. Twenty-seven patients had hernia recurrence on radiographic examination up to 6 years postoperatively. During long-term follow-up, two mesh-related complications required reoperations: mesh removed for chronic pain and mesh removal at the time of colon surgery for perforated cancer. Sixteen additional patients required reoperation within 6 years for the following reasons: hernia recurrence (n = 5), unrelated intraabdominal pathology (n = 9), obstructed port site hernia (n = 1), and adhesive bowel obstruction unrelated to the prosthesis (n = 1). The rate of reoperation due to intraperitoneal mesh complications was 0.62% (2/325) with up to 6 year follow-up.
CONCLUSIONS: Intraperitoneal mesh for repair of small to medium-sized hernias has an extremely low rate of long-term mesh-related complications. It remains a safe and durable option for hernia surgeons.

OBJECTIVE: Despite advancements in laparoscopic ventral hernia repair (LVHR) using the intraperitoneal onlay mesh technique (sIPOM), recurrence remains a common postoperative complication. The objective of this systematic review and meta-analysis is to compare the efficacy of defect closure (IPOM-plus) versus non-closure in ventral and incisional hernia repair. The aim is to determine which technique yields better outcomes in terms of reducing recurrence and complication rates.
METHODS: A comprehensive literature review was conducted in the PubMed, Web of Science, Cochrane Library, Embase, and ClinicalTrials.gov databases from their inception until October 1, 2022, to identify all online English publications that compared the outcomes of laparoscopic ventral hernia repair with and without fascia closure.
RESULTS: Three randomized controlled trials (RCTs) and eleven cohort studies involving 1585 patients met the inclusion criteria. The IPOM-plus technique was found to reduce the recurrence of hernias (OR = 0.51, 95% CI [0.35, 0.76], p < 0.01), seroma (OR = 0.48, 95% CI [0.32, 0.71], p < 0.01), and mesh bulging (OR = 0.08, 95% CI [0.01, 0.42], p < 0.01). Subgroup analysis revealed that body mass index (BMI) (OR = 0.43, 95% CI [0.29, 0.65], p < 0.0001), type of article (OR = 0.51, 95% CI [0.35, 0.76], p = 0.0008 < 0.01), geographical location (OR = 0.54, 95% CI [0.36, 0.82], p = 0.004 < 0.01), follow-up time (OR = 0.50, 95% CI [0.34, 0.73], p = 0.0004 < 0.01) had a significant influence on the postoperative recurrence of the IPOM-plus technique.
CONCLUSIONS: The IPOM-plus technique has been shown to greatly reduce the occurrence of recurrence, seroma, and mesh bulging. Overall, the IPOM-plus technique is considered a safe and effective procedure. However, additional randomized controlled studies with extended follow-up periods are necessary to further evaluate the IPOM-plus technique.

BACKGROUND: Sutures or tacks are commonly used to secure a mesh in intraperitoneal onlay mesh (IPOM) hernia repair, but such penetrating fixations can cause local damage, that can be associated with pain. The use of an adhesive could be an alternative to reduce complications. However, a risk associated with this approach has been identified, particularly when the defect cannot be closed. A mesh glued to the peritoneum only might not provide as much mechanical reinforcement to the abdominal wall (AW) as a mesh anchored to the myofascial structure with penetrating fixations, which could lead to an increased recurrence rate. Additionally, the high elasticity of the peritoneum may increase mesh bulging. Leveraging an ex vivo approach, the objective of this study was to investigate the impact of mesh fixation using glue versus barbed sutures, on its biomechanical response for IPOM surgery.
METHODS: An experimental method was developed using ex vivo porcine abdominal wall samples (n = 12). A 4-cm centered circular defect was created by dissecting the skin and the subcutaneous tissue and removing muscle and extraperitoneal fat, while keeping the peritoneum intact. A 14-cm diameter mesh was secured (Dermabond™ cyanoacrylate adhesive or V-Loc™ barbed sutures) to the AW. The mesh was placed on the peritoneum to remain consistent with the IPOM placement. The sample was then subjected to some inflation tests to simulate increased levels of intra-abdominal pressure (IAP) representing daily activities. For each test, mesh bulging into the defect was assessed as a function of the pressure using Digital Image Correlation (DIC) analysis.
RESULTS: Mesh bulging was studied for 2 configurations: suture fixation and glue. Glued meshes exhibited significantly higher bulging values than when sutured with a significant difference (p = 0.013) observed at 252 mmHg and a certain trend for statistical difference (p < 0.1) for stair climbing or coughing activities. Additionally, the stiffness of the repair was also significantly higher when the mesh was sutured compared to when it was glued to the peritoneum (p < 0.05).
CONCLUSIONS: This study demonstrated that a mesh glued to the peritoneum exhibited higher bulging and a behavior of the repair less stiff compared to when it was sutured to the myofascial structure of the AW, particularly for high intra-abdominal pressures. However, the impact of these differences remains to be evaluated over time. Further preclinical investigations are needed to quantify their impact post-operatively.

BACKGROUND: The optimal operative treatment for umbilical and epigastric hernia, i.e., primary midline ventral hernia (PMVH), is debatable. The most common techniques are the primary suture and open repair with mesh, while laparoscopic approach using intraperitoneally placed onlay mesh (IPOM) is less frequent. The aim of this study was to examine the outcomes of IPOM in PMVH. Perioperative results, recurrence, pain, and functional status were studied.
METHODS: This single-center prospective cohort study included consecutive patients with PMVH operated between September 2006 and December 2015. Systematic follow-up was conducted 6 months and 2 and 5 years postoperatively.
RESULTS: Seven hundred fifty-four patients underwent PMVH repair. Open repair without mesh, open repair with mesh, and IPOM were performed in 251 (34.9%), 273 (38%), and 195 (27.1%) patients, respectively. In the unmatched cohort, the incidence of postoperative complications was similar except postoperative seroma, which was more frequent after IPOM. The latter was also associated with longer length of stay. Open repair with mesh was associated with significantly lower recurrence compared with open repair without mesh and IPOM (5.2 vs 18.2 vs 13.8%, p=0.001, respectively). No differences were seen between the groups in terms of visual analog scale used for registering postoperative pain. These observations persisted after applying propensity score matching. In the multivariable analysis, open repair without mesh and IPOM significantly correlated with recurrence.
CONCLUSIONS: In PMVH, open repair with mesh is associated with lower recurrence compared with open repair without mesh and IPOM. Pain, postoperative complications (except for seroma), and functional status are similar.

OBJECTIVE: Although the treatment of abdominal wall desmoid-type fibromatosis (DF) has evolved over the past decades, surgical treatment remains an important approach. Previously, surgeries for abdominal DF were mostly performed by laparotomy, which involves massive dissection and significant trauma. Here, we report our single-center experience of the laparoscopic management of abdominal wall DF in young female patients.
METHODS: The clinical data of nine patients diagnosed with abdominal wall DF during January 2020-April 2022 at the Qilu Hospital of Shandong University were retrospectively analyzed. All patients underwent laparoscopic resection of abdominal wall DF and immediate abdominal wall reconstruction (AWR) with mesh augmentation via the intraperitoneal onlay mesh (IPOM) technique.
RESULTS: Laparoscopic DF resection and AWR were successfully performed in all patients. The mean operation time was 175.56 ± 46.20 min. The width of abdominal wall defect was 8.61 ± 3.30 cm. Full- and partial-thickness myofascial closure and reapproximation were performed in five, two, and two patients, respectively. The average mesh size was 253.33 ± 71.01 cm2. The total and postoperative lengths of hospital stay were 11.00 ± 3.46 and 4.89 ± 2.03 days, respectively. Tumor recurred in one patient after 20 months of the resection. Nonetheless, death, herniation, or bulging were not observed in any patient during a mean follow-up of 16.11 ± 8.43 months.
CONCLUSIONS: Laparoscopic resection of abdominal wall DF and immediate AWR with IPOM mesh reinforcement is safe and reliable for young female patients. Management of such patients should be decided according to the biological behavior, size, and location of tumors.