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. 2019 Oct;33(10):3361-3369.
doi: 10.1007/s00464-018-06629-2. Epub 2019 Jan 2.

Laparoscopic IPOM versus open sublay technique for elective incisional hernia repair: a registry-based, propensity score-matched comparison of 9907 patients

F Köckerling  1 , T Simon  2 , D Adolf  3 , D Köckerling  4 , F Mayer  5 , W Reinpold  6 , D Weyhe  7 , R Bittner  8
Affiliations

Laparoscopic IPOM versus open sublay technique for elective incisional hernia repair: a registry-based, propensity score-matched comparison of 9907 patients

F Köckerling et al. Surg Endosc. 2019 Oct.

Abstract

Background: For comparison of laparoscopic IPOM versus sublay technique for elective incisional hernia repair, the number of cases included in randomized controlled trials and meta-analyses is limited. Therefore, an urgent need for more comparative data persists.

Methods: In total, 9907 patients with an elective incisional hernia repair and 1-year follow-up were selected from the Herniamed Hernia Registry between September 1, 2009 and June 1, 2016. Using propensity score matching, 3965 (96.5%) matched pairs from 4110 laparoscopic IPOM and 5797 sublay operations were formed for comparison of the techniques.

Results: Comparison of laparoscopic IPOM versus open sublay revealed disadvantages for the sublay operation regarding postoperative surgical complications (3.4% vs. 10.5%; p < 0.001), complication-related reoperations (1.5% vs. 4.7%; p < 0.001), and postoperative general complications (2.5% vs. 3.7%; p = 0.004). The majority of surgical postoperative complications were surgical site infection, seroma, and bleeding. Laparoscopic IPOM had disadvantages in terms of intraoperative complications (2.3% vs. 1.3%; p < 0.001), mainly bleeding, bowel, and other organ injuries. No significant differences in the recurrence and pain rates at 1-year follow-up were observed.

Conclusion: Laparoscopic IPOM was found to have advantages over the open sublay technique regarding the rates of both surgical and general postoperative complications as well as complication-related reoperations, but disadvantages regarding the rate of intraoperative complications.

Keywords: Complications; Hernia registry; Incisional hernia; Laparoscopic IPOM; Sublay.

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Conflict of interest statement

Simon T, Adolf D, Köckerling D, Mayer F, Reinpold W, Weyhe D, and Bittner R have no conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
Flowchart of patient inclusion
Fig. 2
Fig. 2
Flowchart of patient matching
Fig. 3
Fig. 3
Standard differences between the matching variables both before (original sample) and after matching (matched sample)
Fig. 4
Fig. 4
Results of matched pairs analysis of laparoscopic intraperitoneal onlay mesh versus open sublay in incisional hernia repair
See this image and copyright information in PMC

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