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. 2021 Feb;25(1):23-31.
doi: 10.1007/s10029-020-02143-4. Epub 2020 Feb 25.

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

F Köckerling  1 , B Lammers  2 , D Weyhe  3 , W Reinpold  4 , K Zarras  5 , D Adolf  6 , H Riediger  7 , C M Krüger  8
Affiliations

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

F Köckerling et al. Hernia. 2021 Feb.

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.

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Conflict of interest statement

Ferdinand Köckerling - Grants to fund the Herniamed Registry from Johson & Johnson, Norderstedt, Karl Storz, Tuttlingen, pfm medical, Cologne, Dahlhausen, Cologne, B. Braun, Tuttlingen, Menke Med, Munich, Bard, Karlsruhe. B. Lammers, D. Weyhe, W. Reinpold, K. Zarras, D. Adolf, H. Riediger, CM. Krüger have no conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Flowchart of patient inclusion
Fig. 2
Fig. 2
Flowchart of patient matching
Fig. 3
Fig. 3
Standardized differences between the matching variables both before (original sample) and after matching (matched sample)
Fig. 4
Fig. 4
Results of matched pairs analysis of incisional hernia repair with open IPOM versus open Sublay procedures
Fig. 5
Fig. 5
Standardized differences of the influencing factors and the perioperative outcomes between patient collectives with and without follow-up
See this image and copyright information in PMC

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References

    1. Mathes T, Walgenbach M, Siegel R. Suture versus mesh repair in primary and incisional ventral hernias: a systematic review and meta-analysis. World J Surg. 2016;40:826–835. doi: 10.1007/s00268-015-3311-2. - DOI - PubMed
    1. Lopez-Cano M, Martin-Dominguez LA, Pereira JA, Armengo-Carrasco M, Garcia-Alamino JM. Balancing mesh-related complications and benefits in primary ventral and incisional hernia surgery. A meta-analysis and trial sequential analysis: PLOS ONE; 2018. - PMC - PubMed
    1. Kokotovic D, Bisgaard T, Helgstrand F. Long-term recurrence and complications associated with elective incisional hernia repair. JAMA. 2016;316(15):1575–1582. doi: 10.1001/jama.2016.15217. - DOI - PubMed
    1. Liang MK, Holihan JL, Itani K, Alawadi ZM, Flores Gonzales JR, Askenasi EP, et al. Ventral hernia management—expert consensus guided by systematic review. Ann Surg. 2017;265:80–89. doi: 10.1097/SLA.0000000000001701. - DOI - PubMed
    1. Al Chalabi H, Larkin J, Mehigan B, McCormick P. A systematic review of laparoscopic versus open abdominal incisional hernia repair, with meta-analysis of randomized controlled trials. Int J Surg. 2015;20:65–74. doi: 10.1016/j.ijsu.2015.05.050. - DOI - PubMed