ZHUANG Bo,YU Kai,ZHANG Zhiwei, et al. A comparative study between the laparoscopic intraperitoneal onlay mesh and the totally visceral sac separation approach in ventral hernia[J]. JOURNAL OF WEZHOU MEDICAL UNIVERSITY, 2023, 53(1): 55-59.
Abstract：Objective: To investigate the difference between the technique of totally visceral sac separation (TVS) and the laparoscopic intraperitoneal onlay mesh (IPOM) in ventral hernia from the perspective of the clinical application of the TVS procedure and the evaluation of its safety, efficacy and cost-effectiveness. Methods: Data of 56 patients who underwent ventral hernia in Department of General Surgery Jinhua Hospital Zhejiang University School of Medicine from October 2019 to October 2021 were retrospectively analyzed, among whom 27 patients received TVS procedures (TVS group) and 29 patients IPOM operations (IPOM group). Baseline characteristics, operative records and perioperative data were compared between two groups. Follow-up was conducted by outpatient examination and telephone interview to detect patients’ survival and recurrence of ventral hernia. Results: There were no differences in age, sex, BMI,EHS- classification and defect area between two groups (P>0.05). Operative time in TVS procedure was significantly longer with mean time of (216.93± 52.80) min and (187.17±40.73) min in IPOM patients (P=0.021). The visual analogue score (VAS) on first postoperative day and hospitalization cost of the TVS group was lower than that of IPOM group (P=0.003, P<0.001). There was no significant difference in postoperative hospital stay (P=0.067). All procedures were successful, but two TVS group patients underwent open conversion, and one IPOM group patient had a surgical site infection that was cured conservatively. There was one case of recurrence after 6 months in TVS group and no perioperative mortality was found. The patients had been followed-up until March 2022, with the mean postoperative follow-up time being 14 months and the follow-up rate 94.6%. Conclusion: The TVS procedure is time-consuming but safe and feasible. It is a low-cost supplementary technique for surgical ventral hernias.
