1. LPS IPOM in management of complicated inguinal hernias
徐偉峻 王偉林 陳嘉哲
湯堯舜 廖立民 黃宏昌
臺北醫學大學附設醫院
外科部 急症外傷外科

2. Disclosure
I have nothing to disclose 2

3. Introduction
LPS hernioplasty with synthetic mesh has introduced since the 1990s, common methods for such repairs could be classified under three broad categories:
Total extraperitoneal (TEP) repair,
Transabdominal preperitoneal (TAPP) repair
Intraperitoneal onlay mesh (IPOM) repair 3

4. Introduction
IPOM has same advantage to other LPS techniques in terms of postoperative pain and faster recovery.
IPOM repairs allow exploration of the contralateral side that may show a non-symptomatic hernia in 11.2∼32.3% of the cases. The second hernia may be repaired simultaneously without affecting postoperative pain and course.
Sayad P, Abdo Z, Cacchione R, Ferzli G. Surgical Endoscopy 2000;14:

5. Material and Methods
Patients with incarcerated or recurrent hernia received LPS IPOM by a single surgeon from to were retrospectively reviewed
The inclusion criteria were patients, 18 years old and above, who have been diagnosed inguinal hernia with incarceration requiring diagnostic laparoscopy, or patients with prior hernia repairs
The exclusion criteria include contaminated surgical field (bloody ascites, gangrenous change of bowel, bowel perforation)

6. Material and Methods
All patients received a 15×15 cm sized dual facing surgical mesh (PROCEEDTM Mesh, Ethicon Endo-surgery, Inc., Somerville, NJ)
The mesh was further secured with a non-absorbable stitch on the corner of the mesh for transfascial fixation
The edge was further secured with absorbable tacks at 2 cm interval (SECURESTRAP, Ethicon Endo-surgery, Inc., Somerville, NJ)

7. Patient Profile Patient demographic Number of patients 15
Number of hernias 16
Age (mean)
60.2
Gender (M/F)
10/5
Site of hernia
right 14
left 1
bilateral
Type of hernia
direct
indirect
pantaloon
Previous surgery 5

8. Perioperative data Summary of perioperative data Surgical methods LPS
LPS 1
SILS 14
Operative time (average)
Unilateral
45 mins
Bilateral
60 mins
Conversions
Length of stay (average)
3.5 days

9. Complications Complications Intra-operative Post-operative Pain* 1
Post-operative
Pain* 1
Swelling/seroma
Hematoma/bleeding
Adhesion Ileus**
Recurrence
*Requiring oral analgesics 1 week after surgery
** Ileus during OPD follow up

10. Discussion
LPS hernia surgery has gained worldwide acceptance and has become the first choice for inguinal hernia repair in many centers.
The advantages include reduced pain and hospital stay, rapid convalescence, quicker return to work, better functional and cosmetic results.
Dulucq JL, Wintringer P, Mahajna A. Surgical Endoscopy 2006;20:
Toy FK, Smoot RT, Jr. Surgical Laparoscopy & Endoscopy 1991;1:
Spaw AT, Ennis BW, Spaw LP. Laparoscopic hernia repair: 1991;1:

11. Discussion
The size of the mesh should not be less than 10×15 cm so that entire myopectineal orifice (possible inguino-crural hernia sites) can be largely covered. This is utmost important in order to prevent recurrence.
Catani M, De Milito R, Pietroletti R, et al. Hepatostroenterology 2004;51:
Phillips EH, Rosenthal R, Fallas M, et al. Surgical Endoscopy 1995;9: ; discussion

12. Discussion
IPOM repair has concerns about relatively high recurrence rate and complication rate other than other LPS hernia, one study have shown with a median follow up of 51 months, no major complication has been reported, and with only one recurrence (1/50)
IPOM repair is also acceptable in terms of operative times, easiness and length of stay. However, compared to other LPS surgery, IPOM repair is more expensive
Journal of Minimally Invasive Surgery Vol. 17. No. 2, 2014

13. Limitations
Our study have been performed retrospectively to relatively small number of patients, with short follow up time (average 6months)

14. Conclusion
LPS IPOM repair for inguinal hernia is not a standard method, but it can be performed for specific cases of complicated inguinal hernia as an alternative option

15. 謝謝聆聽

16. 
Dual facing surgical mesh, with different characteristics on both sides:
the parietal surface is rough with micro-pores in order to stimulate a strong fibroblastic tissue reaction
the visceral surface is coated with anti-adhesive material in order to minimize tissue reaction, thus avoiding intestinal adhesions