Exploring primary intraperitoneal onlay mesh plasty (IPOM): Incidence of ileus and adhesions

Background: Intraperitoneal onlay mesh plasty (IPOM) represents a minimally invasive approach to ventral- and incisional hernia repair. Recent scrutiny has been directed towards IPOM repair, primarily concerning potential adhesion formation with intraperitoneal mesh. Literature addressing the incidence of ileus following IPOM is limited.

Aims: This study aims to investigate the incidence of mechanical ileus after primary hernia repair using IPOM. Additionally, the impact of IPOM on subsequent unrelated surgeries is evaluated.

Methods: A retrospective analysis was conducted on 230 consecutive patients undergoing primary hernia repair with IPOM between August 2013 and January 2020. Patient data was prospectively collected in the HerniaMed database. Long-term outcomes were assessed through outpatient follow-ups, HerniaMed questionnaires, and phone-call follow-ups.

Results: Over a 7-year period, 230 patients underwent IPOM repair without prior abdominal surgery. Included patients were predominantly male (N=190, 82%). Obesity with an BMI > 30 was found in 114 patients (50%). Umbilical hernia was the most common location (N=170, 74%), and 123 patients (54%) had small hernias (diameter < 2cm). The majority received a small (15x15cm) mesh. Postoperative major complications (Clavien-Dindo grade three and higher) were found in three patients (1.3%). One-year follow-up was available for 184 patients (80%), with three (2%) developing ileus symptoms. Five-year follow-up included 149 patients (65%), with six (3%) hospitalized for ileus and two (1%) requiring re-operation. Hernia recurrence occurred in five patients (3%), nine patients (6%) reported chronic pain. Among 28 patients undergoing subsequent, mostly unrelated, surgery post-IPOM repair, significant adhesions were discovered in eight patients (29%).

Conclusion: Adhesion-ileus is infrequent after primary ventral hernia repair with IPOM. However, nearly one third of patients exhibit significant adhesions, potentially prolonging subsequent abdominal surgeries.

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Artikel online veröffentlicht:
26. September 2024