A Study of Intraperitoneal Onlay Mesh Repair Using Barbed Sutures for Abdominal Incisional Hernia

Objective: We investigated the validity of our intraperitoneal onlay mesh (IPOM) Plus technique with barbed sutures. Background: Laparoscopic intraperitoneal onlay mesh repair has become a proven method for treating abdominal incisional hernias in recent years. There have been a few reports on the utility of IPOM Plus, which is IPOM+celiorrhaphy, although this method has not been widely discussed. We adopted the IPOM Plus technique with barbed sutures at our hospital and investigated the validity of this technique. Methods: We included 7 patients who underwent IPOM Plus repair from 2015 to 2017 at our hospital. We excluded patients with a hernia hilum <2 cm or >= 10 cm, age < 20 years old, PS3 or more, and uncontrolled comorbidity. The hernial orifice was closed laparoscopically using barbed sutures and subsequently secured by tacking on an onlay mesh. Results: The median hernial orifice size of the 7 patients was 45 mm (25 to 55 mm). Hernia onset occurred after laparotomy in all cases. In one case, an abdominal incisional hernia recurred after IPOM used to treat the condition 15 years earlier. The mean duration of surgery was 80.5 minutes (53 to 126 minutes), and the median pain scale score was 3 points (0 to 3 points), indicating little pain. None of the patients reported persistent postoperative pain. The mean duration of the postoperative hospital stay was a median of 3.5 days (2 to 5 days). Both short- and long-term outcomes indicated that no recurrence or complications, such as bulging or seroma, occurred. Conclusions: IPOM Plus with intracavitary abdominal suturing using barbed suture for abdominal scar hernia repair may be a valid surgical procedure.