IPOM technique of indirect inguinal hernia
At World Laparoscopy Hospital, Dr R K Mishra has developed his personnel experience on laparoscopic hernioplasty using the Intraperitoneal Onlay Mesh Repair (IPOM) in 36 patients. In this technique Mishra's knot is used to fix the Mesh. In thhis stydy of suturing technique of Viporo II mesh, all the patients were suffering from either direct or indirect inguinal hernia and only few of them included who had recurrent inguinal hernia, 7 of which were recurrent and 20 had a unilateral hernia, and 9 had bilateral inguinal hernia. The hernia repair was performed utilizing Vipro II Mesh and the prostheses were fixed with titanium spiral tacks (Protack, AutoSuture, Tyco Healthcare) and few of the were fixed with the covedian absorbable tacker AbsorbaTack™ (ABSTACK30X) Fixation Device .
In our study conducted at World Laparoscopy Hospital, Gurgaon, India no intraoperative complications occurred and no conversion was necessary. In this study to preven seroma formation tight srotal support was given to one week. Mean hospital stay was 24 hours. Mean resumption of normal activity was 7 days with return to work within two weeks.
At an average 6 month follow-up, 1 recurrences were recorded. The results of this study as well as the meta-analysis of the series presented in the Literature, indicate that the IPOM inguinal hernia surgery may be a feasible, safe and effective procedure in the treatment of recurrent and bilateral hernias or when a hernia repair is performed during other laparoscopic procedures.
The IPOM has infact been shown to be faster and easier recovery than the other more commonly performed traditional TEP and TAPP laparoscopic hernioplasties. These data may also suggest to utilize this technique in particular cases of primitive hernia such as very active young males without any comorbidity. Our experience of doing this type of hernia repair is very encouraging. However the limited series and the short follow-up ask for a large randomized prospective long term studies to definitely ascertain the true incidence of recurrence and therefore the effectiveness of this attractive procedure.
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