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All about Laparoscopic inguinal hernia repair "IPOM"

  • Posted on- Jan 06, 2018
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Laparoscopic inguinal hernia repair requires an instrument known as laparoscopy. It is a process in which between 2 to 4 small incisions are made through the abdominal wall through which are passed the laparoscope (a thin telescope with a light on the end) and surgical instruments into the abdomen.

What is IPOM?

The IPOM technique implies for the repair of the incision and parastomal hernias have increasingly gained popularity. A complete abdominal wall implies the dissection through laparoscopic technique.

What is the technique used for IPOM?



The laparoscopic intraperitoneal on lay mesh (IPOM) technique for the repair of incisional and parastomal hernias has increasingly gained popularity. The main advantage in comparison with the open approach is the reduced incidence of wound complications and the recurrence rate also seems to be lower.

The technique of laparoscopy is made on the basis of dissection of the abdominal wall. The whole original scar must be covered with a broad overlap of at least 5 cm. A connection used for laparoscopic approaches must induce strong and rapid incorporation on the parietal side and they should also prevent adhesions on the visceral side.

What are the indications of IPOM?



A similar indication of laparoscopic inguinal hernia repair, if opposed to the waiting, is similar as compared to inguinal hernia repair. For operative intervention, the existence of an inguinal hernia has been considered sufficient reason. Whereas, reports have said that the presence of a reducible hernia is not only in itself, an indication for the surgery risk for incarceration is very low to 1%.
 
Patients with these symptoms should go for repair as many as one-third of patients with inguinal hernias are asymptomatic. The case studies versus practical theories in this asymptomatic or minimally symptomatic population were addressed in two randomized clinical trials, both of which found that there were no significant differences in hernia-related symptoms after long-term follow-up and that watchful waiting did not increase the complication rate.

What are the contraindications of IPOM?

General contraindications for laparoscopic herniorrhaphy parallel to those of open repair.
Inguinal hernia repair itself has no absolute contraindications. Just as in any other elective surgical procedure, the patient must be medically optimized. Any medical issues, whether acute (e.g, upper respiratory tract or skin infection) or exacerbations of underlying medical conditions (e.g, poorly controlled diabetes mellitus), should be fully addressed and the surgery delayed accordingly.

Relative contraindications specific to the laparoscopic approach include a lower midline incision, previous preperitoneal surgery, irreducible hernia, and inability to tolerate general anesthesia.

How to reduce inguinal IPOM?

For the reduction of swelling in a hernia, the ice pack is applied and gives a fast feedback. The ice pack is applied to the patient with a left inguinal hernia in Trendelenburg position. To reduce an abdominal hernia, lay the patient supine.

Use sufficient early sedation and analgesia if necessary to reduce pain during the procedure. A reduction in pain also helps decrease guarding and abdominal muscular constriction, thereby lowering the intra-abdominal pressure and permitting easier reduction.

How long does IPOM take to recover?

During open repair surgery, a large cut is made inside the groin. If a hernia swells out of the abdominal wall, then swelling is pushed back into place. In a case hernia moves down the inguinal canal, then hernia sac is removed. The abnormal place where swelling comes out is surgerized by sewing muscles together.

This is appropriate for smaller hernias that have been present since birth (indirect hernias) and for healthy tissues, where it is possible to use stitches without adding stress to the tissue. But the approach of surgery which is laying on the muscle wall that has to be repaired according to the preference of the surgeon.

 

What are the outcomes of IPOM?



Any pain after the operation can occur due to hernia repair. Morbidity is usually low after a TAPP procedure, with one large series reporting a rate of 2.9%. Seroma (a collection of fluid) represent the most common postoperative complication. These usually resolve spontaneously and rarely warrant further intervention.

Recurrence is a concern. More frequently, controlled trial comparing laparoscopic with open repair found that with adequate training, laparoscopic repair yielded equivalent recurrence rates, reduced postoperative pain, and earlier return to work.  Recurrence rates after TAPP repair usually range from 1% to 6%, specialized centers performing large numbers of repairs cite rates of less than 1%.

A rare difficulty is a small-bowel obstruction that occurs after a TAPP hernia repair and most commonly results from holes created in the peritoneal flap during dissection. As a rule, it is easily prevented by repairing these tears or holes and ensuring proper tracking of the peritoneum to the abdominal wall over the mesh, so that there are no potential holes or gaps through which bowel can herniate.

The minimum cost of LAPAROSCOPIC INGUINAL HERNIA REPAIR IPOM is Rs.2,50,000 to maximum Rs. 5,00,000.

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