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Evaluating the impact of diastasis recti on ipom plus ventral hernia repair
Emmanuel E Sadava1,2, Julieta A Giacone Aguiar3,4, Agustin C Valinoti3,4
1Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredon 1640, Buenos Aires, C1118AAT, Argentina. esadava@hospitalaleman.com.
Introduction:
Ventral hernia repair (VHR) via intraperitoneal onlay mesh with primary defect closure (IPOM+) is currently the most widely adopted technique. However, this procedure has not yet been evaluated in patients with diastasis recti (DR). We aimed to determine if the presence of DR affects long-term surgical outcomes of IPOM+.
Methods:
We conducted a retrospective analysis of a consecutive series of patients who underwent IPOM + technique for VHR. Only patients with defects between 3 and 8 cm in width and with at least 1-year follow-up were included. The cohort was divided into two groups; IPOM+: patients with ventral hernia without DR, and IPOM + DR, patients with ventral hernia and DR. Preoperative, intraoperative and postoperative variables were compared between groups.
Results:
A total of 106 patients undergoing VHR were included; 41 (39%) IPOM + and 65 (61%) IPOM + DR (the mean DR was: 4.5 ± 1.3 cm). Demographics and preoperative variables were similar between groups. Mean defect width was 5.3 ± 2 cm and: 4.7 ± 2 cm for IPOM + and IPOM + DR, respectively (p = 0.2). Mean follow-up was also similar between groups (IPOM+: 51.8 versus IPOM + DR: 46.3 months, p = 0.44). Recurrence rate was significantly higher in patients with IPOM + DR (21.5% versus 2.4%, p = 0.003). In addition, 5 (7.6%) patients in IPOM + DR group had DR-recurrence as clinical bulging, and all but one needed reoperation.
Conclusions:
Although IPOM + remains as an effective technique for the repair of midline ventral hernias, the presence of DR increases recurrence rates significantly. Further research is needed to determine the optimal surgical approach in patients with ventral hernias and DR.
