Objective To investigate the clinical efficacy of laparoscopic intraperitoneal onlay mesh (IPOM) versus open Sublay repair for stoma-site incisional hernia (SSIH).
Methods The retrospective cohort study was conducted. The clinical data of 90 patients with SSIH who were admitted to Huadong Hospital Affiliated to Fudan University from January 2019 to December 2024 were collected. There were 62 males and 28 females, aged (69±9) years. Among the 90 patients, 56 cases undergoing laparoscopic IPOM repair were allocated into IPOM group and 34 cases undergoing open Sublay repair were allocated into Sublay group. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow‑up. Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test, comparison of measurement data with skewed distribution between groups was conducted using the Mann-Whitney U test. Com-parison of count data was conducted using the chi-square test or Fisher exact probability. Repeated measurement data were analyzed using generalized estimating equations.
Results (1) Surgical situations: the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay, time of drainage tube placement were (101±12) minutes, (18±8) mL, (7.8±1.2) days, (4.3±1.1) days for the IPOM group, respectively, versus (139±12) minutes, (22±6) mL, (10.6±2.1) days, (6.9±0.7) days for the Sublay group, showing significant differences between the two groups (t=14.57, 2.70, 7.10, 13.70, P<0.05). (2) Postoperative situations: 2 patients in the IPOM group developed postoperative complications (1 case of seroma and 1 case of intestinal obstruction), and 3 patients in the Sublay group developed postoperative complications (2 cases of wound fat liquefaction, 1 case of urinary tract infection), with no significant difference between the two groups (P>0.05). All postoperative complications were observed in ileostomy patients and resolved with conservative or symptomatic treatment in both groups. The visual analogue scale at postoperative day 3, day 7, and 1 month were 3(range, 2-5), 1(range, 0-2), 0(range, 0-1) for the IPOM group, versus 2(range, 1-3), 0(range, 0-1), 0(range, 0-1) for the Sublay group, showing significant difference in the main effect of postoperative visual analogue scale between the two groups after controlling for time (χ²=35.47, P<0.05). Post-operative visual analogue scale decreased significantly over time in both groups (χ²=120.28, P<0.05). The time-by-group interaction effect was not significant (χ²=1.18, P>0.05), indicating no signi-ficant difference in the decreasing trend of visual analogue scale between the two groups. (3) Follow-up: all 90 patients were followed up for 40 (range, 15-68) months. No recurrence or mesh infection occurred in either group.
Conclusions Both laparoscopic IPOM and open Sublay repair are safe and effective for SSIH. Compared with open Sublay repair, laparoscopic IPOM repair has shorter operation time, less volume of intraoperative blood loss, and shorter hospital stay, but is associated with more pronounced early postoperative pain.
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