Laparoscopic transabdominal preperitoneal repair versus laparoscopic intraperitoneal onlay mesh repair for umbilical/para umbilical hernia- an institutional review

Background: Laparoscopy has gained popularity over open surgery in the treatment of umbilical and para-umbilical hernia repair over the last decade due to better defining and cover of the abdominal defect, shorter post-operative stay, less pain and lesser complications. The aim of our study was to compare the two procedures in terms of duration of surgery,cost outcome, complications, recovery time, and recurrence. Materials and Methods: This was a prospective cum retrospective study conducted in patients undergoing laparoscopic surgery for umbilical or para-umbilical hernia in Kasturba hospital, Manipal, aged from 18 to 65 years. The two groups studied were laparoscopic transabdominal preperitoneal hernioplasty (TAPP) group and laparoscopic intraperitoneal onlay mesh hernioplasty (IPOM) group. The IPOM group was further subdivided into IPOM (I) when trans-parietal sutures were used and IPOM (II) when only tackers were used. Observations included intra-operative/postoperative complications, post-operative pain evaluated by using visual analogue scale(VAS) and recurrences. Cost of surgery, mean operating time and length of stay in hospital was evaluated. Result: 120 patients were included. 34 and 59 underwent TAPP and IPOM respectively. IPOM was less time consuming as compared to TAPP (p=0.021). TAPP proved to be a significantly cost effective procedure, (p<0.01). Both procedures had no recurrences. Conclusion: Laparoscopic repair of umbilical hernia by IPOM method is less time consuming but expensive. TAPP allows safe use of less expensive polypropylene mesh, fewer tackers and hence is cost effective. TAPP and IPOM are feasible operations with low morbidity and no recurrences when performed by experts. Both procedures are comparable in terms of length of stay in the hospital, intra-operative, post-operative complications and pain.