Effect of implant fixation method on adhesions formation in IPOM hernia repair: a systematic review

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OBJECTIVE

To assess the efficacy of the mesh fixation technique on abdominal adhesions in IPOM hernia repair.

MATERIAL AND METHODS

The protocol has been developed following the PRISMA guidelines. Electronic searches over the past 20 years were performed in the Web of Science, Scopus, PubMed, RSCI databases. The methodological quality of the articles was assessed using a scoring system based on SYRCLE’s risk of bias tool. The conclusion about the severity of abdominal adhesion was made based on the following parameters: 1) quantity (No. of pieces of mesh with adhesions); 2) extent (percentage of the surface); 3) type (appearance); 4) tenacity (resistance to lysis); 5) organ involvement. In all studies, at least two types of fixation were assessed.

RESULTS

The search in databases yielded 22 experimental studies. Clinical trials that met the inclusion criteria were not found. Mesh fixation was predominantly performed by transfascial sutures, titanium tacks, absorbable tacks, fibrin sealant, and cyanoacrylate glue. Only three studies had a low risk of bias. In 36.36% of the studies, there was no association between mesh fixation and abdominal adhesion. The most positive effect was obtained when using fibrin glue.

CONCLUSION

After analyzing experimental studies evaluating the effect of mesh fixation on adhesion formation, methods that give both a positive trend (fibrin glue) and methods that have risks (transfascial sutures) were identified. The performed systematic analysis showed that the experimental study of adhesion formation issues with different variants of intraperitoneal mesh fixation had been reserved for development. The lack of targeted clinical studies on this topic is the basis for their implementation.

Keywords:

abdominal wall hernia

hernia repair

intraperitoneal onlay mesh

IPOM

mesh fixation

abdominal adhesions

Authors:

Armashov V.P.

Pirogov Russian National Research Medical University

ORCID: 0000-0001-5108-1400

Oettinger A.P.

Pirogov Russian National Research Medical University

ORCID: 0000-0001-9894-0671

Lomaia D.B.

Pirogov Russian National Research Medical University

ORCID: 0000-0002-7293-4369

Makarov S.A.

Center for Surgical Treatment of Obesity and Metabolic Disorders — St. George Hospital

ORCID: 0000-0002-8423-8002

Matveev N.L.

Pirogov Russian National Research Medical University

ORCID: 0000-0001-9113-9400

Received:

14.07.2021

Accepted:

17.08.2021

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