Laparoscopic transabdominal preperitoneal approach to place a polypropylene mesh on the abdominal wall: an experimental swine model of a technique that can be used for incisional hernia repair.
BACKGROUND
The placement of intraabdominal polypropylene mesh entails risks of adhesions and fistulas that can be avoided by preperitoneal placement.


METHODS
This comparative, open, experimental, prospective, randomized, and transversal study randomized pigs into two groups of 11 each for intraperitoneal (IPOM) or preperitoneal (TAPP) polypropylene mesh placement by laparoscopy. Diagnostic laparoscopy and tissue en-bloc resection was performed 28 days postoperatively for histopathologic analysis.


RESULTS
The following data were observed for the two study groups: surgical time (IPOM: 35.73 +/- 4.22 min; TAPP: 58.09 +/- 6.28 min; p = or < 0.0001); adhesions (IPOM: 81.81%; TAPP: 27.27%; p = 0.032), grade III for IPOM and grade II for TAPP (p = 0.001); and interloop adhesions (IPOM: 81.81%; TAPP: 9.09%; p = 0.003). No fistulas were found in either group. The TAPP procedure showed better integration of mesh, without lesion to abdominal organs. Two complications, occurred with IPOM, and one with TAPP (p = 1.0, not significant).


CONCLUSIONS
The perperitoneal technique requires more time, but has fewer adhesions and less intraabdominal inflammatory response. It is a feasible technique that may diminish risks in the laparoscopic treatment of incisional hernias with polypropylene mesh.
Díaz-Pizarro Graf
J I
JI
Division of Endoscopic Surgery, Hospital General Dr. Manuel Gea González, Calzada de Tlalpan 4800, Col. Toriello Guerra, C.P. 14000, Tlalpan, Mexico DF, Mexico. jidiazpizarro@webtelmex.net.mx
Moreno Portillo
M
M
Cárdenas Lailson
L E
LE
Ramírez Solís
M E
ME
Palacios Ruiz
J A
JA
Parraguirre Martínez
S
S
D034861:Abdominal Wall; D000818:Animals; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D005355:Fibrosis; D046449:Hernia, Abdominal / Q000601:surgery*; D007082:Ileum / Q000473:pathology; D010535:Laparoscopy; D023421:Models, Animal; D011126:Polypropylenes; D011446:Prospective Studies; D019736:Prostheses and Implants; D013526:Surgical Mesh
D011126:Polypropylenes