عملية IPOM+ لإصلاح فتق جدار البطن: إمتى بنستخدمها؟ | IPOM+ Ventral Hernia Repair: When Is It Used?
للفتق من 4 لـ 10 سم | For Hernias of 4 to 10 cm
عملية الـ IPOM+ (Intraperitoneal Onlay Mesh Plus) من أشهر طرق إصلاح فتق جدار البطن بالمنظار. د. محمد حسام زيدان بيحكي إن إصلاح الفتق بالمنظار بدأ سنة 1993 بعملية الـ IPOM، وهي وضع شبكة جوه تجويف البطن، لكن نسبة الرجوع كانت عالية شوية، فاتطوّرت الـ IPOM+ اللي بيتصلّح فيها جدار البطن قبل وضع الشبكة، وده نزّل نسبة الرجوع لحوالي 2.7%. وبيوضح إن الإرشادات الأوروبية بتفضّل للفتق الأقل من 4 سم إن الشبكة تتحط خارج تجويف البطن، عشان كده الـ IPOM+ مناسبة للفتق من 4 لـ 10 سم، والفتق الجراحي، وفتق جدار البطن المعقّد. | IPOM+ (intraperitoneal onlay mesh plus) is one of the best-known laparoscopic repairs for ventral hernias. Dr. Mohamed H. Zidan explains that laparoscopic hernia repair began in 1993 with IPOM, in which a mesh is placed inside the abdominal cavity, but recurrence was relatively high, so surgeons developed IPOM+, which closes the abdominal wall defect before placing the mesh and lowered recurrence to about 2.7%. European guidelines favor placing the mesh outside the abdominal cavity for hernias smaller than 4 cm, because an intra-abdominal mesh exposes the bowel to unnecessary mesh and the tackers used to fix it add pain. IPOM+ is therefore suited to hernias of 4 to 10 cm, incisional hernias and complex abdominal wall hernias.
Key Takeaways
Full Transcript
Host: Doctor, you've told us about five types of operation. Could you tell us about IPOM Plus?
Dr. Zidan: Okay, IPOM Plus. Before we start, you should know that laparoscopic hernia repair began in 1993, and the first operation was IPOM; it was one of the earliest laparoscopic hernia repairs. What is it? We place a mesh on the abdominal wall from inside the abdominal cavity to stop the hernia from pushing through the wall. But the problem with IPOM was that the recurrence rate was relatively high, so surgeons developed IPOM Plus, about 20 years ago or a little less. So what did we add in IPOM Plus? We repair the abdominal wall before placing the mesh, and that reduced the recurrence rate to 2.7%. The European hernia guidelines say that if the hernia is smaller than 4 cm, the mesh is better placed outside the abdominal cavity, because placing a mesh inside the abdomen for a small defect exposes the bowel to an unnecessary area of mesh, increases adhesions and problems after surgery, and increases pain because of the tackers we use to fix the mesh. That's why IPOM Plus suits patients with a hernia of 4 to 10 cm, an incisional hernia, a complex abdominal wall hernia, or a problem with the muscle anatomy outside the abdominal cavity. For smaller sizes, we use many other types of repair.