Surgical management of large ventral hernias following damage control surgery: a retrospective comparison of laparoscopic IPOM plus and open repair techniques.

内容摘要

Damage control surgery (DCS) has become the standard of care in the management of severe abdominal trauma, particularly in military settings. Although this approach improves survival, it frequently results in significant disruption of the anterior abdominal wall and subsequent development of large ventral hernias. Reconstruction in this context is technically challenging due to adhesions, distorted anatomy, and loss of normal tissue planes. While open retromuscular repair is generally preferred, it is often not feasible following DCS. Laparoscopic intraperitoneal on-lay mesh repair with primary fascial closure (IPOM plus) may offer an alternative. However, evidence in post-traumatic populations remains limited. This study aimed to compare the feasibility, safety, and short-term outcomes of laparoscopic IPOM plus and open repair techniques in patients undergoing ventral hernia repair after DCS. A retrospective cohort study was conducted at a single military centre between June 2022 and December 2025. A total of 79 male patients with large ventral hernias following abdominal shrapnel injuries were included. Patients underwent either open repair (sub-lay or on-lay, n = 46) or laparoscopic IPOM plus repair (n = 33). Baseline characteristics were comparable between groups. Early postoperative outcomes within 90 days were analysed, including operative time, length of hospital stay, postoperative pain, time to recovery of bowel function, and complication rates. Laparoscopic IPOM plus repair was feasible in all cases, with successful primary fascial closure achieved in every patient. Operative time did not differ significantly between groups. The laparoscopic approach was associated with a significantly shorter hospital stay (p < 0.001), lower early postoperative pain on postoperative days 1 and 2 (p < 0.05), and earlier recovery of bowel function (p < 0.01). Rates of postoperative complications, including seroma formation, were lower following laparoscopic repair but did not reach statistical significance. No surgical site infections, reoperations, or readmissions were observed in either group. In patients with large ventral hernias following DCS, laparoscopic IPOM plus repair appears to be a feasible and safe alternative to open reconstruction. It is associated with improved early postoperative recovery without an increase in short-term complications. Further prospective studies with long-term follow-up are required to confirm these findings.