Hybrid IPOM: A Novel Technique for the Management of Incisional Hernia

Background and Aim: The incidence of incisional hernias has been reported to be around 15%. In the present scenario, a wide array of surgical procedures are available for their better management. In this study, we intend to share our experience with one novel technique, “Hybrid IPOM (Intraperitoneal onlay meshplasty)” as a management option for a selected cohort of patients. Methods: This prospective study was undertaken during January 2019 to July 2023 at King Abdullah medical city, Makkah. A total of 51 cases were selected for Hybrid IPOM repair as per inclusion criteria;medium sized (4 - 10 cm) hernia defects;uncomplicated hernias;age more than 18 years. The follow-up period of the patients varied from 6 months to 4 years. The operation commenced with open hernia dissection, mesh deployment into abdomen, defect closure and then conversion to laparoscopy for the posterior mesh placement. Results: A total of 51 cases were repaired successfully with this technique. 48 out of 51 cases were incisional hernias secondary to some primary procedure done either for hernias itself or some other intra-abdominal pathology. The three cases were primary hernias falling in medium to large category with unaesthetic overlying skin. The age range was 19 to 72 years. The mean (range) operative time was 135 (90 - 240) min, and the average blood loss was 70 ml. The mean (range) hospital stay was 3 (2 - 11) days. All patients returned to routine work within 2 - 3 weeks of surgery. The median follow-up was 15 (6 - 48) months. Of the 51 cases, 3 patients developed seroma (managed conservatively), 1 patient developed a large hematoma (needed evacuation), and 1 patient developed superficial wound infection (managed with antibiotics). Two patients had recurrences;one patient had previously failed multiple repairs, and the other developed a postoperative hematoma. None of our patients had an iatrogenic bowel injury. Conclusion: Hybrid IPOM technique is a safe, feasible and easily reproducible technique. It may prove easier especially for beginners in laparoscopy, as it achieves faster and easy adhesiolysis thereby reducing operative time and easier establishment of the pneumoperitoneum. Besides, it gives the chance to excise ugly scars and improve the cosmesis.

Synoptic review on existing and potential sources for bias in dental research methodology with methods on their prevention and remedies

The results of years of dental study serve as the foundation for the practise of medicine and,for that matter,dentistry.Doctors may have their own preferences for techniques and materials,but whether directly or indirectly,their decisions are influenced by systematic reviews and meta-analyses.However,due to poorly conducted or presented research,this very basic foundation may not be reliable.Bias in research is one of several factors that might make study results or research itself unreliable.Bias can be introduced into research at many stages,deliberately or unknowingly.Bias can appear at any point during the research process,even before the study itself begins.There are many biases in research,but some of them are more relevant to dentistry research than others.Because it is said that“eyes see what the mind knows”,it is essential to have a complete understanding of the different types of bias,how and when they get entrenched,and what steps may be taken to prevent or lessen them if they do occur.This comprehensive summary of bias in dentistry research is provided by this synoptic review.The goal is to identify gaps and measures that have been taken-or that should have been taken-by providing both descriptive and evaluative summaries,as well as examples from the literature,when needed.