Advantages of a Fixation-Free Technique for Open Retromuscular Ventral Hernia Repair

Abstract

Background: In open retromuscular ventral hernia repair, fixation-free mesh placement is increasingly prevalent and may minimize pain; the main concern with this technique is short-term technical failure and hernia recurrence. This study compared outcomes following mechanical mesh fixation (i.e., sutures, staples, tacks) versus fixation-free mesh placement. Methods: Adults who underwent open, elective, retromuscular ventral hernia repair of 15 cm width or less with permanent synthetic mesh placement in a clean wound were identified. Propensity score matching was used to compare patients who received mechanical mesh fixation to those who received fixation-free mesh placement. Thirty-day hernia recurrence was the primary outcome, with secondary outcomes of 30-day hospital length of stay and 30-day rates of readmission, reoperation, wound events, pain, and abdominal wall function. One- and 2-year composite recurrence and 3-year cumulative composite recurrence were also evaluated. Results: A 3:1 propensity score match was performed on 299 fixation-free patients identifying 897 mechanical fixation patients, with a mean body mass index of 31 kg/m2 and mean age of 57.5 years. There was no difference in 30-day recurrence between mechanical and fixation-free approaches (0.2 percent versus 0 percent; p = 1). Median length of stay was longer for mechanical fixation (4 versus 3 days; p = 0.002). In the mechanical fixation group, pain scores were higher (worse pain, 46 versus 44; p = 0.001), and abdominal wall function scores were lower (worse function, 47 versus 60; p = 0.003), with no differences in rates of hospital readmission, reoperation, or wound events. There were no differences in long-term outcomes of 1- and 2-year composite recurrence, or 3-year cumulative composite recurrence. Conclusion: For short-term technical durability, fixation-free mesh placement in open retromuscular ventral hernia repair is an acceptable alternative to mechanical fixation for hernia defects of 15 cm or less. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Three-Year Clinical Outcomes and Quality of Life after Retromuscular Resorbable Mesh Repair Using Fibrin Glue

“…Plastic surgeons have historically been on the forefront of innovating techniques to improve recovery and outcomes for hernia patients. With these goals in mind, and drawing from principles of retromuscular repair and fixationless robotic hernia repairs, 5,[17][18][19] we previously examined perioperative outcomes of ventral hernia repair using fibrin glue versus suture fixation, and found that atraumatic fixation was associated with decreased postoperative pain and increased activity in the immediate postoperative period. Furthermore, fibrin glue was associated with significantly shortened length of stay and decreased hospital costs.…”

“…Lastly, suture fixation and fibrin glue fixation are the two arms for this retrorectus mesh fixation study. However, recent cases of mesh placement without any fixation adjunct have been reported, 29 indicating that future larger studies are needed to compare all possible fixation techniques and help determine best practice.…”

“…The study found that fixation-free repair was associated with decreased pain scores and abdominal wall function when compared to mechanical fixation, and maintained similar long-term clinical outcomes. 5…”

“…The study found that fixation-free repair was associated with decreased pain scores and abdominal wall function when compared to mechanical fixation, and maintained similar longterm clinical outcomes. 5 Atraumatic fibrin glue products, such as Tisseel (Baxter International, Inc., Deerfield, Ill.), have recently gained popularity for use in various types of hernia repair, with studies demonstrating reduced postoperative pain without an increase in recurrence rates. [6][7][8][9][10] Fibrin sealants are biodegradable products composed primarily of two components: human-derived fibrinogen and thrombin.…”

Contemporary Abdominal Wall Reconstruction: Emerging Techniques and Trends

“…Their technique involved the repair of the hernia using 2 cm mesh strips that were passed through the fascial edge and anchored via holes drilled through the iliac crest. The authors reported no hernia recurrence at a 24-month follow-up, though only four patients were included in the case series [19].…”