Closure of the fascial defect during laparoscopic umbilical hernia repair: a randomized clinical trial

Abstract

Background The objective of the study was to analyse patient-reported outcome measures (PROMs), seroma formation, long-term recurrence and chronic pain after closure of the fascial defect in patients undergoing laparoscopic umbilical hernia mesh repair. Methods This was a randomized double-blinded trial in patients undergoing elective laparoscopic umbilical hernia repair comparing sutured closure of the fascial defect before intraperitoneal onlay mesh (IPOM) repair with a no-closure IPOM repair. Postoperative pain, movement limitations, discomfort and fatigue were registered before surgery and on postoperative days 1–3, 7 and 30. Seroma formation, quality of life and cosmesis were assessed at day 30, and at 2 years of follow-up. Recurrence (clinical and reoperation) and chronic pain were assessed after 2 years. Results Eighty patients were randomized. Median defect sizes in closure and no-closure groups were 2·5 (range 1·5–4·0) and 2·5 (2·0–5·5) cm respectively (P = 0·895). There were no significant differences in early and late postoperative pain or in any other early or late PROMs, except for early fatigue which was higher in the closure group (P = 0·011). Seroma formation after 30 days was significantly reduced after closure (14 of 40; 35 (95 per cent c.i. 22 to 51) per cent) compared with no closure (22 of 38; 58 (42 to 72) per cent) (P = 0·043). Cumulative recurrence after 2 years was lower in the closure group: 5 of 36 (7 (3 to 17) per cent) versus 12 of 37 (19 (10 to 33) per cent) for no closure (P = 0·047). Conclusion Closure of the fascial defect in laparoscopic umbilical hernia IPOM repair significantly reduced early seroma formation and long-term recurrence without inducing side-effects such as pain, or other early or late PROMs. Registration number: NCT01962480 (https://www.clinicaltrials.gov).

Needlescopic surgery for large umbilical hernia in a patient with morbid obesity using intraperitoneal onlay mesh with fascial defect closure: a case report

“…Suwa et al [20] revealed that the recurrence rate, incidence rate of seroma formation, and incidence rate of mesh bulging in the IPOM plus technique for ventral and incisional hernias were 0-7.7%, 0-11.4%, and 0%, respectively. Moreover, Christoffersen et al [21] reported that the recurrence rate after 2 years and seroma formation after 30 days were 3-17% and 10-33%, respectively. In the absence of abdominal wall tension during fascial closure, an additional fascial closure technique seems to decrease seroma formation, mesh bulging, and recurrence.…”

Author response to: Comment on: Closure of the fascial defect during laparoscopic umbilical hernia repair: a randomized clinical trial

“…Umbilical hernia repair is often conducted as ambulatory surgery requiring early pain control and is therefore a relevant outcome 2,3 . The present study hypothesised that closure of the fascial defect increase tissue tension, and thus, may increase early postoperative pain 1 .…”

“…Thank you for giving us the opportunity to comment on the correspondence by Dr. Ramakrishna and co‐workers to our recent study 1 .…”

Peritoneal bridging versus fascial closure in laparoscopic intraperitoneal onlay ventral hernia mesh repair: a randomized clinical trial

“…Various procedures have been suggested to reduce seroma formation between the mesh and the sac, but only conventional defect closure seems to reduce postoperative seroma significantly 3 . A recent study 6 reported seroma at the 1-month visit, detected by clinical examination and (if inconclusive) abdominal CT, in 58 per cent of patients who underwent simple IPOM versus 25 per cent of those who had IPOM-plus. It has been hypothesized that the lower incidence of seroma following defect closure is because of decreased dead space in the residual sac.…”