Favorable Outcomes After Retro-Rectus (Rives-Stoppa) Mesh Repair as Treatment for Noncomplex Ventral Abdominal Wall Hernia, a Systematic Review and Meta-analysis

Abstract

Objective: To assess prevalence of hernia recurrence, surgical site infection (SSI), seroma, serious complications, and mortality after retro-rectus repair. Summary Background Data: Ventral abdominal wall hernia is a common problem, tied to increasing frailty and obesity of patients undergoing surgery. For noncomplex ventral hernia, retro-rectus (Rives-Stoppa) repair is considered the gold standard treatment. Level-1 evidence confirming this presumed superiority is lacking. Methods: Five databases were searched for studies reporting on retro-rectus repair. Single-armed and comparative randomized and non-randomized studies were included. Outcomes were pooled with mixed-effects, inverse variance or random-effects models. Results: Ninety-three studies representing 12,440 patients undergoing retrorectus repair were included. Pooled hernia recurrence was estimated at 3.2% [95% confidence interval (CI): 2.2%-4.2%, n ¼ 11,049] after minimally 12months and 4.1%, (95%CI: 2.9%-5.5%, n ¼ 3830) after minimally 24 months. Incidences of SSI and seroma were estimated at respectively 5.2% (95%CI: 4.2%-6.4%, n ¼ 4891) and 5.5% (95%CI: 4.4%-6.8%, n ¼ 3650). Retro-rectus repair was associated with lower recurrence rates compared to onlay repair [odds ratios (OR): 0.27, 95%CI: 0.15-0.51, P < 0.001] and equal recurrence rates compared to intraperitoneal onlay mesh (IPOM) repair (OR: 0.92, 95%CI: 0.75-1.12, P ¼ 0.400). Retro-rectus repair was associated with more SSI than IPOM repair (OR: 1.8, 95%CI: 1.03 -3.14, P ¼ 0.038). Minimally invasive retro-rectus repair displayed low rates of recurrence (1.3%, 95%CI: 0.7%-2.3%, n ¼ 849) and SSI (1.5%, 95%CI: 0.8%-2.8%, n ¼ 982), albeit based on non-randomized studies.Conclusions: Retro-rectus (Rives-Stoppa) repair results in excellent outcomes, superior or similar to other techniques for all outcomes except SSI. The latter rarely occurred, yet less frequently after IPOM repair, which is usually performed by laparoscopy.

Prospective cohort study on mesh shrinkage measured with MRI after robot-assisted minimal invasive retrorectus ventral hernia repair using an iron-oxide-loaded polyvinylidene fluoride mesh

“…In addition, a further improvement was noted at 13 months followup. Our short-term results confirm the finding that minimally invasive retrorectus ventral hernia repair has consolidated its position over the last decade as a safe and effective technique [21].…”

Ventral hernia repair with enhanced-view totally extraperitoneal technique after a massive weight loss by laparoscopic sleeve gastrectomy

“…The open sublay technique (Rives–Stoppa) and laparoscopic intraperitoneal onlay mesh (IPOM) technique are commonly used in VHR; however, these procedures have their specific disadvantages [ 22 , 23 ]. Rives–Stoppa has a higher rate of surgical site infection than laparoscopic VHR [ 22 ]. Furthermore, patients following MBS have a higher risk of surgical site occurrence after surgery requiring a large skin incision [ 24 ].…”

From transabdominal to totally extra-peritoneal robotic ventral hernia repair: observations and outcomes

“…Lastly, placement of mesh consistently in the retrorectus as opposed to the pre-peritoneal space preferentially may have helped with mesh incorporation and prevention of recurrence. The Rives–Stoppa repair has long been popular for this reason with large-scale studies demonstrating low recurrence rates of 4.1% even 2 years post-operatively [ 23 ]. However, previous head-to-head comparisons of recurrence using a Rives–Stoppa repair as opposed to pre-peritoneal repair have not demonstrated much difference in recurrence [ 24 ].…”