Laparoscopic-assisted Ventral Hernia Repair: Primary Fascial Repair with Polyester Mesh versus Polyester Mesh Alone

Abstract

Laparoscopic-assisted ventral hernia repair (LAVHR) with mesh is well established as the preferred technique for hernia repair. We sought to determine whether primary fascial closure and/or overlap of the mesh reduced recurrence and/or complications. We conducted a retrospective review on 57 LAVHR patients using polyester composite mesh between August 2010 and July 2013. They were divided into mesh-only (nonclosure) and primary fascial closure with mesh (closure) groups. Patient demographics, prior surgical history, mesh overlap, complications, and recurrence rates were compared. Thirty-nine (68%) of 57 patients were in the closure group and 18 (32%) in the nonclosure group. Mean defect sizes were 15.5 and 22.5 cm2, respectively. Participants were followed for a mean of 1.3 years [standard deviation (SD) = 0.7]. Recurrence rates were 2/39 (5.1%) in the closure group and 1/18 (5.6%) in the nonclosure group ( P = 0.947). There were no major postoperative complications in the nonclosure group. The closure group experienced four (10.3%) complications. This was not a statistically significant difference ( P = 0.159). The median mesh-to-hernia ratio for all repairs was 15.2 (surface area) and 3.9 (diameter). Median length of stay was 14.5 hours (1.7–99.3) for patients with nonclosure and 11.9 hours (6.9–90.3 hours) for patients with closure ( P = 0.625). In conclusion, this is one of the largest series of LAVHR exclusively using polyester dual-sided mesh. Our recurrence rate was about 5 per cent. Significant mesh overlap is needed to achieve such low recurrence rates. Primary closure of hernias seems less important than adequate mesh overlap in preventing recurrence after LAVHR.

Laparoscopic and percutaneous repair of a large midline incisional hernia extending to the bilateral subcostal region: A case report

“…Laparoscopic repair for an incisional hernia is generally indicated for a mean defect size of 10 cm [6] , with a maximum diameter of 18 cm recently reported [15] . In addition, fascial defect closure has been advocated for reduction of seroma [6] , [9] , mesh bulge [6] , [10] , and recurrence rates [9] , [10] , although conflicting reports have also been published [11] , [16] . A recent study showed that defect closure with intraperitoneal onlay mesh (IPOM-plus) was more effective than standard intraperitoneal onlay mesh (sIPOM) in terms of reducing mesh bulge, for large hernias (greater than 10 cm in diameter) [12] .…”