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Comparison of two fascial defect closure methods for laparoscopic incisional hernia repair

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Abstract

Purpose

Currently there is no consensus regarding the optimal surgical approach to an incisional hernia measuring less than 10 cm. Certain hernia features including defect size, intra-abdominal adhesions, and overlying scar/skin properties contribute to choosing an open versus a laparoscopic approach. This retrospective cohort study was designed to compare incisional hernia defects repaired with laparoscopic suture closure to a hybrid approach with open defect closure, both with laparoscopic intraperitoneal onlay mesh (IPOM) reinforcement.

Methods

We identified 164 consecutive patients who underwent incisional hernia repair from two centers, North York General Hospital (NYGH) and Humber River Hospital (HRH) between 2015 and 2020. Patients were grouped by totally laparoscopic or hybrid fascial closure. Both techniques included laparoscopically placed intra-peritoneal mesh with 5 cm of overlap in all directions. Patients were analyzed by age, sex, body mass index (BMI), ASA class and hernia size. Primary outcomes included surgical site infection (SSI), other wound complications including seroma/hematoma, length of hospital stay, pain reported at follow-up appointment, and hernia recurrence.

Results

Post-operative pain, surgical site infections and seromas did not differ between the totally laparoscopic and hybrid approach. The recurrence rates were 5.8% and 6.8% for the laparoscopic and hybrid group, respectively, which were not significantly different. The time to recurrence was 15 months (range 8–12) in the laparoscopic group and 7 months (range 6–36) in the hybrid group, also not significantly different. The hernia defect size and BMI were significantly higher in the hybrid group, without increased wound complications.

Conclusion

These results suggest that a hybrid approach to incisional ventral hernia repair with open defect closure is comparable to a totally laparoscopic closure. The hybrid technique can help facilitate fascial closure and resection of the hernia sac in patients with higher BMI and hernia defects up to 6 cm.

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All data generated or analysed during this study are included in this article.

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Funding

This study did not receive any funding.

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Authors and Affiliations

  1. Department of Surgery, Division of General Surgery, University of Toronto, Toronto, ON, Canada

    M. Melland-Smith, U. Khan, L. Smith & J. Tan

  2. Department of General Surgery, Division of General Surgery, North York General Hospital, North York, ON, Canada

    M. Melland-Smith & L. Smith

  3. Department of Surgery, Division of General Surgery, Humber River Hospital, Toronto, ON, Canada

    M. Melland-Smith & J. Tan

Authors
  1. M. Melland-Smith
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  2. U. Khan
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  3. L. Smith
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  4. J. Tan
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Corresponding author

Correspondence to J. Tan.

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Conflicts of interest

Drs. Megan Melland-Smith, Usman Kahn, Lloyd Smith and Jensen Tan have no conflicts of interest or financial ties to disclose.

Ethical approval

This retrospective chart review was approved by Research Ethics Board of both North York General Hospital (NYGH) and Humber River Hospital (HRH). The methods were carried out in accordance with the approved guidelines.

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No rights were violated in this study.

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Informed consent obtained within guidelines of Research Ethics Board of NYGH and HRH.

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Melland-Smith, M., Khan, U., Smith, L. et al. Comparison of two fascial defect closure methods for laparoscopic incisional hernia repair. Hernia 26, 945–951 (2022). https://doi.org/10.1007/s10029-021-02443-3

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  • DOI: https://doi.org/10.1007/s10029-021-02443-3

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