Trans-cutaneous Closure of Central Defects (TCCD) in Laparoscopic Ventral Hernia Repairs (LVHR)
Laparoscopic ventral hernia repair (LVHR) has been reported to have lower recurrence rates, fewer surgical site infections, and shorter hospital stays compared to open repair. Despite improved surgical outcomes with standard LVHR (sLVHR), seroma formation, eventration (or bulging of mesh or tissue), and hernia recurrence remain common complications. Our objective was to evaluate outcomes with trans-cutaneous closure of central defects in LVHR compared to sLVHR.
A retrospective review of 176 patients who underwent elective LVHR between January 2007 and December 2010 was performed. Of the 176 patients, 36 (20.5 %) had the LVHR-TCCD (trans-cutaneous closure of central defects) procedure and 140 (79.5 %) had sLVHR. The LVHR-TCCD cases were compared to a 1:1 case-matched control (n = 36). The case control group was matched by hernia type (primary versus secondary), hernia size, Ventral Hernia Working Group (VHWG) grade, institution, and follow-up duration. Patient demographics, co-morbidities, hernia characteristics, operative details, imaging data, and complications were collected. Patient satisfaction (using a 10-point, Likert-type scale), late postoperative pain (using the visual analogue scale), and patient functional status (using the Activities Assessment Scale; AAS) were analyzed. Continuous data were analyzed with either the unpaired Student’s t test or the Mann–Whitney U-test, while Fischer’s exact test was used to compare categorical data.
Patient demographics, co-morbidities, hernia size, hernia type, mesh type, and surgical histories were similar between the LVHR-TCCD group and the case control group. The LVHR-TCCD patients had significantly lower rates of seroma formation (5.6 % versus 27.8 %; p = 0.02), mesh eventration (0.0 % versus 41.4 %; p = 0.0002), tissue eventration (4.0 % versus 37.9 %; p = 0.003), clinical eventration (8.3 % versus 69.4 %; p = 0.0001), and hernia recurrence (0.0 % versus 16.7 %; p = 0.02) when compared to the sLVHR case control. Postoperative infectious complications and early complications classified by the Dindo-Clavien system were similar between the groups. Median follow-up was 24 months (range: 7–34 months) for both groups. Compared to the case control group, patients having undergone LVHR-TCCD had higher patient satisfaction scores (8.8 ± 0.4 versus 7.0 ± 0.5; p = 0.008), cosmetic satisfaction scores (8.8 ± 0.4 versus 7.0 ± 0.6; p = 0.01), and AAS functional status scores (79.1 ± 1.9 versus 71.3 ± 2.3; p = 0.002). There was no difference in worst pain scores or the prevalence of chronic pain.
The incidence of seroma, mesh and tissue eventration, and hernia recurrence was significantly lower following LVHR-TCCD when compared to sLVHR. Subjective improvement in overall patient satisfaction, cosmetic satisfaction, and functional status was reported with closing the central defect. The LVHR-TCCD technique may be superior for treating ventral hernias due to lower complication rates and higher patient satisfaction and functional status.
KeywordsSurgical Site Infection Ventral Hernia Hernia Recurrence Seroma Formation Hernia Defect
- 5.Saber AA, Elgamal MH, Mancl TB et al (2008) Advanced age: is it an indication or contraindication for laparoscopic ventral hernia repair? J Soc Laparoendosc Surg 12:46–50Google Scholar
- 12.Rutkow IM (2003) Demographic and socioeconomic aspects of hernia repair in the United States in 2003. Surg Clin North Am 83:1045–1051, v–viGoogle Scholar
- 14.Sauerland S, Walgenbach M, Habermalz B et al. (2011) Laparoscopic versus open surgical techniques for ventral or incisional hernia repair. Cochrane Database Syst Rev 2011Mar16;(3):CD007781Google Scholar
- 24.Carbajo MA, del Olmo JC, Blanco JI et al (2000) Laparoscopic treatment of ventral abdominal wall hernias: preliminary results in 100 patients. J Soc Laparoendosc Surg 4:141–145Google Scholar
- 33.Liang MK, Subramanian A, Awad SS (2012) Laparoscopic trans-cutaneous closure of central defects in laparoscopic incisional hernia repair. Surg Laparosc Endsc Percut Tech (in press)Google Scholar
- 34.Liang MK, Subramanian A, Awad SS (2011) Laparoscopic Trans-cutaneous closure of central defects in laparoscopic incisional hernia repair. Unpublished data, presentation and abstract. Association of Veterans Affairs SurgeonsGoogle Scholar
- 38.http://www.cdc.gov/nhsn/PDFs/pscManual/9pscSSIcurrent.pdf. Accessed 11/18/2011
- 42.Kutner MH, Natchtsheim CJ, Neter J et al (2005) Applied linear statistical models, 5th edn. McGraw-Hill Irwin, New YorkGoogle Scholar
- 43.R Development Core Team (2012) R: a language and environment for statistical computing. Vienna, Austria, R Foundation for Statistical Computing (ISBN 3-900051-07-0; URL http://www.R-project.org/)