World Journal of Surgery

, Volume 38, Issue 12, pp 3097–3104 | Cite as

Primary Fascial Closure With Laparoscopic Ventral Hernia Repair: Systematic Review

  • Duyen H. Nguyen
  • Mylan T. Nguyen
  • Erik P. Askenasy
  • Lillian S. Kao
  • Mike K. Liang
Scientific Review


Laparoscopic ventral hernia repair (LVHR) has grown in popularity. Typically, this procedure is performed with a mesh bridge technique that results in high rates of seroma, eventration (bulging), and patient dissatisfaction. In an effort to avoid these complications, there is growing interest in the role of laparoscopic primary fascial closure with intraperitoneal mesh placement. This systematic review evaluated the outcomes of closure of the central defect during LVHR. A literature search of PubMed, Cochrane databases, and Embase was conducted using PRISMA guidelines. MINORS was used to assess the methodologic quality. Primary outcome was hernia recurrence. Secondary outcomes were surgical-site infection, seroma formation, bulging, and patient-centered items (satisfaction, chronic pain, functional status). Eleven studies were identified, eight of which were case series (level 4 data). Three comparative studies examined the difference between closure and nonclosure of the fascial defect during laparoscopic ventral incisional hernia repairs (level 3 and 4 data). These studies suggested that primary fascial closure (n = 138) compared to nonclosure (n = 255) resulted in lower recurrence rates (0–5.7 vs. 4.8–16.7 %) and seroma formation rates (5.6–11.4 vs. 4.3–27.8 %). Follow-up periods for both groups were similar (1–108 months). Only one study evaluated patient function and clinical bulging. It showed better outcomes with primary fascial closure. Closure of the central defect during LVHR resulted in less recurrence, bulging, and seroma than nonclosure. Patients with closure were more satisfied with the results and had better functional status. The quality of the data was poor, however. A randomized controlled trial to evaluate the role of closure of the central defect during LVHR is warranted.


Hernia Repair Hernia Recurrence Ventral Hernia Repair Seroma Formation Fascial Closure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Société Internationale de Chirurgie 2014

Authors and Affiliations

  • Duyen H. Nguyen
    • 1
  • Mylan T. Nguyen
    • 1
  • Erik P. Askenasy
    • 2
  • Lillian S. Kao
    • 1
  • Mike K. Liang
    • 1
  1. 1.Department of SurgeryUniversity of Texas Health Science CenterHoustonUSA
  2. 2.Baylor College of MedicineHoustonUSA

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