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Surgical Endoscopy

, Volume 25, Issue 5, pp 1431–1438 | Cite as

A prospective randomized study comparing suture mesh fixation versus tacker mesh fixation for laparoscopic repair of incisional and ventral hernias

  • Virinder Kumar BansalEmail author
  • Mahesh C. Misra
  • Subodh Kumar
  • Y. Keerthi Rao
  • Paras Singhal
  • Amit Goswami
  • Sandeep Guleria
  • M. K. Arora
  • Anjolie Chabra
Article

Abstract

Introduction

After the first report of laparoscopic incisional and ventral hernia repair (LIVHR) in 1993, several studies have proven its efficacy over open method. Among the technical issues, the technique of mesh fixation to the abdominal wall is still an area of debate. This prospective randomized study was done to compare two techniques of mesh fixation, i.e., tacker with four corner transfascial sutures versus transfascial sutures alone.

Materials and methods

68 patients admitted for LIVHR repair (defect size less than 25 cm2) were randomized in two groups: group I, tacker fixation (36 patients) and group II, suture fixation (32 patients). Various intraoperative variables and postoperative outcomes were recorded and analyzed.

Results

The patients in the two groups were well matched in terms of age, sex, body mass index (BMI), and hernia characteristics. Mean BMI was 29.0 kg/m2. Operative time was found to be significantly higher in group II (77.5 versus 52.6 min, p = 0.000). Patients in group I were found to have significantly higher pain scores at 1 h, 6 h, 24 h, 1 week, 1 month, and 3 months postoperatively. At follow-up, incidence of seromas was higher in group II but the difference was not significant (7 versus 4, p = 0.219). During long-term follow-up, patients in group II were satisfied cosmetically.

Conclusion

Suture fixation is a cost-effective alternative to tacker fixation, for small and medium-sized defects in anatomically accessible areas. However, suture fixation requires significantly longer operation time, but patients have statistically significantly less postoperative pain.

Keywords

Laparoscopic Incisional hernia Mesh fixation Tackers Suture fixation Pain score 

Notes

Disclosures

Authors Virinder Kumar Bansal, Mahesh C Misra, Subodh Kumar, Y Keerthi Rao, Paras Singhal, Amit Goswami, Sandeep Guleria, M K Arora, and Anjolie Chabra have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    LeBlanc KA, Booth WV (1993) Laparoscopic repair of incisional hernias using ePTFE: preliminary findings. Surg Laparosc Endosc 3:39–41PubMedGoogle Scholar
  2. 2.
    LeBlanc KA (2007) Laparoscopic incisional hernia repair: are trans-fascial sutures necessary? A review of the literature. Surg Endosc 21:508–513PubMedCrossRefGoogle Scholar
  3. 3.
    Chowbey PK, Sharma A, Khullar R, Mann V, Baijal M, Vashistha A (2000) Laparoscopic ventral hernia repair. Laparo Endosc Adv Surg Tech A 10:79–84CrossRefGoogle Scholar
  4. 4.
    Chelala E, Thoma M, Tatete B, Lemye AC, Dessily M, Alle JL (2007) The suturing concept for laparoscopic mesh fixation in ventral and incisional hernia repair: mid-term analysis of 400 cases. Surg Endosc 21:391–395PubMedCrossRefGoogle Scholar
  5. 5.
    Carbajo MA, Martin del Olmo JC, Blanco JI, de la Cuesta C, Toledano M, Martin F, Vaquero C, Inglada L (1999) Laparoscopic treatment versus open surgery in the solution of major incisional and abdominal wall hernias with mesh. Surg Endosc 13:250–252PubMedCrossRefGoogle Scholar
  6. 6.
    Olmi S, Magnone S, Erba L, Bertolini A (2005) Croce E (2005) Results of laparoscopic versus open abdominal and incisional hernia repair. JSLS 9:189–195PubMedGoogle Scholar
  7. 7.
    Misra MC, Bansal VK, Kulkarni MP, Pawar DK (2006) Comparison of laparoscopic and open repair of incisional and primary ventral hernia: results of a prospective randomized study. Surg Endosc 20:1839–1845PubMedCrossRefGoogle Scholar
  8. 8.
    Barbaros U, Asoglu O, SevenR ErbilY, Dinccag A, Deveci U, Ozarmagan S, Mercan S (2007) The comparision of laparoscopic and open ventral hernia repairs: a prospective randomized study. Hernia 11:51–56PubMedCrossRefGoogle Scholar
  9. 9.
    Kirshtein B, Lantsberg L, Avinoach E, Bayme M, Mizrahi (2002) Laparoscopic repair of large incisional hernias. Surg Endosc 16:1717–1719PubMedCrossRefGoogle Scholar
  10. 10.
    Carbajo MA, Martin del Olmo JC, Blanco JI, Toledano M, de la Cuesta C, Ferreras C, Vaquero C (2003) Laparoscopic approach to incisional hernia. Surg Endosc 17:118–122PubMedCrossRefGoogle Scholar
  11. 11.
    Heniford BT, Park A, Ramshaw BJ, Voeller G (2003) Laparoscopic repair of ventral hernias: nine years’ experience with 850 consecutive hernias. Ann Surg 238:391–399PubMedGoogle Scholar
  12. 12.
    Rudmik LR, Schieman C, Debru E, Dixon E (2006) Laparoscopic incisional hernia repair: a review of the literature. Hernia 10:110–119PubMedCrossRefGoogle Scholar
  13. 13.
    van’t Riet M,de Vos van Steenwijk PJ, Kleinrensink GJ, Steyerberg EW, Bonjer HJ (2002) Tensile strength of mesh fixation methods in laparoscopic incisional hernia repair. Surg Endosc 16:1713-1716Google Scholar
  14. 14.
    Winslow ER, Diaz S, Desai K, Meininger T, Soper NJ, Klingensmith ME (2004) Laparoscopic incisional hernia repair in a porcine model: what do transfixation sutures add? Surg Endosc 18:529–535PubMedCrossRefGoogle Scholar
  15. 15.
    Wassenaar EB, Raymakers JTFJ, Rakic S (2008) Impact of the mesh fixation technique on operative time in laparoscopic repair of ventral hernias. Hernia 12:23–25PubMedCrossRefGoogle Scholar
  16. 16.
    Wassenaar EB, Schoenmaeckers EJP, Raymakers JTFJ, Rakic S (2009) Recurrences after laparoscopic repair of ventral and incisional hernia: lessons learned from 505 repairs. Surg Endosc 23:825–832PubMedCrossRefGoogle Scholar
  17. 17.
    Nguyen SQ, Divino CM, Buch KE, Schnur J, Weber KJ, Katz B, Reiner MA, Aldoroty RA, Herron D (2008) Postoperative pain after laparoscopic ventral hernia repair: a prospective comparison of sutures versus tacks. JSLS 12:113–116PubMedGoogle Scholar
  18. 18.
    Mudge M, Hughes LE (1985) Incisional hernia: a 10 year prospective study of incidence and attitudes. Br J Surg 72:70–71PubMedCrossRefGoogle Scholar
  19. 19.
    Burger JW, Luijendijk RW, Hop WCJ, Halm JA, Verdaasdonk EGG, Jeekel J (2004) Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 240:578–583PubMedGoogle Scholar
  20. 20.
    Bencini L, Sanchez LJ, Boffi B, Farsi M, Scatizzi M, Moretti R (2003) Incisional hernia repair: retrospective comparison of laparoscopic and open techniques. Surg Endosc 17:1546–1551PubMedCrossRefGoogle Scholar
  21. 21.
    Wassenaar EB, Raymakers JTFJ, Rakic S (2007) Removalof transabdominal sutures for chronic pain after laparoscopic ventral and incisional hernia repair. Surg Laparosc Endosc Percutan Tech 17:514–516PubMedCrossRefGoogle Scholar
  22. 22.
    Cobb WS, Kercher KW, Heniford BT (2005) Laparoscopic repair of incisional hernias. Surg Clin North Am 85:91–103PubMedCrossRefGoogle Scholar
  23. 23.
    Carbonell AM, Harold KL, Mahmutovic AJ, Hassan R, Matthews BD, Kercher KW, Sing RF, Heniford BT (2003) Local injection for the treatment of suture site pain after laparoscopic ventral hernia repair. Am Surg 69:688–691PubMedGoogle Scholar
  24. 24.
    Gillian GK, Geis WP, Grover G (2002) Laparoscopic incisional and ventral hernia repair (LIVH): an evolving outpatient technique. JSLS 6:315–322PubMedGoogle Scholar
  25. 25.
    Bageacu S, Blanc P, Breton C, Gonzaled M, Porcheron J, Chabert M, Balique JG (2002) Laparoscopic repair of incisional hernia: a retrospective study of 159 patients. Surg Endosc 16:345–348PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Virinder Kumar Bansal
    • 1
    Email author
  • Mahesh C. Misra
    • 1
  • Subodh Kumar
    • 1
  • Y. Keerthi Rao
    • 1
  • Paras Singhal
    • 1
  • Amit Goswami
    • 1
  • Sandeep Guleria
    • 1
  • M. K. Arora
    • 2
  • Anjolie Chabra
    • 2
  1. 1.Department of Surgical DisciplinesAll India Institute of Medical SciencesNew DelhiIndia
  2. 2.Department of AnesthesiologyAll India Institute of Medical SciencesNew DelhiIndia

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