Advertisement

Surgical Endoscopy

, Volume 31, Issue 9, pp 3656–3663 | Cite as

Assessment of predictive factors for recurrence in laparoscopic ventral hernia repair using a bridging technique

  • P. HautersEmail author
  • J. Desmet
  • D. Gherardi
  • S. Dewaele
  • H. Poilvache
  • P. Malvaux
Article

Abstract

Aim

To assess the long-term incidence and predictive factors for recurrence after laparoscopic ventral hernia repair using a bridging technique.

Methods

The study group consisted of 213 consecutive patients operated by laparoscopy for primary ventral (n = 158) or incisional hernia (n = 55) between 2001 and 2014. Patients had a repair without fascia closure by intra-peritoneal onlay placement of a Parietex® composite mesh centred on the defect with an overlap of at least 3 cm. Clinical outcome was assessed by a combination of office consultation, patient’s electronic medical file review and telephone interview.

Results

There were 144 men and 69 women with a mean age of 55 ± 12 years and a BMI of 32 ± 6. With a mean follow-up of 69 ± 44 months, a recurrent hernia was noted in 16 patients (7.5%). Univariate analysis showed a statistically significant higher recurrence rate in the following conditions: incisional hernia (15%), BMI ≥ 35 (21%), defect width >4 cm (27%), defect area >20 cm2 (27%), mesh overlap <5 cm (32%) and ratio of mesh area to defect area (M/D ratio) ≤12 (48%). Multivariate logistic analysis revealed that M/D ratio was the only independent predictive factor for recurrence (coefficient −0.79, OR 0.46, p < 0.002). With a M/D ratio ≤8, between 9 and 12, between 13 and 16, and ≥17, the recurrence rate was, respectively, 70, 35, 9 and 0% (p < 0.001).

Conclusions

In laparoscopic repair of ventral hernia using a bridging technique, an overlap of at least 5 cm is not all that is required to prevent hernia recurrence. The M/D ratio is the most important predictive factor for recurrence. A ratio of 13 appears as the threshold under which that technique cannot be recommended and 16 as the threshold over which the risk of recurrence is virtually nil. If a satisfactory M/D ratio cannot be achieved, other surgical repair should be proposed to the patient.

Keywords

Laparoscopic ventral hernia repair Recurrence rate Bridging technique Predictive factors Mesh/defect area ratio 

Notes

Compliance with ethical standards

Disclosures

Drs Hauters, Desmet, Gherardi, Dewaele, Poilvache and Malvaux have no conflict of interest or financial ties to disclose.

References

  1. 1.
    Sauerland S, Walgenbach M, Habermalz B, Seiler CM, Miserez M (2011) Laparoscopic versus open surgical techniques for ventral or incisional hernia repair (Review). Cochrane Database Syst Rev. doi: 10.1002/14651858 Google Scholar
  2. 2.
    Zhang Y, Zhou H, Chai Y, Cao C, Jin K, Hu Z (2014) Laparoscopic versus open incisional and ventral hernia repair: a systematic review and meta-analysis. World J Surg 38:2233–2240CrossRefPubMedGoogle Scholar
  3. 3.
    Awaiz A, Rahman F, Hossain M et al (2015) Meta-analysis and systematic review of laparoscopic versus open mesh repair for elective incisional hernia. Hernia 19:449–463CrossRefPubMedGoogle Scholar
  4. 4.
    LeBlanc K, Elieson M, Corder J (2007) Enterotomy and mortality rates of laparoscopic incisional and ventral hernia repair: a review of the literature. JSLS 11:408–414PubMedPubMedCentralGoogle Scholar
  5. 5.
    Johanet H, Dabrowski A, Hauters P, Coelio C (2006) Laparoscopic cure of small ventral hernias with composite mesh. Hernia 10(5):414–418CrossRefPubMedGoogle Scholar
  6. 6.
    Tulloh B, de Beaux A (2016) Defects and donuts: the importance of the mesh:defect area ratio. Hernia. doi: 10.1007/s10029-016-1524-4 PubMedGoogle Scholar
  7. 7.
    Leblanc K (2015) Proper mesh overlap is a key determinant in hernia recurrence following laparoscopic ventral and incisional hernia repair. Hernia 20:85–99CrossRefPubMedGoogle Scholar
  8. 8.
    Ballem N, Parikh R, Berber E, Siperstein A (2008) Laparoscopic versus open ventral hernia repairs: 5 year recurrence rates. Surg Endosc 22:1935–1940CrossRefPubMedGoogle Scholar
  9. 9.
    Heniford T, Park A, Ramshaw J, Voeller G (2003) Laparoscopic repair of ventral hernias nine years’ experience with 850 consecutive hernias. Ann Surg 238:391–400PubMedPubMedCentralGoogle Scholar
  10. 10.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Muysoms F, Miserez M, Berrevoet F et al (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13:407–414CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Deerenberg EB, Timmermans L, Hogerzeil DP et al (2015) Systematic review of the surgical treatment of large incisional hernia. Hernia 19:89–1001CrossRefPubMedGoogle Scholar
  13. 13.
    LeBlanc KA, Booth WV (1993) Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: preliminary findings. Surg Laparosc Endosc 3:39–41PubMedGoogle Scholar
  14. 14.
    Itani K, Neumayer L, Reda D, Kim L, Anthony T (2004) Repair of ventral incisional hernia: the design of a randomized trial to compare open and laparoscopic surgical techniques. Am J Surg 188(6A Suppl):22S–29SCrossRefPubMedGoogle Scholar
  15. 15.
    Rudmik L, Schieman C, Dixon E (2006) Laparoscopic incisional hernia repair : a review of the literature. Hernia 10:110–119CrossRefPubMedGoogle Scholar
  16. 16.
    Guerin G, Turquier F (2013) Impact of the defect size, the mesh overlap and the fixation depth on ventral hernia repairs: a combined experimental and numerical approach. Hernia 17:647–655CrossRefPubMedGoogle Scholar
  17. 17.
    Abet E, Duchalais E, Denimal F et al (2014) Laparoscopic incisional hernia repair: long term results. J Visc Surg 151:103–106CrossRefPubMedGoogle Scholar
  18. 18.
    Rosen M, Brody F, Ponsky J et al (2003) Recurrence after laparoscopic ventral hernia repair. A five-year experience. Surg Endosc 17:123–128CrossRefPubMedGoogle Scholar
  19. 19.
    Reynvoet E, Deschepper E, Rogiers X, Troisi R, Berrevoet F (2014) Laparoscopic ventral hernia repair: is there an optimal mesh fixation technique? A systematic review. Langenbecks Arch Surg 399:55–63CrossRefPubMedGoogle Scholar
  20. 20.
    Gherardi D, Van Steenberghe M, Derrey A-S, Malvaux P, Landenne J, Hauters P (2012) Repair of primary ventral hernias : a series of 118 consecutive patients. Acta Chir Belg 113:96–102Google Scholar
  21. 21.
    Hollinsky C, Hollinsky KH (1999) Static calculations for mesh fixation by intraabdominal pressure in laparoscopic extraperitoneal herniorrhaphy. Surg Laparosc Endosc Percutan Tech 9:106–109PubMedGoogle Scholar
  22. 22.
    Lyons M, Mohan H, Winter D, Simms C (2015) Biomechanical abdominal wall model applied to hernia repair. Br J Surg 102:133–139CrossRefGoogle Scholar
  23. 23.
    Estour E (2010) Traitement coelioscopique des éventrations par grandes prothèses intra-abdomianles. J coelio-chirurgie 75:19–23Google Scholar
  24. 24.
    Van den Heuvel B, Van Jarwaarde J, Wichers P, Klerk EDL, Bonjer H, Dwars B (2015) Follow-up after laparoscopic inguinal hernia repair, can it be done by phone? A prospective study in 300 patients, the PINQ-PHONE. Surg Endosc 29:3292–3297CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • P. Hauters
    • 1
    Email author
  • J. Desmet
    • 1
  • D. Gherardi
    • 1
  • S. Dewaele
    • 1
  • H. Poilvache
    • 1
  • P. Malvaux
    • 1
  1. 1.Department of SurgeryCH wapiTournaiBelgium

Personalised recommendations