, Volume 17, Issue 5, pp 589–596 | Cite as

Closure versus non-closure of hernia defect during laparoscopic ventral hernia repair with mesh

  • M. S. Zeichen
  • H. J. Lujan
  • W. N. Mata
  • V. H. Maciel
  • D. Lee
  • I. Jorge
  • G. Plasencia
  • E. Gomez
  • A. M. Hernandez



Laparoscopic ventral hernia repair with mesh versus laparoscopic ventral hernia defect closure with mesh reinforcement. The primary end-point was recurrence.


Retrospective review of patients who underwent laparoscopic ventral hernia repair for small- and medium-sized hernias between July 2000 and September 2011. These patients were divided: (1) repair with mesh alone (non-closure group) and (2) those with hernia defect closure and mesh reinforcement (closure group). The closure group was further divided by technique: percutaneous versus intracorporeal closure of the defect.


128 patients were studied: 93 patients (72.66 %) in the non-closure group and 35 patients (27.34 %) in the closure group. Follow-up was available in 105 patients (82.03 %) at a mean of 797.2 days (range 7–3,286 days). In the non-closure group there were 14 patients (15.05 %) with postoperative complications and 8 patients (22.86 %) in the closure group, four of which were seromas. Fourteen patients (19.18 %) developed recurrent hernias in the non-closure group with an average time to presentation of 23.17 months (range 5.3–75.3). Two patients (6.25 %) developed recurrent hernias in the percutaneous group with an average time to presentation of 12.95 months (range 9.57–16.33). There have been no recurrences in patients whose defect was closed intracorporeally.


Although our study demonstrated a difference in recurrence rates of 19.18 % in the non-closure group versus 6.25 % in the closure group, the difference did not reach statistical significance. A larger series with longer follow-up may demonstrate clinical significance.


Ventral hernia Laparoscopic Closure Mesh 



The authors thank Victor Pestien and David Nepomechie from the University of Miami, department of mathematics for providing data and statistical analysis. Dustin Lee, DO, is a Foundation of Surgical Fellowships grant recipient.

Conflict of interest

Drs. Plasencia, Lujan and Gomez are consultants for Ethicon-Endosurgery.


  1. 1.
    National Center for Health Statistics (1998) Vital and health statistics of the Centers for Disease Control and Prevention. Adv Data 300:7Google Scholar
  2. 2.
    Millenium Research Group (2009) US markets for soft tissue repair. Millennium Research Group, Inc., TorontoGoogle Scholar
  3. 3.
    Mudge M, Hughes LE (1985) Incisional hernia: a 10 year prospective study of incidence and attitudes. Br J Surg 72:70–71PubMedCrossRefGoogle Scholar
  4. 4.
    Flum DR, Horvath K, Koepsell T (2003) Have outcomes of incisional hernia repair improved with time? A population-based analysis. Ann Surg 237:129–135PubMedCrossRefGoogle Scholar
  5. 5.
    Girotto JA, Chiaramonte M, Menon NG et al (2003) Recalcitrant abdominal wall hernias: long term results of autologous tissue repair. Plast Reconstr Surg 112:106–114PubMedCrossRefGoogle Scholar
  6. 6.
    Anthony T, Bergen PC, Kim LT (2000) Factors affecting recurrence following incisonal herniorrhaphy. World J Surg 24:95–101PubMedCrossRefGoogle Scholar
  7. 7.
    LeBlanc KA, Booth WV (1993) Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: preliminary findings. Surg Laparosc Endosc 3:39–41PubMedGoogle Scholar
  8. 8.
    Pierce RA, Spitler JA, Frisella MM et al (2007) Pooled data analysis of laparoscopic versus open ventral hernia repair: 14 years of patient data accrual. Surg Endosc 21:378–386PubMedCrossRefGoogle Scholar
  9. 9.
    Heniford BT, Park A, Ramshaw BJ et al (2003) Laparoscopic repair of ventral hernias: nine years’ experience with 850 consecutive hernias. Ann Surg 238:391–399 (discussion 399–400)PubMedGoogle Scholar
  10. 10.
    DeMaria EJ, Moss JM, Sugerman HJ (2000) Laparoscopic intraperitoneal polytetrafluoroethylene (PTFE) prosthetic patch repair of ventral hernia: prospective comparison to open prefascial polypropylene mesh repair. Surg Endosc 14:326–329PubMedCrossRefGoogle Scholar
  11. 11.
    Olmi S, Scaini GC, Erba L, Croce E (2007) Laparoscopic versus open incisional hernia repair. Surg Endosc 21:555–559PubMedCrossRefGoogle Scholar
  12. 12.
    LeBlanc KA (2005) Incisional hernia repair: laparoscopic techniques. World J Surg 29:1073–1079PubMedCrossRefGoogle Scholar
  13. 13.
    Sauerland S, Walgenbach M, Habermalz B, Seiler CM, Miserez M (2011) Laparoscopic versus open surgical techniques for ventral or incisional hernia repair. Cochrane Database Syst Rev (3):CD007781. doi: 10.1002/14651858.CD007781.pub2
  14. 14.
    De Vries Reilingh TS, van Geldere D, Langernhorst B et al (2004) Repair of large midline incisional hernias with polypropylene mesh: comparison of three operative techniques. Hernia 8:56–59PubMedCrossRefGoogle Scholar
  15. 15.
    Luijendijk RW, Hop WC, van den Tol MP et al (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 343:392–398PubMedCrossRefGoogle Scholar
  16. 16.
    Burger JW, Luijendijk RW, Hop WC et al (2004) Long term follow up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 240:578–583PubMedGoogle Scholar
  17. 17.
    DenHartog D, Dur AH, Tuinebreijer WE, et al (2008) Open surgical procedures for incisional hernias. Cochrane Database Syst Rev (3):CD006438Google Scholar
  18. 18.
    Franklin M, Dorman J, Glass J, Balli J, Gonzalez J (1998) Laparoscopic ventral hernia repair. Surg Laparosc Endosc 8(4):294–299PubMedCrossRefGoogle Scholar
  19. 19.
    Franklin ME, Gonzalez JJ, Glass JL, Manjarrez A (2004) Laparoscopic ventral and incisional hernia repair: 11-year experience. Hernia 8:23–27PubMedCrossRefGoogle Scholar
  20. 20.
    Chowbey P, Sharma A, Khullar R, Soni V, Baijal M (2003) Laparoscopic ventral hernia repair with extraperitoneal mesh. Surg Laparosc Endosc Percutan Tech 13(2):101–105PubMedCrossRefGoogle Scholar
  21. 21.
    Palanivelu C, Jani KV, Senthilnathan P et al (2007) Laparoscopic sutured closure with mesh reinforcement of incisional hernias. Hernia 11:223–228PubMedCrossRefGoogle Scholar
  22. 22.
    Palanivelu C, Rangarajan M, Parthasarathi R et al (2008) Laparoscopic repair of suprapubic incisional hernias: suturing and intraperitoneal composite mesh onlay. A retrospective study. Hernia 12(3):251–256PubMedCrossRefGoogle Scholar
  23. 23.
    Sharma D, Jindal V, Pathania OP, Thomas S (2010) Novel technique for closure of defect in laparoscopic ventral hernia repair. J Min Access Surg 6(3):86–88CrossRefGoogle Scholar
  24. 24.
    Jorge I, Maciel VH, Lujan H (2011) New technique for fascial defect approximation during laparoscopic ventral hernia repair with mesh. Abstract-Emerging Technology Session SAGES Annual MeetingGoogle Scholar
  25. 25.
    Agarwal BB, Agarwal S, Mahajan KC (2008) Laparoscopic ventral hernia repair: innovative anatomical closure, mesh insertion without 10 mm transmyofascial port, and atraumatic mesh fixation: a preliminary experience of a new technique. Surg Endosc 23(4):900–905PubMedCrossRefGoogle Scholar
  26. 26.
    Clapp ML, Hicks SC, Awad SS, Liang MK (2012) Trans-cutaneous closure of central defects (TCCD) in laparoscopic ventral hernia repairs (LVHR). World J Surg 37(1):42–51Google Scholar
  27. 27.
    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
  28. 28.
    Schoenmaeckers E, Wassenaar EB, Raymakers JT, Rakic S (2010) Bulging of the mesh after laparoscopic repair of ventral and incisional hernias. J Society Laparoendosc Surg 14(4):541–546CrossRefGoogle Scholar
  29. 29.
    Tse GH, Stutchfield BM, Duckworth AD, de Beaux AC, Tulloh B (2010) Pseudo-recurrence following laparoscopic ventral and incisional hernia repair. Hernia 14(6):583–587PubMedCrossRefGoogle Scholar
  30. 30.
    Jagad RB (2008) Laparoscopic ventral hernia repair: a new method for fixation of the mesh with sutures. Surg Laparosc Endosc Percutan Tech 18(3):277–279PubMedCrossRefGoogle Scholar
  31. 31.
    Sajid MS, Parampalli U, McFall MR (2012) A meta-analysis comparing tacker mesh fixation with suture mesh fixation in laparoscopic incisional and ventral hernia repair. Hernia 17(2):159–166Google Scholar

Copyright information

© Springer-Verlag France 2013

Authors and Affiliations

  • M. S. Zeichen
    • 1
  • H. J. Lujan
    • 1
  • W. N. Mata
    • 1
  • V. H. Maciel
    • 2
  • D. Lee
    • 3
  • I. Jorge
    • 2
  • G. Plasencia
    • 1
  • E. Gomez
    • 4
  • A. M. Hernandez
    • 4
  1. 1.Miami International Surgical Services at Jackson South Community HospitalMiamiUSA
  2. 2.General Surgery, Mount Sinai Medical CenterMiamiUSA
  3. 3.MiamiUSA
  4. 4.Jackson South Community HospitalMiamiUSA

Personalised recommendations