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