Laparoscopic ventral hernia repair: outcomes in primary versus incisional hernias: no effect of defect closure
Supposing divergent aetiology, we found it interesting to investigate outcomes between primary (PH) versus incisional (IH) hernias. In addition, we wanted to analyse the effect of defect closure and mesh fixation techniques.
37 patients with PH and 70 with IH were enrolled in a prospective cohort-study, treated with laparoscopic ventral hernia repair (LVHR) and randomised to ± transfascial sutures. In addition, we analysed results from a retrospective study with 36 PH and 51 IH patients. Mean follow-up time was 38 months in the prospective study and 27 months in the retrospective study.
35 % of PH’s and 10 % of IH’s were recurrences after previous suture repair. No late infections or mesh removals occurred. Recurrence rates in the prospective study were 0 vs. 4.3 % (p = 0.55) and the complication rates were 16 vs. 27 % (p = 0.24) in favour of the PH cohort. The IH group had a mesh protrusion rate of 13 vs. 5 % in the PH group (p = 0.32), and significantly (p < 0.01) larger hernias and adhesion score, longer operating time (100 vs. 79 min) and admission time (2.8 vs. 1.6 days). Closure of the hernia defect did not influence rate of seroma, pain at 2 months, protrusion or recurrence. An overall increased complication rate was seen after defect closure (OR 3.42; CI 1.25–9.33).
With PH, in comparison to IH treated with LVHR, no differences were observed regarding recurrence, protrusion or complication rates. Defect closure (raphe), when using absorbable suture, did not benefit long-term outcomes and caused a higher overall complication rate. (ClinicalTrials.gov number: NCT00455299).
KeywordsHernia Ventral Primary Incisional Laparoscopy Repair
The study was conducted without funding, but we thank involved hospitals (Oslo University Hospital and Innlandet Hospital Trust) for help from logistic personnel and loan of out-patient facilities. We thank TYCO Healthcare (now Covidien, Mansfield, MA, USA) for the gift of a fax machine to report serious adverse events. None of the authors or authors’ spouses are employed or in any other manner economically involved in the medical industry. All authors are employees of the Kingdom of Norway.
Conflict of interest
JL declares non-financial support (fax machine) from Covidien, Mansfield, MA, USA but otherwise no conflict of interest. AV declares no conflict of interest. ET declares no conflict of interest. OØ declares no conflict of interest. OR declares no conflict of interest.
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