Abstract
Background
There are various ways of fixating an intraperitoneal onlay mesh during a laparoscopic ventral hernia repair. The risk of complications is high, and around 22% of the hernias will recur within 3.5 years. The aim of this study was to assess if sutures in addition to tack fixation would reduce the re-operation rate for recurrence compared with permanent tacks without sutures.
Methods
This study was based on the data from the nationwide Danish Ventral Hernia Database, which contains information of ventral hernia repairs from all hospitals in Denmark. Two different cohorts of patients were created and analyzed separately. The primary outcome was the re-operation rate for recurrence, analyzed with the Cox regression model and illustrated with a Kaplan-Meier plot adjusted for confounders. The follow-up period was defined as months from the first hernia repair to re-operation for recurrence, death, or the 1st of June 2017.
Results
The first cohort included 598 patients with absorbable sutures and tacks compared with 1793 patients with permanent tacks. The second cohort included 72 patients with permanent sutures and tacks compared with 216 patients with permanent tacks. In the suture groups, the tack material was either permanent or absorbable. When adjusting for possible confounders in the Cox regression model, there were no significant differences in the re-operation rate for recurrence between the groups in the two cohorts.
Conclusion
Adding sutures, either absorbable or permanent, to tack fixation of mesh during laparoscopic ventral hernia repair did not influence the re-operation rates for recurrence.
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This study received no financial support from extramural sources.
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Baker contributed substantially to the study conception and design and analysis and interpretation of data and drafted the work. Öberg, Andresen, and Rosenberg contributed substantially to the study conception and design and the interpretation of data and revised the work critically for important intellectual content. Helgstrand contributed to the conception and design of the work and revised it critically for important intellectual content. All authors gave final approval of the version to be published and have agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
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Baker and Öberg declare that they have no conflict of interest. Andresen has received personal fees from Bard outside the submitted work. Helgstrand has received personal fees outside the submitted work from Medtronic and Bard. Rosenberg has received personal fees from Bard and Merck, outside the submitted work.
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Baker, J.J., Öberg, S., Andresen, K. et al. Adding sutures to tack fixation of mesh does not lower the re-operation rate after laparoscopic ventral hernia repair: a nationwide cohort study. Langenbecks Arch Surg 403, 521–527 (2018). https://doi.org/10.1007/s00423-018-1681-2
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DOI: https://doi.org/10.1007/s00423-018-1681-2