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Comparison of long-term outcome and quality of life after laparoscopic repair of incisional and ventral hernias with suture fixation with and without tacks: a prospective, randomized, controlled study

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Abstract

Background

Technique of mesh fixation in laparoscopic incisional hernia repair is a matter of debate. Literature is lacking in randomized trials comparing various methods of mesh fixation. This study was designed to compare the cost-effectiveness and long-term outcomes following the two methods of mesh fixation.

Methods

A total of 110 patients were randomized to tacker mesh fixation or suture mesh fixation. Patients with nonrecurrent hernias with defect size ranging from 2 to 5 cm were included. The cost and incremental cost-effectiveness ratio was calculated. SF-36v2 health survey was used for quality-of-life analysis. Patients were followed up at regular intervals, and return to activity and satisfaction scores were recorded.

Results

Demographic profile and hernia characteristics were comparable between the two groups. Operation time was significantly higher (p < 0) and early postoperative pain at 1 h, 6 h, and 1 month was significantly lower in the suture group. There was no significant difference in the incidence of chronic pain and seroma formation over a mean follow-up of 32.2 months. Cost of procedure was significantly higher in group I (p < 0.001). Suture fixation was found to be more cost-effective than tacker fixation. Postoperative quality of life outcomes were similar in the two groups. Among return to activity parameters, time to resumption of daily activities and starting climbing stairs were significantly shorter in the suture group.

Conclusions

The suture fixation method is a cost-effective alternative to tacker fixation in patients with small- to medium-sized defects in laparoscopic incisional and ventral hernia repair. Suture fixation is better than tacker fixation in terms of early postoperative pain and return to activity. The two procedures are equally effective regarding the recurrence rates, complications, hospital stay, chronic pain, quality of life determinants, and patient satisfaction.

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Disclosures

Drs. Virinder Kumar Bansal, Mahesh C. Misra, Divya Babu, Paras Singhal, Keerthi Rao, Rajesh Sagar, Subodh Kumar, S. Rajeshwari, and Vimi Rewari have no conflict of interest or financial ties to report.

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Authors and Affiliations

  1. Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India

    Mahesh C. Misra, Divya Babu, Paras Singhal, Keerthi Rao & Subodh Kumar

  2. Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India

    Rajesh Sagar

  3. Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India

    S. Rajeshwari & Vimi Rewari

  4. Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5021, 5th Floor Teaching Block, New Delhi, India

    Virinder Kumar Bansal

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  1. Virinder Kumar Bansal
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  2. Mahesh C. Misra
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Corresponding author

Correspondence to Virinder Kumar Bansal.

Additional information

Presented at the SAGES 2012 Annual Meeting, March 7–March 10, 2012, San Diego, CA.

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Bansal, V.K., Misra, M.C., Babu, D. et al. Comparison of long-term outcome and quality of life after laparoscopic repair of incisional and ventral hernias with suture fixation with and without tacks: a prospective, randomized, controlled study. Surg Endosc 26, 3476–3485 (2012). https://doi.org/10.1007/s00464-012-2390-5

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  • DOI: https://doi.org/10.1007/s00464-012-2390-5

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