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Laparoscopic ventral hernia repair with and without defect closure: comparative analysis of a single-institution experience with 783 patients

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Abstract

Background

Laparoscopic ventral hernia repair (LVHR) has gained popularity, since it can decrease the incidence of surgical site complications while providing similar recurrence rates as open repairs. The role of defect closure in LVHR has been a subject of controversy and has not been fully elucidated. We aimed to compare outcomes of LVHR with and without defect closure in a contemporary cohort.

Methods

Single-institution retrospective review of consecutive adults undergoes elective LVHR for 2–8 cm defects. Demographics, perioperative, and post-operative data were included for analysis. Surgical site events (SSE), surgical site infection (SSI), and recurrence were the main measured outcomes. Abdominal CT scan was used to differentiate true recurrence from pseudo-recurrence.

Results

A total of 783 patients were analyzed. 222 of them had their defects closed (DC), while the remaining 561 defects were not closed (NC) at the discretion/routine of the operating surgeon. Patients were slightly older in the non-closure group, while those in the defect closure group had a significantly higher BMI. There were no other differences in demographics between groups. After a mean follow-up of 12.1 months, the incidence of surgical site events (3.6 vs 14.9%, p < 0.0001) and seromas (0.4 vs 11.5%, p < 0.0001) was significantly lower in the defect closure group. Objectively confirmed recurrences were also significantly lower in the DC group (5.4 vs 14.2%, p = 0.003).

Conclusions

In our experience, the addition of defect closure can reduce the incidence of surgical site events, seroma, and hernia recurrence after LVHR. We advocate for routine closure of defects when laparoscopic repair is chosen for small-to-mid-sized ventral hernias.

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Authors and Affiliations

  1. Department of Surgery, Cleveland Medical Center, Cleveland, OH, USA

    Luis A. Martin-del-Campo, Heidi J. Miller, Heidi L. Elliott & Yuri W. Novitsky

  2. Department of Surgery, Comprehensive Hernia Center, Columbia University Medical Center, Columbia University College of Physicians and Surgeons, New York, NY, USA

    Yuri W. Novitsky

Authors
  1. Luis A. Martin-del-Campo
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  2. Heidi J. Miller
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  3. Heidi L. Elliott
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  4. Yuri W. Novitsky
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Correspondence to Yuri W. Novitsky.

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Conflict of interest

LAMDC, HJM, and HLE declare no conflict of interest. YWN is a consultant for Intuitive Surgical, CR Bard, and Cooper Surgical.

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Martin-del-Campo, L.A., Miller, H.J., Elliott, H.L. et al. Laparoscopic ventral hernia repair with and without defect closure: comparative analysis of a single-institution experience with 783 patients. Hernia 22, 1061–1065 (2018). https://doi.org/10.1007/s10029-018-1812-2

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  • DOI: https://doi.org/10.1007/s10029-018-1812-2

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