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Laparoscopic ventral hernia repair: is there an optimal mesh fixation technique? A systematic review

  • Systematic Reviews and Meta-analyses
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Abstract

Purpose

The purpose of this study is to distinguish the optimal mesh fixation technique used in laparoscopic ventral hernia repair (LVHR). A particular fixation technique of the mesh to the abdominal wall is required, which should be strong enough to prevent migration of the mesh and, at the same time, keep injury to the abdominal wall minimal to prevent postoperative discomfort and pain.

Methods

An extensive literature search was performed in the PubMed database from its onset until November 2012. All series of at least 30 patients operated by laparoscopy for a ventral hernia, with the use of a standardized surgical technique well-defined in the “Methods” section, and with a follow-up of at least 12 months were included. The series were categorized according to the technique of mesh fixation described: “tacks and sutures,” “tacks only,” and “sutures only.” For each treatment group, the recurrence rate was adjusted to the number of patients treated and the 95 % confidence interval was calculated. No overlap between two intervals was defined as a significant difference in recurrence rate.

Results

A total of 25 series were included for statistical evaluation. Thirteen trials used both tacks and sutures, ten used only tacks, and two used only sutures. Overall recurrence rate was 2.7 % (95 % CI [1.9–3.4 %]).

Conclusion

None of the currently available mesh fixation techniques used for LVHR was found to be superior in preventing hernia recurrence as well as in reducing abdominal wall pain. The pain reported was remarkably high with all different fixation devices. Further research to develop solid and atraumatic fixation devices is warranted.

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Authors and Affiliations

  1. Department of General and Hepatobiliary Surgery and Liver Transplantation, Ghent University and Medical School, De Pintelaan 185 2 K12-IC, 9000, Ghent, Belgium

    Emmelie Reynvoet, Xavier Rogiers, Roberto Troisi & Frederik Berrevoet

  2. Biostatistics Unit, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium

    Ellen Deschepper

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  1. Emmelie Reynvoet
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  2. Ellen Deschepper
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Correspondence to Frederik Berrevoet.

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Reynvoet, E., Deschepper, E., Rogiers, X. et al. Laparoscopic ventral hernia repair: is there an optimal mesh fixation technique? A systematic review. Langenbecks Arch Surg 399, 55–63 (2014). https://doi.org/10.1007/s00423-013-1126-x

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