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Sutureless onlay hernia repair: a review of 97 patients

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Abstract

Background

Repair of large ventral/incisional (V/I) hernias is a common problem. Outside of recurrence, other factors such as wound complications and mesh infection can create significant morbidity. Chevrel described the premuscular repair and later modified it by using glue over the midline closure. We previously described our onlay technique using fibrin glue alone in a small case series. The aim of this study is to review the largest case series of sutureless onlay V/I hernia repair whereby mesh is fixated with fibrin glue alone for complex ventral hernias, and how the technique has evolved.

Methods

All patients who underwent onlay V/I hernia repair over a 3-year period were reviewed. Patient demographics, operative details, complications, and follow-up were reviewed.

Results

In total, 97 patients were included. 54.6 % were female, with a mean age of 57.3 years. Mean BMI was 32.2. 23(23.7 %) patients had diabetes. 90 (92.8 %) of the operations were for incisional hernias, 3 (3.1 %) primary ventral hernias, 2 (2.1 %) flank hernias, and 2 (2 %) complex abdominal wall reconstruction. 88 (90.7 %) of the cases were performed on an elective basis. 77 (77.3 %) cases were classified as clean, 21 (21.6 %) clean-contaminated, and 1 (1.0 %) contaminated. The mean defect size was 150 cm2. Mean follow-up was 386 days, and maximum was 3.1 years. There were 21 (21.6 %) seromas, 4 (4.1 %) wound infections, 7 (7.4 %) had skin necrosis, and 9 (9.3 %) required re-operation due to a complication. At 3 years, there have been no recurrences or mesh explants.

Conclusions

The sutureless onlay V/I hernia repair with fibrin glue fixation has proven to be durable with a comparable complication profile to other techniques. The most common sequela, seroma, is easily managed in the outpatient setting. This sutureless technique is an effective option for onlay hernia repair that may provide several advantages over traditional suture techniques.

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Acknowledgments

The authors acknowledge the University of Tennessee Health Science Center, Department of Surgery, for funding the study. We would also like to thank the clinic staff that helped make the study possible.

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Authors and Affiliations

  1. Department of Surgery, University of Tennessee Health Science Center, 910 Madison Ave, 2nd Floor, Memphis, TN, 38163, USA

    Charles P. Shahan MD, Nathaniel F. Stoikes MD, David L. Webb MD & Guy R. Voeller MD

Authors
  1. Charles P. Shahan MD
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  2. Nathaniel F. Stoikes MD
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  3. David L. Webb MD
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  4. Guy R. Voeller MD
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Corresponding author

Correspondence to Charles P. Shahan MD.

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Disclosures

Dr. Charles P. Shahan has no financial disclosures to report. Drs. Nathaniel Stoikes, David Webb, and Guy Voeller report consulting honoraria and research grants from Bard Inc. outside of this study. Charles P. Shahan, Nathaniel Stoikes, David Webb, and Guy Voeller have no conflicts of interest or financial ties to disclose that are directly relevant to this study.

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Shahan, C.P., Stoikes, N. ., Webb, D. . et al. Sutureless onlay hernia repair: a review of 97 patients. Surg Endosc 30, 3256–3261 (2016). https://doi.org/10.1007/s00464-015-4647-2

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  • DOI: https://doi.org/10.1007/s00464-015-4647-2

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