Deborshi Sharma, Prof, Dr. Lady Hardinge and Dr RML Hospital
Ventral hernia repair has local complications and high recurrence rates. Laparoscopic ventral hernia repair (LVHR) has reduced some complications however left many unanswered. Consensus is building towards closure of defect during LVHR, creating better abdominal wall dynamics and reducing local complications. We analyze and present our 7 year results of LVHR with defect closure (IPOM plus)
Materials & Methods:
All LVHR done between July 2007 and June 2014 with a minimum follow-up of 1year included. Defect closure was done by intracorporeal suturing using a non absorbable monofilament suture. Data was prospectively collected and patients were followed up for maximum 7 years from hospital records, unit follow up data and telephone calls made for uncertain records. Post-operative complications were analyzed and compared between Group I: Defect complete closure, Group II: Defect incomplete closure and Group III: Defect not closed. Analysis was done using SPSS 17. Data was analyzed using Chi Square/Fischer Exact test. P-value of <0.05 taken as significant.
After excluding recurrent hernia and lateral hernias, 181 ventral midline hernias were operated (Primary Hernia N=96, Incisional Hernia N=85). Vertical hernia size in 83 patients were ≤5cm, 76 had 5-10cm, and 22 between 10-20cm. Mean follow-up was 51months (Range 1-7yrs).
Defect closure was attempted in 86/181 (47.51%) – 36, 35 and 15 patients with Hernia sizes ≤5cm, 5.1-10cm and 10.1-20cm respectively. All patients with defect size ≤5cm (36/36) had complete defect closure while 20 with defect sizes 5.1-10cm (5/35) and 10.1-20cm (15/15) had incomplete closure of defect. Closure attempted Group I&II had longer operating time than Group III (114min vs 95min) (P-Value 0.104).
Hernia size ≤5cm, Group I had no incidence of Post operative buldge(POB), Seroma or recurrence while group III had POB in 2.1% and Seroma in 21.2%.
Hernia Sizes 5.1-10cm, Seroma was seen in 13.3% in Group I, while it was 60% and 24% in Group II and III respectively (P-value 0.021). Three recurrences (7.3%) were seen in Group III within 1 year.
Hernia Size 10.1-20cm, Seroma was seen in 4(57.1%), POB in 6(85.7%) and recurrence in 2(28.5%) in Group III. Complications were highest in Group II&III, particularly when hernia size was 10.1-20cm (P-value 0.043).
Defect closure gives significantly better patient outcome and result among all hernia sizes. However all defects beyond ≥5cm may not be amenable for defect closure. Partial/Incomplete closure even has better results than non closure of defect except in terms of seroma formation.