Closure Versus Non-closure of Hernia Defect During Laparoscopic Ventral Hernia Repair With Mesh

Marianna Zeichen, MD, Wilmer Mata, MD, Henry J Lujan, MD, Irving Jorge, MD, Victor Maciel, MD, Dustin Lee, DO, Eddie Gomez, MD, Alejandro M Hernandez, MD, Gustavo Plasencia, MD. Jackson South Community Hospital

 

Introduction: There are few published data regarding the benefits of closing the hernia fascial defect during laparoscopic ventral hernia repair with mesh. We compared outcomes of patients who underwent laparoscopic ventral hernia repair with mesh (LVHRwM) alone to laparoscopic ventral hernia defect closure with mesh reinforcement (LVHDCwM).

Methods: A retrospective review of 128 patients who underwent laparoscopic ventral hernia repair of defects less than 20 cm between July 2000 and September 2011. These patients were divided into two groups: (1) Repair with mesh alone and (2) those with hernia defect closure and mesh reinforcement. Group 2 was further divided by technique: extracorporeal versus intracorporeal closure of the defect.

Results: 93 patients underwent LVHRwM and 35 patients underwent LVHDCwM. Follow-up was available in 105 of 128 patients (82.03%) at a mean of 25.60 months (Range 1 – 110 months). Mean operative times and hospital stay were: 75.05 ± 42.53 minutes (range 18 – 215) and 1.38 ± 1.12 days (range 1 – 6) in Group 1 and 88.96 ± 30.23 minutes (range 45 – 143) and 1.26 days ± 0.54 (range 1 – 3) in Group 2. In Group 1 there were a total of 13 patients with postoperative complications (13.98%) and in Group 2 there were a total of 8 patients with postoperative complications (22.86%). Fourteen patients (19.18%) developed recurrent hernias in Group 1.  Two patients (6.25%) developed recurrent hernias in Groups 2.  In Group 1 the average time to develop recurrence was 23.17 months (range 5.3 – 75.3) and 25.9 months (range 9.57 – 16.33) in Group 2. Finally, in Group 2, there have been no recurrences in patients whose defect was closed intracorporeally versus 2 patients when the defect was closed extracorporeally.

Conclusion: The overall complication rate was higher in Group 2, but half of these complications were seroma formation. Closing the primary defect decreased the recurrence rate without significantly increasing operative times. The difference in recurrence rates (19.18% vs 6.25%) did not reach statistical significance (P value 0.0914). However, we believe that with a larger series and longer follow-up, statistically significant advantages for closing the defect will be demonstrated.

 


Session Number: SS15 – Hernia
Program Number: S085

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