Is the Recurrence Rate of Incisional Hernia Influenced by Surgical Approach? A Comparative Study with Long-Term Follow-Up

Ezequiel Sadava, Martin Galvarini, Rudolf Von Buxhoeveden, Romina Reino, Belen Castro Fuentes, Jose Alvarez Gallesio, Francisco Schlottmann. Hospital Aleman of Buenos Aires

Introduction: Laparoscopic approach prevents major abdominal wall incisions and improves patient recovery. Although laparoscopic incisional hernia repair has proven to be at least as safe as open repair, the mini-invasive approach has not been standardized. Several investigations have been conducted about the best method to repair an incisional hernia, but few reports assess which technique offers better results in terms of durability.  We aimed to evaluate the mid- and long-term results of laparoscopic incisional hernia repair.

Methods and procedures: From June 2012 to February 2015 all charts of consecutive patients underwent to incisional ventral hernia repairs were revised. Patients who underwent ventral hernia repair with defects between 15 and 150 cm2 and had at least a minimum of 6 months of-follow-up were included. Demographics, operative features and post-operative complications were analyzed comparing laparoscopic repair (LR) and open repair (OR). Also mid- and long-term follow-up was evaluated with focus in hernia recurrence.

Results: A total of 137 patients were included in the study: 34 (25 %) laparoscopic and 103 (75 %) open incisional hernia repairs with synthetic prosthesis. There was no difference in gender, age, BMI and ASA score between groups (p=NS). The mean defect size was 49 cm2 in LR and 55 cm2 in OR (p=NS). In laparoscopic repairs a composite with anti-adhesive barrier mesh was placed in all cases, and heavy-weight polypropylene (78 %) and composite low-weight macroporous mesh (28 %) were implanted in a sub-lay fashion for open repairs. There was no difference in operative time (LR: 100 minutes vs OR: 120 minutes, p=NS). There was a significant higher rate of postoperative complications in OR (LR: 14 % vs OR 41 %, p= 0.007). Length of stay was similar between the two groups (LR 0.9 days vs G2 1.7 days, p= NS). With a mean follow up of 18 (6-30) months, the incidence of recurrence was 10 % in LR and 13 % in OR (p=NS).

Conclusions: Laparoscopic incisional hernia repair showed a reduction in postoperative complications and hospital stay compared with open approach. At mid- and long-term follow-up, no difference was found in terms of recurrence. 

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