Mechanisms of Ventral Hernia Recurrence Following Laparoscopic Repair

Objective: To determine mechanisms of ventral hernia recurrence following laparoscopic repair.
Background: Laparoscopic ventral hernia repair techniques have demonstrated low recurrence rates in recent years. Mechanisms of recurrence following open repair are well-documented, but there is less data defining how laparoscopically-repaired hernias recur.
Methods: We performed a retrospective analysis of 25 patients who had previously undergone at least one laparoscopic hernia repair, and who subsequently required repair for recurrence. Mechanisms of recurrence were determined at the time of surgery, and documented in the operative note for 23 of the patients, while two were determined later through video analysis.
Results: Sixty percent (n=15) of recurrences demonstrated mesh retraction or contraction, exposing the previous defect. On several occurrences, these retractions caused ripping of the mesh at transfascial suture sites, causing defects within the mesh. Four (16%) recurrences were located at the periphery of the previously placed mesh. One primary mesh failure was noted. In this instance, mesh was torn through the center, with intact retention devices along edges of the mesh. Failed retention devices were noted in two patients. Two patients had loss of domain. In one case infected mesh was noted, and in another, an inflammatory reaction to mesh was seen laparoscopically. Eighty-eight percent were female, with a mean age of 48.9 years (SD±10.2) and an average BMI of 38.2 (SD±6.7). Patients averaged three previous hernia repairs, with an average of 1.5 (SD±1) previous laparoscopic repairs. Thirty-six percent required extensive (greater than one hour) lysis of adhesions. Median defect size was 207 cm2 (Range16-750), while median mesh size was 624 cm2 (Range 225-1768).
Conclusion: The documented mechanism of recurrence after lap ventral hernia repair appeared to be mesh contraction and/or migration in 60% of this patient series. Other mechanisms of recurrence appeared to be failure of fixation and inadequate mesh coverage.

Session: Podium Presentation

Program Number: S048

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