A Comparative Study to Assess the Efficacy of Absorbable Versus Permanent Fixation Tacks in Laparoscopic Ventral Hernia Repair

Eva Lourdes, Sujith Wijerathne, Lynette MA Loo, Siau Wei Tang, Davide Lomanto, Prof. Minimally Invasive Surgery Centre, Department of Surgery, National University Health System, Singapore

Introduction: Laparoscopic repair of ventral hernia is increasingly becoming the standard of care in many institutions. However, debates still exist regarding the approach, the role of mesh fixation and the type of fixation device used. Our study aims to compare the outcomes of patients who underwent laparoscopic ventral hernia repair with an absorbable fixation tack to those who had a permanent (non-absorbable) fixation tack.

Methods: This is a treatment based, retrospective study involving patients who underwent laparoscopic ventral hernia repair at a single institution. Patients were divided into two groups based on the type of fixation tack used (absorbable or permanent), irrespective of the mesh used. Post surgery, patients were routinely followed up in the outpatient clinic and their notes were reviewed to record demographic data, surgical details, complications, level of pain and the recurrence of ventral hernias.

Results: All patients underwent laparoscopic repair of ventral hernia during the period 2011-2014. We compared 57 patients who had absorbable fixation tacks (Group A) to 37 patients who had permanent fixation tacks (Group B). Most patients presented with cosmetic concerns (86% in A vs 92% in B) or pain (12% in A vs 8% in B). Post-operatively, 81% of patients from Group A and 73% of patients from Group B developed acute pain, defined as pain requiring more than 1 type of analgesia. Seromas were found in 2% of patients in Group A and 11% in Group B (p=0.011). Recurrence rates of ventral hernia were 3% in both Groups A and B.

Conclusion: The overall incidence of complications for both types of tacks is low and both fared equally well in providing mesh anchorage as evidenced by a low recurrence rate of hernia. With regards to pain, no significant difference was demonstrated in our study, as assessed by the use of analgesia, a surrogate measure of pain. Absorbable and permanent fixation tacks may be used in laparoscopic ventral hernia repair with equal effect.