Laparoscopic Ventral Hernia Repair Using Ultra-Light Weight Polypropylene Mesh: A Single Surgeon Experience in a University Hospital

Yusuf Gunay, MD, Alyssa Capper, BA, Isaac Samuel, MD, Mohammad K Jamal, MD. University of Iowa Hospitals and Clinics, Iowa City, IA.

Introduction: Laparoscopic ventral hernia repair (LVHR) with mesh is gaining popularity given superior cosmetic and long term outcomes. There are several kinds of mesh and various techniques available for performing LVHR. The aim of our study was to analyze the results of LVHR using ultra-lightweight polypropylene (ULWP) mesh and multiple transfascial sutures.

Materials and methods: One hundred and seventy eight consecutive patients underwent ventral hernia repair by a single surgeon at our institution between December 2005 and September 2009. Of these, 96 patients had the procedure performed laparoscopically using ULWP mesh and had at least a 12 month follow-up. The standard surgical technique involved the use of ULWP mesh placed in an intraperitoneal onlay (IPOM) fashion. Multiple transfascial sutures placed 3 cm apart and tackers were used to secure the mesh to the anterior abdominal wall. We used an electronic database to retrieve all pre- and post-operative data.

Results: Of the 96 patients, 46 (48%) were males and 50 (52%) were females with a mean age of 53 years (range 24-77 years) and body mass index (BMI) of 36.5 kg/m² (SD ± 7.1 kg/m²). Of the 96 hernias repaired, 69 (72%) were incisional, 17(18%) were umbilical and periumbilical and 10 (10%) were various anterior abdominal wall hernias. Thirty eight patients (39.5%) had previous failed hernia repairs done elsewhere. The mean hernia size was 132.8 cm² (SD ± 129.7 cm²), the average size of mesh used for hernia repair was 404 cm² (SD ± 186.6 cm²) and the mean operative time was 140 mins (range 35-360 mins). All procedures were completed laparoscopically; however, three patients required a small incision for hand-assisted reduction of hernia contents without the need for an open conversion. The mean hospital stay was 3 days (range 1-8 days) with the main reason for hospital stay being pain control and a prolonged ileus. Early complications (defined as those occurring within 30 days following surgery) occurred in 18 patients and included 4 (4%) port site superficial skin infections (SSI) treated with antibiotics and 14 (15%) seromas with three requiring aspiration. There were no hollow viscus injuries or major bleeding requiring transfusions reported in this series. Late complications (those occurring more than 30 days following surgery) occurred in 8 patients and included 2 (2%) seromas, 3 (3%) port site SSI and 3 (3%) deep tissue infections. The latter three patients required removal of mesh due to associated soft tissue infection and sepsis. Twenty-five patients (26%) developed chronic pain lasting an average of 8 weeks following LVHR. There were no hernia recurrences in this series for a mean follow-up of 25 months (SD ± 14).

Conclusion: The results this study support the view that LVHR using ULWP mesh placed in an IPOM fashion using multiple transfascial sutures substantially decreases hernia recurrence. Minor complications including seromas, SSI and chronic pain are well tolerated and generally self-limited.