Laparoscopic Ventral Hernia Repair with Polyester Mesh: Primary Fascial Repair with Mesh vs. Mesh Only

Priya Joshi, BS, Farah Karipineni, MD, MPH, Afshin Parsikia, MD, Amit Joshi, MD, FACS. Jefferson Medical College, Philadelphia, PA & Einstein Healthcare Network, Philadelphia, PA.

Several studies have suggested that primary closure of hernia defects may decrease recurrence rates of laparoscopic ventral hernia repair (LVHR). This paper expands on the data regarding recurrence rates in primary closure with mesh versus mesh-only repair of LVHR and examines the ideal overlap required to prevent recurrence.

An IRB-approved, retrospective review was conducted on 57 patients who underwent LVHR performed by a single surgeon between August 2010 and July 2013. Polyester dual-sided mesh was used in all patients. These patients were divided into mesh-only (non-closure) and primary fascial closure with mesh (closure) groups. Patient demographics, hernia locations, mesh overlap, complications, and recurrence rates were compared between the two groups. The data were tested for normality. Non-parametric tests and medians were utilized for the data which were not in normal distribution.

Of the 57 patients included, 39 (68%) were in the closure group and 18 (32%) in the non-closure group. Median defect sizes were 5.1cm2 and 9.1cm2, respectively (p=0.378). Participants were followed for a mean of 1.3 years (SD=0.7). Recurrence rates were 2/39 (5.1%) in the closure group and 1/18 (5.6%) in the non-closure group (p=0.947). There were no post-operative complications in the non-closure group. The closure group experienced 3 (7.7%) post-operative complications (hematoma and paralytic ileus). This was not statistically different between the two groups (p=0.544). The median mesh-to-hernia ratio (surface area of mesh:surface area of hernia) for all repairs was 15.2 (1.3 to 769.2).

Median length of stay was 14.5 (1.7 to 1496.6) hours for patients with non-closure and 11.9 (6.9-815.9) hours for patients with closure (P = 0.466)

This is one of the largest series of LVHR using polyester dual-sided mesh. Our recurrence rate was quite favorable at about 5%. Significant overlap is needed to achieve such low recurrence rates. The surface area of the mesh should be at least three times that of the hernia defect itself. Primary closure of hernias seems less important than adequate mesh overlap in preventing recurrence after LVHR. Primary closure may help to prevent postoperative seroma formation.

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