Optimal Methods of Laparoscopic Repair of Incisional Ventral Hernia

V.v. Grubnik, K.o. Vorotyntseva. Odessa national medical university, Ukraine

Introduction. Many articles have shown that laparoscopic repair of ventral hernia is preferred over open repair.

The aim of the study was to compare different types of mesh and fixation methods for laparoscopic incisional ventral hernia repair.

Methods and procedures. Prospective randomized controlled study was conducted from 2008 to 2013. Total enrollement was 63 patients (men – 24, women – 39) with a mean age of 45.9 ± 10.6 (22–72). They were prospectively randomized into two arms: arm I included 32 patients where lightweight PTFEe mesh with peripheral nitinol frame (Rebound, MMDI, Inc.) was used, arm II included 31 patients (composite PTFEe mesh (Dualmesh, Gore, Inc.). In arm I mesh was fixed to abdominal wall using only 3-4 transfascial sutures. In arm II mesh was fixed with double row of spiral tackers. Two groups of patients were statistically comparable by demographic data, symptom scores, and size of the defects.

Results. The mean mesh fixation time was higher in arm II (27.8 min ± 6.8 versus 41.1 min ± 10.9, p<0.001). The mean operative time was also higher in arm II (68.5 ± 8.2 min versus 108.2 ± 12.8 min, p<0.001). There were 2 conversions to open repair in arm I and in arm II. The pain score was significantly less at 24 and 48 hours in arm I compared to arm II (mean visual analog scale score, 2.74 vs. 3.82, p<0.01). The rate of complications was 9.4% (3 patients) in arm I and 12.9% (4 patients) in arm II (p>0.05). Recurrence rate at mean follow-up of 36 months was 6.25% (2 patients) in arm I, and 9.6% (3 patients) in arm II (p>0.05).

Conclusions. The new type of meshes with nitinol frame is better for laparoscopic repair of incisional ventral hernia in terms of recurrence rate. Fixation of this mesh is very simple. We consider that the new type of prosthesis can significantly improve results of laparoscopic incisional hernia repair.