Primary Fascial Closure During Laparoscopic Ventral Hernia Repair Does Not Reduce 30-Day Wound Complications

Laparoscopic-assisted ventral hernia repair (LAVHR) with mesh is well established as the preferred technique for hernia repair. We sought to determine whether primary fascial closure and/or overlap of the mesh reduced recurrence and/or complications. We conducted a retrospective review on 57 LAVHR patients using polyester composite mesh between August 2010 and July 2013. They were divided into mesh-only (nonclosure) and primary fascial closure with mesh (closure) groups. Patient demographics, prior surgical history, mesh overlap, complications, and recurrence rates were compared. Thirty-nine (68%) of 57 patients were in the closure group and 18 (32%) in the nonclosure group. Mean defect sizes were 15.5 and 22.5 cm2, respectively. Participants were followed for a mean of 1.3 years [standard deviation (SD) = 0.7]. Recurrence rates were 2/39 (5.1%) in the closure group and 1/18 (5.6%) in the nonclosure group ( P = 0.947). There were no major postoperative complications in the nonclosure group. The closure group experienced four (10.3%) complications. This was not a statistically significant difference ( P = 0.159). The median mesh-to-hernia ratio for all repairs was 15.2 (surface area) and 3.9 (diameter). Median length of stay was 14.5 hours (1.7–99.3) for patients with nonclosure and 11.9 hours (6.9–90.3 hours) for patients with closure ( P = 0.625). In conclusion, this is one of the largest series of LAVHR exclusively using polyester dual-sided mesh. Our recurrence rate was about 5 per cent. Significant mesh overlap is needed to achieve such low recurrence rates. Primary closure of hernias seems less important than adequate mesh overlap in preventing recurrence after LAVHR.

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Primary Fascial Closure During Laparoscopic Ventral Hernia Repair Improves Patient Quality of Life: A Multicenter, Blinded Randomized Controlled Trial

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2019.08.250 ◽

2019 ◽

Vol 229 (4) ◽

pp. S111

Author(s):

Karla Bernardi ◽

Oscar A. Olavarria ◽

Julie Holihan ◽

Lillian S. Kao ◽

Tien C. Ko ◽

...

Keyword(s):

Quality Of Life ◽

Randomized Controlled Trial ◽

Hernia Repair ◽

Ventral Hernia ◽

Ventral Hernia Repair ◽

Controlled Trial ◽

Fascial Closure ◽

Randomized Controlled ◽

Primary Fascial Closure

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Trans-fascial closure in laparoscopic ventral hernia repair

Surgical Endoscopy ◽

10.1007/s00464-016-4868-z ◽

2016 ◽

Vol 30 (12) ◽

pp. 5228-5231 ◽

Cited By ~ 9

Author(s):

Duncan Light ◽

Sadiq Bawa

Keyword(s):

Hernia Repair ◽

Ventral Hernia ◽

Ventral Hernia Repair ◽

Laparoscopic Ventral Hernia Repair ◽

Fascial Closure

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Primary Fascial Closure During Minimally Invasive Ventral Hernia Repair

JAMA Surgery ◽

10.1001/jamasurg.2019.5088 ◽

2020 ◽

Vol 155 (3) ◽

pp. 256 ◽

Cited By ~ 2

Author(s):

Karla Bernardi ◽

Oscar A. Olavarria ◽

Mike K. Liang

Keyword(s):

Minimally Invasive ◽

Hernia Repair ◽

Ventral Hernia ◽

Ventral Hernia Repair ◽

Fascial Closure ◽

Primary Fascial Closure

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Robotic versus laparoscopic ventral hernia repair: multicenter, blinded randomized controlled trial

BMJ ◽

10.1136/bmj.m2457 ◽

2020 ◽

pp. m2457 ◽

Cited By ~ 2

Author(s):

Oscar A Olavarria ◽

Karla Bernardi ◽

Shinil K Shah ◽

Todd D Wilson ◽

Shuyan Wei ◽

...

Keyword(s):

Hernia Repair ◽

Ventral Hernia ◽

Laparoscopic Repair ◽

Ventral Hernia Repair ◽

Controlled Trial ◽

Emergency Department Visits ◽

Laparoscopic Ventral Hernia Repair ◽

Wound Complications ◽

Robotic Ventral Hernia Repair

AbstractObjectiveTo determine whether robotic ventral hernia repair is associated with fewer days in the hospital 90 days after surgery compared with laparoscopic repair.DesignPragmatic, blinded randomized controlled trial.SettingMultidisciplinary hernia clinics in Houston, USA.Participants124 patients, deemed appropriate candidates for elective minimally invasive ventral hernia repair, consecutively presenting from April 2018 to February 2019.InterventionsRobotic ventral hernia repair (n=65) versus laparoscopic ventral hernia repair (n=59).Main outcome measuresThe primary outcome was number of days in hospital within 90 days after surgery. Secondary outcomes included emergency department visits, operating room time, wound complications, hernia recurrence, reoperation, abdominal wall quality of life, and costs from the healthcare system perspective. Outcomes were pre-specified before data collection began and analyzed as intention to treat.ResultsPatients from both groups were similar at baseline. Ninety day follow-up was completed in 123 (99%) patients. No evidence was seen of a difference in days in hospital between the two groups (median 0 v 0 days; relative rate 0.90, 95% confidence interval 0.37 to 2.19; P=0.82). For secondary outcomes, no differences were noted in emergency department visits, wound complications, hernia recurrence, or reoperation. However, robotic repair had longer operative duration (141 v 77 min; mean difference 62.89, 45.75 to 80.01; P≤0.001) and increased healthcare costs ($15 865 (£12 746; €14 125) v $12 955; cost ratio 1.21, 1.07 to 1.38; adjusted absolute cost difference $2767, $910 to $4626; P=0.004). Among patients with robotic ventral hernia repair, two had an enterotomy compared none with laparoscopic repair. The median one month postoperative improvement in abdominal wall quality of life was 3 with robotic ventral hernia repair compared with 15 following laparoscopic repair.ConclusionThis study found no evidence of a difference in 90 day postoperative hospital days between robotic and laparoscopic ventral hernia repair. However, robotic repair increased operative duration and healthcare costs.Trial registrationClinicaltrials.gov NCT03490266.

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Laparoscopic Ventral Hernia Repair in the Geriatric Population

The American Surgeon ◽

10.1177/0003134820942149 ◽

2020 ◽

Vol 86 (8) ◽

pp. 1015-1021

Author(s):

Sharbel A. Elhage ◽

Jenny M. Shao ◽

Eva B. Deerenberg ◽

Tanushree Prasad ◽

Paul D. Colavita ◽

...

Keyword(s):

Hernia Repair ◽

Ventral Hernia ◽

Ventral Hernia Repair ◽

Geriatric Patients ◽

Age Groups ◽

Wound Complication ◽

Laparoscopic Ventral Hernia Repair ◽

Wound Complications ◽

Cardiac Events ◽

Geriatric Population

Objectives Laparoscopic ventral hernia repair (LVHR) has been shown to decrease wound complications and length of stay (LOS) but results in more postoperative discomfort. The benefits of LVHR for the growing geriatric population are unclear. The aim of our study is to evaluate long-term outcomes and quality of life (QOL) after LVHR in the geriatric population. Methods A prospectively collected single-center database was queried for all patients who underwent LVHR (1999-2019). Age groups were defined as <40 (young), 40-64 (middle age), and ≥65 years (geriatric). QOL was assessed with the Carolinas Comfort Scale. Results LVHR was performed in 1181 patients, of which 13.4% were young, 61.6% middle aged, and 25.0% geriatric. Hernia defect size (64.2 ± 94.4 vs 79.9 ± 102.4 vs 84.7 ± 110.0 cm2) and number of comorbidities (2.2 ± 2.1 vs 3.2 ± 2.2 vs 4.3 ± 2.2) increased with age (all P < .05). LOS increased with age (2.9 ± 2.5 vs 3.8 ± 2.9 vs 5.2 ± 5.3 days, P < .0001). Rates of postoperative cardiac events, pneumonia, respiratory failure, wound complication, reoperation, and death were similar ( P > .05). Geriatric patients had increased rate of ileus and urinary retention (all P < .05). Overall recurrence rate was 5.7% with an average follow-up of 43.5 months, with no differences in recurrence between groups ( P > .05). Geriatric patients had better overall QOL at 2 weeks ( P = .0008) and similar QOL at 1, 6, and 12 months. Discussion LVHR offers excellent results in the geriatric population. Despite having increased rates of comorbidities and larger hernia defects, which may relate to LOS, rates of complications and recurrence were similar compared with younger cohorts, with better short-term QOL.

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