Mechanical vs Non-Mechanical Mesh Fixation in Open Retromuscular Ventral Hernia Repair: A Comparative Analysis from the Americas Hernia Society Quality Collaborative

Introduction: The laparoscopic approach to repairing ventral and incisional hernias has gained increasing popularity worldwide. The approximation of the hernia defect during laparoscopic ventral hernia repair, prior to mesh fixation, provides a more physiologic and anatomic repair. Defect closure also provides more defect overlap with mesh placement and, possibly decreases recurrence rates. We reviewed the experience of laparoscopic repair of large ventral hernia (diameter ≥5cm) at a university hospital in the Nepal with particular reference to patients with massive defects (diameter ≥15cm) and transfascial closure.Methods: A total of 32 patients underwent laparoscopic ventral (incisional or umbilical/paraumbilical) hernia repair between July 2014 and September 2015.Results: The prevalence of conversion to open surgery was 3.1%. The prevalence of postoperative complications was 15.6%. Median postoperative follow-up was 8.2 months. A total of 9.4% cases suffered late complications and 3.1% developed recurrence. Twelve patients underwent repair of defects ≥10cm in diameter with no recurrence. Three patients underwent repair of ‘massive’ incisional hernia (diameter ≥15cm) with a prevalence of recurrence of 3.1%. Ten patients with a body mass index (BMI) ≥30kg/m2 (range, 32–35kg/m2) underwent laparoscopic repair without any recurrence.Conclusions: Laparoscopic ventral hernia repair with transfascial suturing can be carried out safely with a low prevalence of recurrence. It may have advantages in obese patients in whom open repair would represent a significant undertaking. Laparoscopic ventral hernia repair may be used in cases of large and massive hernias, in which the risk of recurrence increases but is comparable with open repair and associated with low morbidity.

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Patterns of Recurrence and Mechanisms of Failure after Open Ventral Hernia Repair with Mesh

The American Surgeon ◽

10.1177/000313481708301131 ◽

2017 ◽

Vol 83 (11) ◽

pp. 1275-1282 ◽

Cited By ~ 7

Author(s):

Jeremy A. Warren ◽

Sean P. McGrath ◽

Allyson L. Hale ◽

Joseph A. Ewing ◽

Alfredo M. Carbonell ◽

...

Keyword(s):

Hernia Repair ◽

Ventral Hernia ◽

Ventral Hernia Repair ◽

Mesh Fixation ◽

Wound Complications ◽

Light Weight ◽

Group 2 ◽

Clean Contaminated ◽

Recurrence Group ◽

Group 1

Recurrence after ventral hernia repair (VHR) remains a significant complication. We sought to identify the technical aspects of VHR associated with recurrence. Patients who underwent open midline VHR between 2006 and 2013 (n = 261) were retrospectively evaluated. Patients with recurrence (Group 1, n = 48) were compared with those without recurrence (Group 2, n = 213). Smoking, diabetes, and body mass index were not different between groups. More patients in Group 1 underwent clean-contaminated, contaminated, or dirty procedures (43.8 vs 27.7%; P = 0.021). Group 1 had a higher incidence of surgical site occurrence (52.1 vs 32.9%; P = 0.020) and surgical site infection (43.8 vs 15.5%; P < 0.001). Recurrences were due to central mesh failure (CMF) (39.6%), midline recurrence after biologic or bioabsorbable mesh repair (18.8%), superior midline (16.7%), lateral (16.7%), and after mesh explantation (12.5%). Most CMF (78.9%) occurred with light-weight polypropylene (LWPP). Recurrence was higher if the midline fascia was unable to be closed. Recurrence with midweight polypropylene (MWPP) was lower than biologic (P < 0.001), bioabsorbable (P = 0.006), and light-weight polypropylene (P = 0.046) mesh. Fixation, component separation technique, and mesh position were not different between groups. Wound complications are associated with subsequent recurrence, whereas midweight polypropylene is associated with a lower overall risk of recurrence and, specifically, CMF.

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