Laparoscopic incisional and ventral hernia repair without sutures: a single-center experience with 200 cases.

Background: Laparoscopic incisional and ventral herniorraphy (LIVH), using a mesh, has gained recognition as an effective method and is associated with lower complication and recurrence. Controversies in the operative technique still exist about biomaterial, method of fixation, and overlap of the mesh over the defect. The aim of this study was to evaluate the outcomes achieved with LIVH in 200 consecutive patients treated in a single hospital, using fixation of the mesh with only tacks. Results of the first 100 (group A) and the last 100 (group B) operations were also compared.

Methods: From 2003 through 2007, 200 patients underwent LIVH. Overlap of the mesh was 3-5 cm. The mesh was secured with tacks alone, with the "double crown" technique. In group B, adhesiolysis was performed, avoiding high energies.

Results: Mean ventral defect was 107.5 (+/- 95.4) cm2. The recurrent ventral hernia rate was 20%, and the conversion rate was 2.5%. Mean operative time was 77.5 (+/- 33.9) minutes. Mean mesh dimension was 326.4 (+/- 166.8) cm2. The overall morbidity rate was 10.5%. Bowel injuries were 5 (2.5 %). Minor complications were 8.0%. Median postoperative hospital stay was 3 days. Recurrence rate was 3.5%, with a mean follow-up of 22.5 months. Chronic pain was 1%. No difference was seen between groups A and B regarding minor complications, whereas a significant difference was found regarding enterotomies (5 vs. 0; P = 0.024) and recurrences (6 vs. 1; P = 0.056).

Conclusions: Fixation of the mesh with the sole use of tacks was demonstrated to be safe and effective. Avoiding high energies, no case of enterotomy occurred.