Background: Laparoscopy, specifically the bridged mesh technique, is a popular means used for ventral hernia repair. While laparoscopy has decreased the incidence of surgical site infection (SSI), hernia recurrence rates remain unchanged. Some surgeons advocate laparoscopic primary fascial closure (PFC) with placement of intraperitoneal mesh to decrease recurrence rates. We hypothesize that in patients undergoing laparoscopic ventral hernia repair (LVHR), PFC compared to a bridged mesh repair decreases hernia recurrence rates.
Methods: A multicenter, retrospective database of all ventral hernia repairs performed from 2010-2012 was accessed. Patients who underwent LVHR with mesh were reviewed. Patients who had PFC were compared to bridged repair. Primary outcome was hernia recurrence determined by clinical examination or CT scan. Secondary outcomes included SSI and seroma formation.
Results: A total of 1594 patients were identified. Following exclusion, a total of 196 patients were left who underwent LVHR with a mean follow-up period of 17.5 months. Ninety-seven patients underwent PFC, while 99 underwent bridged repairs. Initial comparisons between both groups was negative for any significant statistical difference in terms of recurrence, seroma formation, SSI, deep/organ space SSI, reoperation, and readmission. The same initial findings held true during subgroup analysis. Propensity score analysis was then performed for recurrence, seroma, and SSI controlling for age, gender, immune status, ASA class, BMI, smoking status, and acute repair. No statistically significant differences were identified in either group.
Conclusion: Primary fascial closure during laparoscopic hernia repairs did not result in reduced recurrence, seroma, and SSI as compared to bridge repairs in a retrospective, multi-institutional study. However, additional research is needed to further evaluate benefits to the patient in terms of pain, function, cosmesis, and overall satisfaction. Randomized, blinded, control trials should focus on these parameters in future investigations.
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http://dx.doi.org/10.1007/s00464-015-4644-5 | DOI Listing |
Hernia
January 2025
Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
Purpose: The AFTERHERNIA Project aims to shift the focus of hernia surgery towards patient-reported outcomes by examining the impact of surgical methods and long-term complications on a national level. Groin and ventral hernia repairs are common surgical procedures with significant impact on patient quality of life and healthcare costs. Most large-scale studies focus on clinical outcomes like reoperation and readmission rates, rather than patient-reported outcomes.
View Article and Find Full Text PDFHernia
January 2025
Department of Surgery, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA.
Purpose: Decision regret following hernia repair is common, particularly for patients who experience complications. Frailty is a risk factor for complications, but whether frailty is independently associated with regret remains unknown.
Methods: We retrospectively reviewed the Michigan Surgical Quality Collaborative Core Optimization Hernia Registry, a representative sample of adult patients from > 70 hospitals across Michigan.
Hernia
January 2025
Department of General Surgery, Horsens Regional Hospital, Horsens, Denmark.
Purpose: Parastomal hernia is a frequent complication after stoma construction, with increasing incidence over time. Surgical repair is reported with a high recurrence rate and the evidence on the topic is limited. We conducted a retrospective study to evaluate the incidence of recurrence after parastomal hernia repair and assessed the risk factors and predictors for recurrence at the Regional Hernia Center at Horsens Regional Hospital, Denmark.
View Article and Find Full Text PDFSurg Pract Sci
March 2024
Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
Introduction: Repair of midsize (4-6 cm) ventral hernias is challenging given lack of guidelines. Within this context, we sought to characterize surgical approach among patients undergoing repair of midsize ventral hernias within the only population-level, clinically-nuanced hernia registry in the US.
Methods: Retrospective cohort study of patients undergoing ventral hernia repair in the Michigan Surgical Quality Collaborative Core Optimization Hernia Registry (MSQC-COHR).
Surg Endosc
January 2025
Department of Hernia and Abdominal Wall Surgery, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe Road, Zhengzhou, 450052, Henan, China.
Background: Self-gripping mesh, made of monofilament polypropylene and covered by a layer of polylactic acid micro-hooks, is applied in ventral hernia repair, whereas cytological change and collagen expression around the mesh are rarely reported. The objective of this research was to compare inflammatory response and collagen proliferation between self-gripping and polypropylene mesh in rat model of incisional hernia.
Methods: Forty-five rats were randomly divided into unrepaired (UR) group, polypropylene (PP) mesh group, and self-gripping (SG) mesh group and euthanized at 1, 2 and 4 weeks postoperatively.
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