The Effect of Fixation Methods on Outcomes in Laparoscopic Ventral Hernia Repair.

Introduction: The ideal fixation methods in laparoscopic ventral hernia repair continue to be debated. Early series touted the importance of suture and tack fixation; however, due to the perceived concern for increased pain, newer tack-only fixation methods have emerged. The purpose of this study was to compare fixation methods in laparoscopic ventral hernia repairs using a large hernia database.

Materials And Methods: We retrospectively reviewed data from the Americas Hernia Society Quality Collaborative (AHSQC) database comparing two groups of fixation (all tacks vs. all sutures and tacks and sutures and permanent tacks vs. sutures and absorbable tacks). The primary outcome measures were hernia recurrence, hospital length of stay, surgical site infection, surgical site occurrence, pain intensity scores, and quality-of-life scores evaluated at 30 days, six months, one year, and two years, Propensity score matching was used to strengthen the retrospective nature of the study.

Results: Eight hundred and fifty-two patients were included for analysis; 426 patients with tack-only fixation and 426 with tack and suture fixation. Eight hundred and four total patients were included for analysis; 402 patients with sutures with permanent tacks and 402 patients with sutures and absorbable tacks. For both comparisons, there was no significant difference in hospital length of stay, hernia recurrence rate, surgical site infection rate, surgical site occurrence rate, or surgical site occurrence requiring procedural intervention (p>0.05). There was also no significant difference in pain scores and quality-of-life scores at baseline, 30 days, six months, and one year. The only significant difference was in quality of life at two years. Patients with sutures and tacks had better quality-of-life scores compared with patients with tacks only (64 vs. 39, p<0.001).

Conclusion: Data available in the AHSQC database reviewed in this study indicate that there were no clinically significant differences between types of fixation methods when used in laparoscopic ventral hernia repair.