Laparoscopic versus open mesh repairs for small-sized ventral and incisional hernias: a propensity score analysis of a retrospective cohort of patients.

Introduction: For ventral/incisional hernias between 1 and 4 cm, there is still controversy regarding open or laparoscopic mesh repairs. The study evaluated via a propensity-score adjusted analysis, the differences in outcomes between a laparoscopic and open ventral hernia mesh repair.

Methodology: A single institution retrospective cohort study was performed. All patients with a ventral or incisional hernia between 1 and ≤ 4 cm, with a mesh repair, were reviewed. A propensity-score adjusted analysis was performed to account for baseline differences. Subgroup analyses were also performed. Outcome measures included recurrence, chronic pain, complications, postoperative adhesive occurrences, length of stay and operative duration.

Results: Over a 6-year period, 194 patients (91 laparoscopic; 103 open) were included. Mean follow-up duration and defect size were 8.0 months and 2.6 cm, respectively. Baseline differences in the univariate analysis between groups were adjusted for via propensity scoring. In the propensity-score adjusted analysis, a laparoscopic mesh repair was significantly associated with a lower likelihood of postoperative adhesive occurrences, with no differences in recurrence, chronic pain, complications, length of stay and operative duration. This association remained for hernia defects down to ≤ 3 cm. There were no significant differences between the laparoscopic and open groups when stratified for hernia defects of 1-2 cm. For the subgroup analysis, in contrast to an intraperitoneal on-lay mesh placement, open on-lay mesh placement was associated with a higher likelihood of postoperative adhesive occurrences.

Conclusion: For patients with small-sized ventral/incisional hernias between 1 and 4 cm, laparoscopic mesh repairs may be associated with reduced postoperative adhesive occurrences, with no difference in other outcomes.