Laparoscopic ventral hernia repair with primary fascial closure versus bridged repair: a risk-adjusted comparative study

John Emil Wennergren, Erik P. Askenasy, Jacob A. Greenberg, Julie Holihan, Jerrod Keith, Mike K. Liang, Robert Martindale, Skylar Trott, Margaret Plymale, John Scott Roth

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1-8
Number of pages8
JournalSurgical Endoscopy and Other Interventional Techniques
DOIs
StateAccepted/In press - Nov 17 2015

Fingerprint

Ventral Hernia
Herniorrhaphy
Surgical Wound Infection
Seroma
Recurrence
Hernia
Laparoscopy
Propensity Score
Reoperation
Smoking
Databases
Pain
Incidence
Research

Keywords

  • Fascial closure
  • Hernia
  • Laparoscopic
  • Mesh
  • Recurrence
  • Seroma

ASJC Scopus subject areas

  • Surgery

Cite this

Laparoscopic ventral hernia repair with primary fascial closure versus bridged repair : a risk-adjusted comparative study. / Wennergren, John Emil; Askenasy, Erik P.; Greenberg, Jacob A.; Holihan, Julie; Keith, Jerrod; Liang, Mike K.; Martindale, Robert; Trott, Skylar; Plymale, Margaret; Roth, John Scott.

In: Surgical Endoscopy and Other Interventional Techniques, 17.11.2015, p. 1-8.

Research output: Contribution to journalArticle

Wennergren, John Emil ; Askenasy, Erik P. ; Greenberg, Jacob A. ; Holihan, Julie ; Keith, Jerrod ; Liang, Mike K. ; Martindale, Robert ; Trott, Skylar ; Plymale, Margaret ; Roth, John Scott. / Laparoscopic ventral hernia repair with primary fascial closure versus bridged repair : a risk-adjusted comparative study. In: Surgical Endoscopy and Other Interventional Techniques. 2015 ; pp. 1-8.
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T1 - Laparoscopic ventral hernia repair with primary fascial closure versus bridged repair

T2 - a risk-adjusted comparative study

AU - Wennergren, John Emil

AU - Askenasy, Erik P.

AU - Greenberg, Jacob A.

AU - Holihan, Julie

AU - Keith, Jerrod

AU - Liang, Mike K.

AU - Martindale, Robert

AU - Trott, Skylar

AU - Plymale, Margaret

AU - Roth, John Scott

PY - 2015/11/17

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N2 - 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.

AB - 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.

KW - Fascial closure

KW - Hernia

KW - Laparoscopic

KW - Mesh

KW - Recurrence

KW - Seroma

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