Assessment of predictive factors for recurrence in laparoscopic ventral hernia repair using a bridging technique.

Abstract

To assess the long-term incidence and predictive factors for recurrence after laparoscopic ventral hernia repair using a bridging technique. The study group consisted of 213 consecutive patients operated by laparoscopy for primary ventral (n=158) or incisional hernia (n=55) between 2001 and 2014. Patients had a repair without fascia closure by intra-peritoneal onlay placement of a Parietex® composite mesh centred on the defect with an overlap of at least 3cm. Clinical outcome was assessed by a combination of office consultation, patient's electronic medical file review and telephone interview. There were 144 men and 69 women with a mean age of 55±12years and a BMI of 32±6. With a mean follow-up of 69±44months, a recurrent hernia was noted in 16 patients (7.5%). Univariate analysis showed a statistically significant higher recurrence rate in the following conditions: incisional hernia (15%), BMI≥35 (21%), defect width >4cm (27%), defect area >20cm2 (27%), mesh overlap <5cm (32%) and ratio of mesh area to defect area (M/D ratio) ≤12 (48%). Multivariate logistic analysis revealed that M/D ratio was the only independent predictive factor for recurrence (coefficient -0.79, OR 0.46, p<0.002). With a M/D ratio ≤8, between 9 and 12, between 13 and 16, and ≥17, the recurrence rate was, respectively, 70, 35, 9 and 0% (p<0.001). In laparoscopic repair of ventral hernia using a bridging technique, an overlap of at least 5cm is not all that is required to prevent hernia recurrence. The M/D ratio is the most important predictive factor for recurrence. A ratio of 13 appears as the threshold under which that technique cannot be recommended and 16 as the threshold over which the risk of recurrence is virtually nil. If a satisfactory M/D ratio cannot be achieved, other surgical repair should be proposed to the patient.