Closure Versus Non-closure of Hernia Defect in Laparoscopic Ventral Hernia Repair with Mesh: a Systematic Review

Emad Aljohani

doi:10.1007/s12262-021-03203-4

Abstract

AbstractThere is a controversial premise about choosing a surgical approach in ventral hernia using laparoscopic repair. Some surgeons prefer to use mesh with closure while others prefer to use mesh without closure. This study aims to compare mainly the rate of recurrence in mesh repair with and without closure. A wide range of electronic bibliographic databases such as PubMed, Embase and Education Resources Information Center (ERIC) was searched. Based on the eligibility criteria, all studies which compared the results after hernia repair from 2010 to 2020 were incorporated. Following screening the abstracts, we ended up reviewing seven full-text articles, and data were extracted on important parameters such as demographic attributes of participants, sample size and recurrence rate of hernia. Of the total studies that were reviewed, three were randomized controlled trials (RCT’s) and four retrospective observational studies. The sample size of all included studies varied between 80 and 176. The findings appear promising for the fascial closure as it showed evidence of a significant reduction in the recurrence rate with P = 0.047 in one out of the three randomized controlled trials and in the retrospective observational studies reaching up to 16.7% recurrence reduction rate. Likewise, there is also a reduction in the bulging, surgical site infection and seroma formation with higher patient’s satisfaction and quality of life score. Primary fascial closure appears to be effective as it can decrease the rates of recurrence, seroma formation and bulging, and improve patient’s satisfaction and quality of life. Given the dearth of studies, mainly randomized controlled trials, there is a need to carry out large randomized controlled trials with enough follow-up.

Highlights

Ventral hernias are widespread and difficult-to-treat surgical ailments [1]
The sample size of all included studies varied from 80 to 176, with a similar distribution between patients who underwent a laparoscopic procedure for hernia repair utilizing mesh with and without defect closure
Medical Subject Heading (Mesh) repair with primary defect closure decreases the rate of hernia recurrence because the closure of the fascial defect permits broader lateral mesh overlap

Summary

Introduction

Ventral hernias are widespread and difficult-to-treat surgical ailments [1]. Surgical repair is performed for most symptomatic umbilical hernias and can be done by different techniques, such as using a mesh with and without closure. Many challenges have been faced by surgeons and patients in augmenting treatment regardless of the type of surgical procedure [2]. Surgeons debate the best possible treatment for managing ventral hernias. Almost all surgeons prefer to use laparoscopic procedures rather than open surgery. Surgical repair for ventral hernias is often associated with surgical wound infection and hernia recurrence [3]. Hernia repair using laparoscopic techniques has a

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