Cost and Clinical Outcomes of Laparoscopic Ventral Hernia Repair Using Intraperitoneal Nonheavyweight Polypropylene Mesh

Abstract

There are a variety of different products available for laparoscopic ventral hernia repairs (LVHR), which vary widely in their costs. There are few clinical studies commenting on cost efficacy of LVHR. The objective of this study is to investigate the cost, safety, and efficacy of using intraperitoneal nonheavyweight polypropylene (PP) mesh in LVHR. Between the years 2002 and 2006, LVHR was performed in 141 consecutive patients (84 male, 57 female) using intraperitoneal PP. Using a 3-trocar technique, PP mesh was underlayed by 3 to 5 cm beyond the edges of the hernia defect and fixed to the abdominal wall with 2 rows of titanium staples. Data concerning the demographics of patients, mesh cost, operative time, length of hospital stay, and complications were collected. One hundred thirty-four patients (95%) were discharged on the day of surgery. Mean age was 58.7 years (range, 29 to 91 y). Mean operative time was 63 minutes (range, 34 to 124 min). Follow-up was achieved in 123 patients (87%) with a mean of 40 months (range, 12 to 68 mo). The average mesh size was 256.9 cm (range, 116 to 903 cm). The cost of the PP mesh was US$0.14 per cm. The average mesh cost per patient was $35.90. When compared with other meshes commonly used for LVHR, PP mesh was substantially cheaper with a cost saving of $436 per patient with proceed, $770 per patient with composix, and $931 per patient with polytetrafluoroethylene. The postoperative complications included: Wound infection n=4 (3.2%), transient partial small bowel obstruction which resolved in all cases without operative management n=3 (2.4%), port site hernia n=2 (1.6%), and seroma n=1 (0.7%). Overall recurrence rate was n=6 (4.8%). There were no conversions to an open procedure. LVHR with intraperitoneal PP results in outcomes comparable with earlier publications on LVHR but at reduced costs. These data suggest that the use of intraperitoneal PP in LVHR is safe and cost effective.