Non-absorbable Barbed Sutures for Primary Fascial Closure in Laparoscopic Ventral Hernia Repair.

Lisandro Montorfano,Raul J Rosenthal,Stephen J Bordes,Samuel Szomstein,Roberto J Valera,Mauricio Sarmiento Cobos,Emanuele Lo Menzo,Frederico P Quirante

doi:10.7759/cureus.22523

Abstract

PurposeThe aim of this study is to describe the safety and effectiveness of laparoscopic ventral hernia repair with intraperitoneal fascial closure using a barbed suture prior to mesh placement.Materials and methodsPatients who underwent laparoscopic ventral hernia repair were included in this retrospective review. Patients were divided into two groups. In the first group, primary fascial closure was performed with a 2-polypropylene non-absorbable unidirectional barbed suture followed by fixation of the intraperitoneal mesh. In the second group, the mesh was fixed intraperitoneally using tacks without closing the fascial defect.ResultsA total of 148 patients who underwent laparoscopic primary ventral hernia repair were included. A total of 72 (48.6%) patients were included in the barbed suture with mesh group and 76 (51.4%) patients in the mesh-only group. The mean fascial defect size was 25 cm2 in the first group and 64 cm2 in the second group. The median suturing time for fascial closure was 15 minutes. The average surgery time was 98 minutes in the first group and 96 minutes in the second group. The mean follow-up period was 80 days for Group 1 and 135 days for Group 2. No hernia recurrence or mortality occurred in this study.ConclusionThe barbed suture closure technique is a fast, safe, and effective technique for fascial closure during laparoscopic ventral hernia repair in combination with mesh placement. Further evidence to support these findings and longer follow-up periods are warranted to evaluate long-term outcomes.

Highlights

Incisional hernias affect approximately 16-20% of patients undergoing laparotomy
Patients who underwent laparoscopic ventral hernia repair were included in this retrospective review
Primary fascial closure was performed with a 2polypropylene non-absorbable unidirectional barbed suture followed by fixation of the intraperitoneal mesh

Summary

Introduction

Billions of dollars are spent in the American healthcare system for incisional hernia repairs [1]. Ventral hernia repair has improved over the years. Sauerland et al reported that laparoscopic repair of abdominal wall hernias decreased wound infection rates and allowed for faster recovery [5]. Since the introduction of laparoscopic ventral hernia repair, many techniques have been described. Laparoscopic techniques are normally performed using mesh. The mesh supports the repair and reduces tension on the abdominal wall. Chowbey et al proposed an onlay technique in which a mesh is placed extraperitoneal to minimize complications, such as fistula formation and adhesions [6]. The sublay technique places the mesh below the fascia and is associated with lower recurrence rates [7]

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