Postoperative complications as an independent risk factor for recurrence after laparoscopic ventral hernia repair: a prospective study of 417 patients with long-term follow-up.

Abstract

Laparoscopic ventral hernia repair (LVHR) has become widely used. This study evaluates outcomes of LVHR, with particular reference to complications, seromas, and long-term recurrence. A review of a prospective database of consecutive patients undergoing LVHR with intraperitoneal onlay mesh (IPOM) was performed at a single institution. Patient's characteristics, surgical procedures, and postoperative outcomes were analyzed and related to long-term recurrence. From 2005 to 2014, 417 patients underwent LVHR. Mean age and body mass index (BMI) were 54years and 31kg/m2. Mesh fixation was carried out with transfascial sutures, completed with absorbable tacks (72%), metal tacks (24%), or intraperitoneal sutures (4%). Intraoperative complications occurred in three patients. Overall morbidity included 8.25% of minor complications and 2.5% of major complications without mortality. The overall recurrence rate was 9.8%. Median time for recurrence was 15.3months (3-72) and median follow-up was 31.6months (8-119). In a multivariate analysis, previous interventions (OR 1.44; CI 1.15-1.79; p=0.01), postoperative complications (OR 2.57; CI 1.09-6.03; p=0.03), and Clavien-Dindo score >2 (OR 1.43; CI 1.031-1.876; p=0.02) appeared as independent prognostic factors of recurrence. Minor complications were associated with 14.7% of recurrence and major complications with 30% of recurrence. Emergency LVHR (6%) did not increase the rate of complications. Overall seroma rate was 18.7%, with 1.4% of persisting or complicated seroma. BMI (OR 1.05; CI 1.01-1.08; p=0.026) and vascular surgery history (OR 5.74; CI 2.11-15.58; p<0.001) were independent predictive factors for seroma. Recurrence did not appear to be related to seroma. LVHR combines the benefits of laparoscopy with those of mesh repair. Seroma formation should no longer be considered as a complication. It is spontaneously regressive in most cases. Postoperative complications and their degree of severity appear to be independent prognostic factors for recurrence, which can be limited with a standardized technique and may make IPOM-LVHR a reference procedure.