Abstract
Laparoscopic ventral hernia repair (LVHR) is a widely practiced treatment for primary (PH) and incisional (IH) hernias, with acceptable outcomes. Prevention of recurrence is crucial and still highly debated. Purpose of this study was to evaluate predictive factors of recurrence following LVHR with intraperitoneal onlay mesh with a single type of mesh for both PH and IH. A retrospective, multicentre study of data collected from patients who underwent LVHR for PH and IH with an intraperitoneal monofilament polypropylene mesh from January 2014 to December 2018 at 8 referral centers was conducted, and statistical analysis for risk factors of recurrence and post-operative outcomes was performed. A total of 1018 patients were collected, with 665 cases of IH (65.3%) and 353 of PH (34.7%). IH patients were older (p < 0.001), less frequently obese (p = 0.031), at higher ASA class (p < 0.001) and presented more frequently with large, swiss cheese type and border site defects (p < 0.001), compared to PH patients. Operative time and hospital stay were longer for IH (p < 0.001), but intraoperative and early post-operative complications and reinterventions were comparable. IH group presented at major risk of recurrence than PH (6.7% vs 0.9%, p < 0.001) and application of absorbable tacks resulted a significative predictive factor for recurrence increasing the risk by 2.94 (95% CI 1.18–7.31). LVHR with a light-weight polypropylene mesh has low intra- and post-operative complications and is appropriate for both IH and PH. Non absorbable tacks and mixed fixation system seem to be preferable to absorbable tacks alone.
Highlights
Laparoscopic ventral hernia repair (LVHR) is a widely practiced treatment for primary (PH) and incisional (IH) hernias, with acceptable outcomes
Ventral hernia repair has become routine for general surgeons around the world despite the fact that management can be extremely challenging, especially in cases of complex incisional defects
The aim of this study is to retrospectively evaluate a multicentre Italian series of patients treated with a standardized LVHR technique and a single type of prosthetic mesh, according to pathological subgroups of PH or IH, with at least 12 months follow-up
Summary
Laparoscopic ventral hernia repair (LVHR) is a widely practiced treatment for primary (PH) and incisional (IH) hernias, with acceptable outcomes. A retrospective, multicentre study of data collected from patients who underwent LVHR for PH and IH with an intraperitoneal monofilament polypropylene mesh from January 2014 to December 2018 at 8 referral centers was conducted, and statistical analysis for risk factors of recurrence and post-operative outcomes was performed. Patient selection, defect characteristics and the choice of mesh and fixation devices seem to influence surgical success and hernia recurrence risk. Most reports of LVHR available in literature include heterogeneous patient cohorts with widely different hernia characteristics, treated with different surgical approaches utilizing several types of mesh and fixation d evices[3,13]. The aim of this study is to retrospectively evaluate a multicentre Italian series of patients treated with a standardized LVHR technique and a single type of prosthetic mesh, according to pathological subgroups of PH or IH, with at least 12 months follow-up. This study reports one of the largest series of laparoscopic IPOM approach with the application of a single mesh type, and an assessment of barriers to technical success
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