Prospective Analysis and Technical Recommendations for Repair of Small Ventral/Umbilical Hernias Using the Ventralex Hernia Patch

Abstract

Background: Mesh reinforcement of small ventral/umbilical hernias has become increasingly popular over the last decade. The Ventralex TM hernia patch has been evaluated for this purpose in a small number of studies with equivocal results, particularly in relation to post-operative hernia recurrence and mesh-related complications. The aim of this study was to examine the short- and long-term clinical outcomes of the technique, and to address the possible limiting factors. Methods: Open mesh repair following strict surgical methodology was performed on 100 consecutive patients with small ventral/ umbilical hernia defects of 1-3cm in diameter between April 2007 and December 2012. Short-term clinical outcome was obtained at 2- and 6-week post-operative visits, and long-term results were assessed by telephone interview with subsequent clinical review if judged necessary. Immediate post-operative complications, hernia recurrence, pain and Quality-of-Life (QoL) were also evaluated. Results: There were no major short-term complications; minor complications including superficial wound infection and haemoserous wound discharge occurred in 9 patients (9%). The mean long-term follow-up was 37.9 months (range 6-75 months), with no hernia recurrences. No pain or mild pain was reported in 93.6% of patients, and 96.1% reported being satisfied or very satisfied with their repair. Conclusions: This study demonstrates that open repair of small ventral/umbilical hernias using the Ventralex TM patch can be extremely safe and effective, with excellent long-term clinical outcome, when following a meticulous but easily reproducible surgical technique. Those main clinical steps include avoidance of large-sized patches, placing the mesh extraperitoneally (sublay) wherever possible, fixing the positioning straps with minimum tension, and always closing the abdominal fascia defect in front of the hernia patch.