Open Suture Repair Research Articles

Open suture repair versus PermacolTM mesh repair of small ventral hernias in patients with end-stage kidney disease.

Ventral hernia is a common surgical problem among patients with end-stage kidney disease (ESKD), while the optimal repair technique for small ventral hernias is controversial. This study aimed to compare the outcomes of open suture repair versus biological mesh repair of small ventral hernias with defect size ≤2 cm in ESKD patients. Data from consecutive ESKD patients who underwent elective ventral hernia repair with defect size ≤2 cm at a single institution from January 2012 to January 2022 were retrospectively reviewed. Outcomes of open suture repair were compared to PermacolTM mesh repair. The primary outcome was recurrence rate. Secondary outcomes included post-operative complications, peri-operative and post-operative dialysis regimen. Forty-seven ventral hernia repairs were included, with 20 being suture repairs and 27 being PermacolTM mesh repairs. Median age at hernia repair was 60 (range 32-81) years old. Pre-operatively, 42 patients (89.4%) were on peritoneal dialysis (PD). Paraumbilical hernia (59.6%) was most common. Median hernia defect size was 15 mm (range 2-20 mm). Upon median follow-up of 56 (range 9-119) months, more patients in the suture repair group developed recurrence (30% vs. 0%, p = 0.004). Median time to recurrence was 10 (range 5-16) months. There was no wound or mesh infection. The majority of patients underwent intermittent PD peri-operatively and were able to resume on PD in the long run. Ventral hernia repair is indicated in ESKD patients even for small defects; repair with PermacolTM mesh was associated with a lower recurrence rate when compared to suture repair and post-operative morbidity was low.

Suture versus open mesh repair for small umbilical hernia: Results of a propensity-matched cohort study

BackgroundThe objective was to compare the outcomes of open mesh repair versus suture repair for small (≤1 cm in diameter) umbilical hernia. The primary endpoint was the 30-day outcomes including pain, and secondary endpoints were the 2-year outcomes including recurrences and patient-reported outcomes. MethodsThis propensity-matched, multicenter study was carried out on data collected prospectively in the Hernia-Club database between 2011 and 2021. A total of 590 mesh repairs and 590 suture repairs were propensity score matched (age, sex, body mass index) at a ratio of 1:1. Postoperative pain was assessed using the Verbal Rating Scale-4 and 0‒10 Numerical Rating Scale-11. ResultsMesh insertion was intraperitoneal in 331 patients (56.1%), extraperitoneal in 249 (42.2%), and onlay in 10 (1.7%). The rate of 30-day complications and Numerical Rating Scale-11 pain scores on postoperative days 8 and 30 were similar between the groups, including surgical site occurrences (2.2 vs 1.4% after suture repair). At 1 month, postoperative discomfort (sensation of something different from before) was significantly (P < .0001) more frequent after mesh repair, whereas the rate of relevant (moderate or severe) pain (mesh repair: 1.1% vs suture repair: 2.6%) and the distribution of Numerical Rating Scale-11 scores did not differ between the groups. At the 2-year follow-up, mesh repair patients had fewer reoperated recurrences (0.2% vs 1.7%; P = .035) and no more pain or discomfort than suture repair patients. ConclusionBoth techniques are effective and safe. Mesh repair is likely to reduce the rate of recurrences. Concerns about postoperative pain and infection might not prevent the use of mesh in smallest umbilical hernias.

Obstructed femoral hernia with an associated De Garengeot hernia

A De Garengeot hernia is the eponymous name to describe a femoral hernia containing the appendix. Imaging may confirm the diagnosis pre-operatively; however, many are identified at the time of surgery. We describe the case of an elderley female patient who presented with a small bowel obtruction due to an incarcerated femoral hernia, with the unexpected finding at the time of surgery of the appendix additionally within the hernia. Following diagnostic laparoscopy, she underwent a laparoscopic appendicectomy and open suture repair of the femoral hernia.

Surgical strategies for recurrent parastomal hernia after a primary repair with a Dynamesh® IPST mesh.

To introduce our surgical strategies for recurrent parastomal hernia after a primary repair with a Dynamesh® IPST mesh. Ten patients who underwent recurrent parastomal hernia repair with previous Dynamesh® IPST mesh use were analyzed retrospectively. Distinct surgery strategies were applied. Accordingly, we investigated the recurrence rate and postoperative complications in these patients, who were followed for an average of 35.9months after surgery. There was no recorded death and no readmission during the 30-day postoperative period. And the lap-re-do Sugarbaker group had no recurrence, whereas the open suture group had one recurrence (16.7%). One patient in the Sugarbaker group developed ileus and recovered conservatively during the follow-up period. There were no other complications, including seroma, mesh infection and bulging, or prolonged postoperative pain. We offer two predominant surgery strategies for recurrent parastomal hernia with a previous Dynamesh® IPST mesh usage, the open suture repair, and the Lap-re-do Sugarbaker repair. Even though the results of the Lap-re-do Sugarbaker repair are satisfactory, we recommend the open suture technique as it is safer in a setting of dense adhesions in recurrent parastomal hernias.

BJS-02 LONG-TERM REOPERATION RATE FOLLOWING PRIMARY VENTRAL HERNIA REPAIR: A REGISTER-BASED STUDY

Abstract Aim The aim of this study was to analyse the risk for reoperation following primary ventral hernia repair. Methods The study was based on umbilical hernia and epigastric hernia repairs registered in the population-based Swedish National Patient Register (NPR) 2010–2019. Reoperation was defined as repeat repair after primary repair. Results Altogether 30,253 umbilical hernia repairs and 7407 epigastric hernia repairs were identified. There were 624 reoperations registered following primary umbilical repair and 137 following primary epigastric repairs. In multivariable Cox proportional hazard analysis, the hazard ratio (HR) for reoperation was 0.284 (95% confidence interval (CI) 0.106–0.760) after open onlay mesh repair, 0.476 (CI 0.359–0.629) after open interstitial mesh repair, 0.368 (CI 0.230–0.590) after open sublay mesh repair, 0.446 (CI 0.167–1.194) after open intraperitoneal onlay mesh repair, 0.931 (CI 0.639–1.357) after laparoscopic repair, and 0.939 (CI 0.502–1.757) after other (unknown) techniques, when compared to open suture repair as reference method. Following umbilical hernia repair, the risk for reoperation was also significantly higher for patients aged ≤49 years (HR 1.669, CI 1.391–2.002), for women (HR 1.390, CI 1.178–1.641), and for patients with liver cirrhosis (HR 2.546, CI 1.050–6.174). For patients undergoing epigastric hernia repair, the only significant risk factor for reoperation was age ≤49 years (HR 2.079, CI 1.380–3.134). Conclusions All types of open mesh repair were associated with lower reoperation rates than open suture repair and laparoscopic repair. Female sex, young age and liver cirrhosis were risk factors for reoperation due to hernia recurrence, regardless of method.

Long-term reoperation rate following primary ventral hernia repair: a register-based study

BackgroundThe aim of this study was to analyse the risk for reoperation following primary ventral hernia repair.MethodsThe study was based on umbilical hernia and epigastric hernia repairs registered in the population-based Swedish National Patient Register (NPR) 2010–2019. Reoperation was defined as repeat repair after primary repair.ResultsAltogether 29,360 umbilical hernia repairs and 6514 epigastric hernia repairs were identified. There were 624 reoperations registered following primary umbilical repair and 137 following primary epigastric repairs. In multivariable Cox proportional hazard analysis, the hazard ratio (HR) for reoperation was 0.292 (95% confidence interval (CI) 0.109–0.782) after open onlay mesh repair, 0.484 (CI 0.366–0.641) after open interstitial mesh repair, 0.382 (CI 0.238–0.613) after open sublay mesh repair, 0.453 (CI 0.169–1.212) after open intraperitoneal onlay mesh repair, 1.004 (CI 0.688–1.464) after laparoscopic repair, and 0.940 (CI 0.502–1.759) after other techniques, when compared to open suture repair as reference method. Following umbilical hernia repair, the risk for reoperation was also significantly higher for patients aged < 50 years (HR 1.669, CI 1.389–2.005), for women (HR 1.401, CI 1.186–1.655), and for patients with liver cirrhosis (HR 2.544, CI 1.049–6.170). For patients undergoing epigastric hernia repair, the only significant risk factor for reoperation was age < 50 years (HR 2.046, CI 1.337–3.130).ConclusionsAll types of open mesh repair were associated with lower reoperation rates than open suture repair and laparoscopic repair. Female sex, young age and liver cirrhosis were risk factors for reoperation due to hernia recurrence, regardless of method.

Microfragmented Adipose Tissue (M-FATS) for Improved Healing of Surgically Repaired Achilles Tendon Tears: A Preliminary Study.

Tendon healing is a complicated process that results in inferior structural and functional properties when compared with healthy tendon; the purpose of this study was to assess the effects of the adjunct of microfragmented adipose tissue (M-FATS) after the suture of a series of Achilles tendons. After complete Achilles tendon tear, 8 patients underwent open suture repair in conjunction with perilesional application of a preparation of M-FATS rich in mesenchymal stem cells. Results were compared with a similar group of patients treated with conventional open suture. Outcomes were evaluated based on range of motion, functional recovery, and complications according to the American Orthopedic Foot and Ankle Society (AOFAS) score and Foot and Ankle Disability Index (FADI). Achilles tendons were examined by ultrasound (US) at 3 months. The AOFAS and FADI scores showed no differences between the 2 groups. US evaluation showed quicker tendon remodeling in the M-FATS group. Adverse events were not documented for both procedures. The combined application of derived M-FATS for tendon rupture is safe and presents new possibilities for enhanced healing. Level IIIb: Case control study.

Assessment of potential influencing factors on the outcome in small (< 2cm) umbilical hernia repair: a registry-based multivariable analysis of 31,965 patients.

How best to treat a small (< 2cm) umbilical hernia continues to be the subject of controversial debate. The recently published guidelines for treatment of umbilical hernias from the European Hernia Society and Americas Hernia Society recommend open mesh repair for defects ≥ 1cm. Since the quality of evidence is limited for hernias with defect sizes smaller than 1cm, suture repair can be considered. To date, little is known about the potential influencing factors on the outcome in small (< 2cm) umbilical hernia repair. This multivariable analysis of data from the Herniamed Registry now aims to assess these factors. The data of patients with primary elective umbilical hernia repair and defect size < 2cm entered into the Herniamed Registry from September 1, 2009 to December 31, 2018 were analyzed to assess through multivariable analysis all confirmatory pre-defined potential influencing factors on the primary outcome criteria intraoperative and postoperative complications, general complications, complication-related reoperations, recurrence rate and rates of pain at rest, pain on exertion and chronic pain requiring treatment at 1-year follow-up. 31,965 patients (60%) met the inclusion criteria. The proportion of suture repairs was 78.6% (n = 25,119), of open mesh repairs 15.2% (n = 4853), and of laparoscopic mesh repairs 6.2% (n = 1993). Compared with open mesh repair, suture repair had a highly significantly unfavorable association with the recurrence rate (OR = 1.956 [1.463; 2.614]; p < 0.001). Female gender also had an unfavorable relation to the recurrence rate (OR = 1.644 [1.385; 1.952]; p < 0.001). Compared with open mesh repair, open suture repair had a highly significantly favorable association with the rate of postoperative complications (OR = 0.583 [0.484; 0.702]; p < 0.001) and complication-related reoperations (OR = 0.567 [0.397; 0.810]; p = 0.002).While laparoscopic IPOM showed a favorable relationship with the postoperative complications and complication-related reoperations, it demonstrated an unfavorable association with the intraoperative complications, general complications, recurrence rate and pain rates. Suture repair continues to be used for 78% of umbilical hernias with a defect < 2cm. While suture repair has a favorable influence on the rates of postoperative complications and complication-related reoperations, it has a higher risk of recurrence. Female gender also has an unfavorable influence on the recurrence rate. Laparoscopic IPOM appears to be indicated only in settings of obesity (BMI ≥ 30).

Mesh versus suture in elective repair of umbilical hernia: systematic review and meta-analysis.

BackgroundMesh repair of umbilical hernia has been associated with a reduced recurrence rate compared with suture closure, but potentially at the expense of increased postoperative complications and chronic pain. The objective of this systematic review and meta‐analysis was to examine the outcomes after elective open mesh and suture repair for umbilical hernia in adults.MethodsA literature search was conducted to identify studies presenting original data on elective open mesh and suture repair of umbilical hernia. The primary outcome was hernia recurrence. Secondary outcomes included surgical‐site infection (SSI), seroma, haematoma and chronic pain. Meta‐analyses were undertaken.ResultsThe search resulted in 5353 hits and led to 14 studies being included (6 RCTs and 8 observational studies) describing a total of 2361 patients. Compared with suture, mesh repair was associated with a lower risk of recurrence (risk ratio (RR) 0·48, 95 per cent c.i. 0·30 to 0·77), with number needed to treat 19 (95 per cent c.i. 14 to 31). Mesh repair was associated with a higher risk of seroma (RR 2·37, 1·45 to 3·87), with number needed to harm 30 (17 to 86). There was no significant difference in the risk of SSI, haematoma or chronic pain.ConclusionThe use of mesh in elective repair of umbilical hernia reduced the risk of recurrence compared with suture closure without altering the risk of chronic pain.

Assessment of perioperative outcome in primary unilateral inguinal hernia: A comparative study

Background: An inguinal hernia is a protrusion of abdominal-cavity contents through the inguinal canal. Various technique available to repair of inguinal Hernia: Open suture repair, Open mesh repair and Laparoscopic hernia repair (TEP/TAPP). In this study comparison was done between laparoscopic procedure Transabdominal pre-peritoneal repair (TAPP) and totally extraperitoneal repair (TEP). Materials & methods: The study compared the result of two laproscopic hernioplasties in 50 cases divided in two groups. 25 cases in TEP group and 25 cases in TAPP group admitted in department of surgery, Govt. medical college and Rajindra hospital, Patiala. The evaluation and comparison was done in term of operative time, postoperative pain, Recurrence, cost effectiveness, and technical adaptation of surgery. Results: Difference in duration of surgery, cost effectiveness and technical adaptation in TEP and TAPP was not statistically significant. On observation post operative complication was more associate with TAPP than TEP. In case of hospital stay and time to return to usual activity no statistical difference present between TEP and TAPP. Pain was analysed by vast scale when pain was compared at the end of one month, it was inferred that number of patients in TEP more than TAPP have pain and p value was 0.6836 which was not significant. Conclusion: Higher incidence of postoperative complications is associated with TAPP in comparison to TEP. However; there was no difference in hospital stay, cost effectiveness, and technical adaptively.

A retrospective cohort study of open preperitoneal repair versus open suture repair for the treatment of emergency femoral hernia

To compare the outcomes of open preperitoneal repair (OPR) with the use of mesh and open suture repair (OSR) without mesh via inguinal approach for the treatment of emergency femoral hernia (FH). The primary outcome was the postoperative complication and the secondary outcomes were the recurrence rate of FH and the postoperative comfort level at the surgical site. 104 patients with emergency FHs were included, of whom 51 patients were treated with OPR, 53 patients were treated with OSR. Between the two groups, no significant difference was found in surgical site infection (SSI) (P = 0.801) or seroma (P = 0.843), while there was significant difference in the improvement of comfort at the surgical site (P = 0.013). The results of the 2-year follow-up demonstrated 1 and 8 cases of recurrence in the OPR and OSR group respectively, which was statistically significant (HR, 8.193 [95% CI, 1.024 to 65.547], P = 0.047). Compared with OSR, OPR with the use of mesh did not increase the risk of SSI and was safe to apply even under the condition of an emergency FH operation with intestine resection; OPR could reduce the recurrence rate of FH and improve the comfort at the surgical site.

A comparative study of various techniques of incisional hernia repair in a tertiary care center at Bikaner (North-West Rajasthan)

Background: Incisional hernia can be defined as an internal abdominal wall defect that develops after a previously closed laparotomy. Aim of present study was to compare open suture repair and mesh repair (onlay and sublay), various factors predisposing to incisional hernia and evaluate complications following surgery for incisional hernias.Methods: A prospective study was conducted in 60 cases of incisional hernia admitted in Department of General Surgery, PBM Hospital Bikaner between October 2017 to September 2018. 20 cases were selected in each group (open anatomical repair, onlay mesh repair and sublay mesh repair). All cases were followed up for 6 months postoperatively.Results: Incisional hernia was found to occur more often in 41-60 years age group (61.67%) and in females. Wound infection (46.67%) after index surgery was most important risk factor followed by obesity. LSCS (30%) was found to be most common index surgery followed by hysterectomy (28.33%). Seroma was most common postoperative complication (5% patient in anatomical repair group, 30% patients in onlay group and 10% patients in sublay group).Only one recurrence (5%) was observed in anatomical repair group over a period of 6 months follow up.Conclusions: Sublay mesh repair is superior to onlay mesh repair and Anatomical suture repair regarding recurrence rate. Local postoperative complications like seroma formation or wound infection were more common in mesh repair surgery than anatomical repair. Among mesh repair these complications were higher in onlay group than sublay repair.

Randomized clinical trial of open suture repairversustotally extraperitoneal repair for treatment of sportsman's hernia

Sportsman's hernia/athletic pubalgia is a recognized cause of chronic groin pain in athletes. Both open and laparoscopic surgical repairs have been described for treatment, but there are no comparative studies. The hypothesis here was that relief of pain would be achieved earlier in patients treated with open minimal suture repair than totally extraperitoneal repair. A randomized multicentre trial in four European countries was conducted to compare open minimal suture repair with totally extraperitoneal repair. The primary endpoint was complete relief of pain (visual analogue scale (VAS) score 20 or less on a scale from 0 to 100 mm) at 1 month. Secondary endpoints included complications, time to return to sporting activity, and number of patients returning to sport within 1 year. A total of 65 athletes (92 per cent men) with a median age of 29 years were enrolled (31 open repair, 34 totally extraperitoneal repair). By 4 weeks after surgery, median preoperative VAS scores had dropped from 70-80 to 10-20 in both groups (P < 0·001). Relief of pain (VAS score 20 or less) during sports activity 4 weeks after surgery was achieved in 14 of 31 patients after open repair and 24 of 34 after totally extraperitoneal repair (P = 0·047). Return to full sporting activity was achieved by 16 and 18 patients respectively after 1 month (P = 0·992), and by 25 versus 31 after 3 months (P = 0·408). Totally extraperitoneal repair was less painful than open repair in the first month, but otherwise both procedures were similarly effective in treating chronic pain due to sportsman's hernia. Registration number: NCT02297711 ( http://www.clinical.trials.gov).

Arthroscopic All-Inside Repair of Medial Meniscus Grade 2 Horizontal Cleavage Tear Using Additional Posteromedial Portal

Management of intrasubstance horizontal cleavage meniscal lesions of microtraumatic origin remains poorly defined in young patients. For grade 2 lesions resistant to conservative measures, the standard technique is debridement of the intrasubstance tear and open suture repair via a posteromedial approach. The objective of this Technical Note is to propose an arthroscopic alternative to this open technique, using an arthroscopic additional posteromedial portal. This technique facilitates an approach to the lesion via its peripheral portion without creating an iatrogenic lesion of the free edge of the meniscus, which is located in the white zone and thus exhibits limited vascularity.

Factors Indicative of Recurrence Paraumbilical Hernia: Experience at a Tertiary Care Hospital in Dhaka City

Background: Paraumbilical hernia has gained little attention from surgeons in comparison with other types of abdominal wall hernias (inguinal, postoperative); however, the primary suture for paraumbilical hernia is associated with a recurrence rate of 19.0 to 54.0%.Objective: The aim of this study was to analyze the results of the paraumbilical hernia repair and to assess the independent risk factors influencing paraumbilical hernia recurrence.Methodology: A retrospective analysis of patients who underwent surgery for paraumbilical hernia in the department of surgery, Dhaka Medical College Hospital from 2012 to 2015 was performed. Age, sex, hospital stay, hernia size, patient’s body mass index, and postoperative complications were analyzed. Postoperative evaluation included pain and discomfort in the abdomen and hernia recurrence rate. Hernia recurrence was diagnosed during the patients’ visit to a surgeon. Two surgical methods were used to repair paraumbilical hernia: open suture repair technique (keel technique) and open mesh repair technique (onlay technique). Every operation was chosen individually by the surgeon.Results: Ninety-seven patients (31 males and 66 females) with paraumbilical hernia were examined. The rate of postoperative complications was 5.2%. The complete patient’s recovery time after surgery was 2.4±3.4 months. Fourteen patients (20.9%) complained of pain or discomfort in the abdomen, and 7(10.4%) patients had ligature fistula after the surgery. Forty-five patients (67.2%) did not have any complaints after surgery. The recurrence rate after paraumbilical hernia repair was 8.9%. The recurrence rate was higher when hernia size was &gt;2cm (9% for &lt;2 cm vs 10.5% for &gt;2 cm) and patient’s BMI was &gt;30 kg/m2 (8.6% for &lt;30 vs 10.7% for &gt;30).Conclusion: In conclusion significant independent risk factors are found for paraumbilical hernia recurrence.Journal of Current and Advance Medical Research 2018;5(1):11-14

Approach to hernial defect in laparoscopic incisional hernia repair

Background: Ventral hernias are the second most common type of abdominal hernias and account for approximately 10% of all hernias. Recurrence rates after open suture repair have been reported to be as high as 31% to 49%. Laparoscopic ventral hernia repair (LVHR) has been reported to have reduced recurrence rates as compared to open mesh repair, reduced infection rate, shorter recovery time and hospital stay. During LVHR, closure of the hernial defect is a contentious issue. Author describe our observations with the closure of hernial defect in LVHR in comparison to non-closure of defects in relation to seroma, pain, ileus, and recurrence.Methods: An observational study of closure versus non-closure of hernial defect in laparoscopic ventral hernia mesh repair was conducted in 81 patients from March 2016 to March 2017. Ventral hernia repair with mesh was done without closure of defect in 32 cases as compared to 49 cases in which closure of defect was done.Results: Seroma, pain, ileus and recurrence incidence are less in closure of defect in comparison to non-closure of defect in present study.Conclusions: With increasing experience, different theories and techniques have been described by different surgeons to overcome the intra operative and postoperative problems. During LVHR, closure of the hernial defect is a contentious issue. Closure of defect in the experience decreases rate of seroma formation. Closure of defect induce more post-operative pain but may be superior with regard to other important surgical outcomes. Duration of follow up is inadequate to conclude about incidence of recurrence in present study.

Evidence-based Lichtenstein technique

Lichtenstein hernioplasty is the number one technique worldwide for open, mesh-based inguinal hernia repair. The principle of Lichtenstein hernioplasty is the tension-free reinforcement of the abdominal wall by covering the transversalis fascia and the oblique muscles with an artificial patch of mesh. The Lichtenstein technique has been modified since its inception. The technique has the benefits of low costs and a rapid learning curve and can be performed with the patient under local anesthesia. The recurrence rates after the Lichtenstein operation are significantly lower compared to open suture repair and equal to laparoendoscopic techniques. Compared to laparoendoscopic techniques the Lichtenstein operation is associated with less severe visceral lesions but more early postoperative and chronic pain; however, the chronic pain rates in long-term follow-up studies are comparable.

Incisional Hernias: Risk Factors and Treatment in a Context of Limited Resources

Background: The purpose of this study was to describe the etiologic factors and therapeutic modalities of incisional hernias in the department of surgery at the regional hospital of Tenkodogo, in Burkina Faso. Methods: It is a cross sectional study covering the period from 2010 to 2012. Sampling was comprehensive, including all the patients operated for incisional hernias during this period. Results: Fifty-four patients were included. Their average age was 22.3 years. There were 35 (64.8%) males and 19 (35.2%) female patients. We counted 28 large-size incisional hernias, 14 medium-size incisional hernias and 12 incisional hernias of small size. The average time from the first surgery to the diagnosis of incisional hernias was 8 months. Generalized acute peritonitis (44.4%) and acute intestinal obstructions (22.2%) were the main indications of initial surgical interventions. Vertical midline incisions have been involved in 37 cases (68.5%). Therapeutically, two surgical techniques have been used: open suture repair and open mesh repair. Forty-two patients (77.8%) were treated by open suture repair. Twelve patients (22.2%) benefited from open mesh repair. Post-operative complications were noted in 2 patients. Nine patients (16.7%) presented a recurrence after 12 months. Conclusion: In the rural area of Burkina Faso, incisional hernias occur in young patients. Emergencies with abdominal Infections are the main operative indications. Prostheses are relatively high cost and less accessible. The recidivism rate is high.

Comparison of Laparoscopic Primary and Open Primary Repair of Ventral Hernias

Prosthetic materials have gained popularity for ventral hernia repair. There are situations when the use of a mesh is either unnecessary or contraindicated. This study compares 51 patients with ventral hernia who underwent laparoscopic or open primary suture repair. Results were determined by a median follow-up of 33 months. Recurrence rates and operative time were the major parameters of outcome. Mean operative time was insignificantly shorter in the laparoscopic group (14.8 ± 4.3 vs. 15.6 ± 3.7 min). There were no short-term complications in groups. One patient in each group had recurrence. Conclusively, laparoscopic primary repair of small ventral hernias is simple and can be performed as an initial approach for small defects. Compared with open repair, it has the advantages of better exposure, reduced pain, and less morbidity. It can also be performed as a component of a combined laparoscopic operation. However, this technique is not recommended for repair of large ventral hernias.

VENTRAL INCISIONAL HERNIAS

Ventral Incisional Hernias are a well known complication after abdominal surgery with a reported incidence of 10% - 20% and a recurrence rate of 30% - 50% after open suture repair and less than 10% after open mesh repair. Objectives: To compare the outcome of two different methods of open repair of VIH (i.e. Mesh versus Non-mesh or Suture Repair in terms of morbidity, complications and recurrence. Period: 11 years period (January 2000 – December 2010). Setting: Shaikh Zayed Hospital, Lahore. Patients &amp; Methods: The total number of patients who underwent surgery for repair of VIH during the study period was 321.There were only 33 patients in Group A (simple suture/Keel repair) while Group B had 288 patients. The most common early postoperative complications seen in both the groups were wound seroma and infection. Post-operative respiratory insufficiency was more common in the obese. Chronic pain and feeling of foreign body was more frequently seen in the mesh group. On the other hand, recurrence rates were far greater in the suture repair group. The overall mortality in the whole series was 3 patients (0.93%). Conclusions: The rates of ventral incisional hernia recurrence and complications are significantly lower after open onlay mesh repair as compared to the open suture repair. However, these results require confirmation by prospective randomized clinical trials which should also include the results of laparoscopic ventral incisional hernia repair which is a new and emerging technique in Pakistan.