Laparoscopic repair of incisional and ventral hernias with the new type of meshes: randomized control trial.

Abstract

IntroductionLaparoscopic incisional and ventral hernia repair (LIVHR) was first reported by Le Blanc and Booth in 1993. Many studies are available in the literature that have shown that laparoscopic repair of incisional and ventral hernia is preferred over open repair because of lower recurrence rates (less than 10%), less wound morbidity, less pain, and early return to work.AimTo identify the long-term outcomes between the different types of meshes and two techniques of mesh fixation, i.e., tacks (method Double crown) and transfascial polypropylene sutures.Material and methodsA total of 92 patients underwent LIVHR at our department between January 2009 and August 2012. The hernias were umbilical in 26 patients, paraumbilical in 15 patients and incisional in 51 patients. All patients admitted for LIVHR were randomized to either group I (tacker fixation of ePTFE meshes) or group II (suture fixation of meshes with nitinol frame) using computer-generated random numbers with block randomization and sealed envelopes for concealed allocation.ResultsThe mean mesh fixation time was significantly higher in the tacker fixation group (117 ±15 min vs. 72 ±6 min, p < 0.01). There were no conversions in either group. The median postoperative hospital stay was 3.5 ±1.5 days. All patients were followed up at 1, 3, 6, 12 and every 6 months thereafter postoperatively. There were 5 recurrences in the study population. In group I there were 4 patients with recurrence, and only 1 patient in the group with meshes with a nitinol frame.ConclusionsMeshes of the new generation with a nitinol framework can significantly improve laparoscopic ventral hernia repair. The fixation of these meshes is very simple using 3–4 transfascial sutures. The absence of shrinkage of these meshes makes the probability of recurrence minimal. Absence of tackers allows postoperative pain to be minimized. We consider that these new meshes can significantly improve laparoscopic ventral hernia repair.

Systematic review and network meta-analysis of methods of mesh fixation during laparoscopic ventral hernia repair

“…All studies used a minimum mesh overlap of 3–5 cm. Thirty studies reported the percentage of patients at last follow‐up, with a median of 98 (range 76–100) per cent. Follow‐up was given as either a mean or median value, with an overall median of 22 (range 6–64) months.…”

“…There was an unclear risk of attrition bias in three studies as they did not describe patients lost to follow‐up. The risk of funding bias was unclear in two studies that did not describe the source of funding, and high in five studies that were funded by industry. The remaining three studies reported no funding from industry and had a low risk of funding bias.…”

“…All studies used a minimum mesh overlap of 3-5 cm. Thirty studies 17 -26,30,34,37,42-44,46-48,51-53,55-60,64,66 reported the Bansal et al 17 2 19 Grubnik et al 22 Total Total events Heterogeneity: τ 2 = 0·00; χ 2 = 0·77, 2 d.f., P = 0·68; I 2 = 0% Test for overall effect: Z = 1·50, P = 0·13 The risk of bias in the RCTs was in generally low, except for detection bias ( Table 2). In the assessment of detection bias, most of the outcome assessors could not be blinded, because it was possible to identify the fixation technique by the skin marks left from placing the transfascial sutures.…”

“…There was in general a low risk of bias in the cohort studies, except that 21 27 -29,31-33,35,37-41,45,49,50,54,61-63,65,67 of 41 had less than 90 per cent follow-up or did not account adequately for the lost subjects. Besides that, there were three 36,40,41 studies with a selected group that was not rep- Table 4 Risk ratios for recurrence in studies included in the network meta-analysis Christoffersen et al 51 Absorbable tacks Permanent tacks 1⋅37 (1⋅04, 1⋅81) Beldi et al 19 Sutures Permanent tacks 0⋅89 (0⋅06, 13⋅08) Eriksen et al 21 Fibrin Permanent tacks 5⋅00 (0⋅64, 38⋅87) Grubnik et al 22 Sutures Permanent tacks 0⋅22 (0⋅03, 1⋅89) Bansal et al 17 Sutures Permanent tacks and sutures 0⋅20 (0⋅01, 4⋅15)* Muysoms et al 24 Permanent tacks and sutures Permanent tacks 3⋅00 (0⋅36, 25⋅34)…”

“…Three RCTs 17,19,22 that compared permanent tacks with sutures were included in a conventional meta-analysis (Fig. 2).…”