Primary Fascial Closure With Laparoscopic Ventral Hernia Repair: Systematic Review

Abstract

Laparoscopic ventral hernia repair (LVHR) has grown in popularity. Typically, this procedure is performed with a mesh bridge technique that results in high rates of seroma, eventration (bulging), and patient dissatisfaction. In an effort to avoid these complications, there is growing interest in the role of laparoscopic primary fascial closure with intraperitoneal mesh placement. This systematic review evaluated the outcomes of closure of the central defect during LVHR. A literature search of PubMed, Cochrane databases, and Embase was conducted using PRISMA guidelines. MINORS was used to assess the methodologic quality. Primary outcome was hernia recurrence. Secondary outcomes were surgical-site infection, seroma formation, bulging, and patient-centered items (satisfaction, chronic pain, functional status). Eleven studies were identified, eight of which were case series (level 4 data). Three comparative studies examined the difference between closure and nonclosure of the fascial defect during laparoscopic ventral incisional hernia repairs (level 3 and 4 data). These studies suggested that primary fascial closure (n = 138) compared to nonclosure (n = 255) resulted in lower recurrence rates (0-5.7 vs. 4.8-16.7 %) and seroma formation rates (5.6-11.4 vs. 4.3-27.8 %). Follow-up periods for both groups were similar (1-108 months). Only one study evaluated patient function and clinical bulging. It showed better outcomes with primary fascial closure. Closure of the central defect during LVHR resulted in less recurrence, bulging, and seroma than nonclosure. Patients with closure were more satisfied with the results and had better functional status. The quality of the data was poor, however. A randomized controlled trial to evaluate the role of closure of the central defect during LVHR is warranted.

Laparoscopic versus Hybrid Approach for Treatment of Incisional Ventral Hernia

“…Adhesiolysis lengthens the duration of operation [8] and this has been observed also in our series as average operative time in LA and HA groups were 128 and 134 min respectively. Contrary to the findings of several previous studies [13,16,26,27] , the incidence of seroma was not lower after hybrid operations. A similar result was also seen in a recent study [25] .…”

Unidirectional barbed sutures as a novel technique for laparoscopic ventral hernia repair

“…Primary closing of the defect appears increasingly to be a necessary complement in diminishing postoperative complications both short and long term [9]. A systematic review by Nguyen et al [18] comprising of 11 studies on primary closure with laparoscopic ventral repair suggested improved abdominal wall function compared to the standard bridging repair. This is based on recreating a dynamic abdominal wall with eliminating dead space.…”

Laparoscopic intra-peritoneal onlay mesh plus repair for ventral abdominal wall hernias - is there substance to the hype?

“…The extracorporeal technique consists of placing multiple stab wounds on either side of the defect to pass the suture material and take interrupted stitches [16] . This may increase the risk of suture granuloma, infection or cosmetic dissatisfaction [17] . We prefer to suture the defect intracorporeally with the knots placed extracorporeally at the two ends.…”