Laparoscopic versus open ventral hernia repairs: 5 year recurrence rates.
BACKGROUND
Current studies with 2-3 year follow-up favor laparoscopic ventral hernia repair due to lower recurrence rates, fewer wound infections, and shorter hospital stays. There is scant data in the literature for this group of patients regarding longer follow-up. This study compares the actual 5 year recurrence rates of laparoscopic versus open techniques and determines factors that may affect recurrence.


METHODS
A retrospective analysis of ventral hernia repairs at a tertiary center between January 1996 and December 2001 was performed. In this era, the method of repair often depended on which surgeon evaluated the patient. All patients were followed for a minimum of 5 years (median 7.5 years). Demographic and clinical parameters were analyzed using Kaplan-Meier analyses and the multivariate Cox proportional hazard model.


RESULTS
Of 331 patients, 119 underwent laparoscopic ventral hernia repair (LAP), 106 open hernia repair with mesh (O-M), 86 open suture repair (O-S), and 20 laparoscopic converted to open (LCO). Statistical analyses showed equal parameters among groups except defect sizes (mean +/- standard error on the mean [SEM]): LAP (9.8 +/- 1.2 cm), O-M (11.2 +/- 3.3 cm), LCO (16.6 +/- 5.4 cm) versus O-S (4.6 +/- 1.6 cm) (p < 0.02). Actual recurrence rates at 1 and 5 years were LAP (15% and 29%), O-M (11% and 28%), O-S (10% and 19%), and LCO (35% and 60%). Multivariate analysis identified larger defects to have higher recurrence rates, particularly in the O-S group (p < 0.02). With the exception of the LCO group, surgical technique did not predict recurrence, nor did body mass index, diabetes, smoking, or use of tacks versus sutures.


CONCLUSIONS
This is the first study to compare 5 year actual recurrence rates between laparoscopic and open ventral hernia repairs. Contrary to prior reports, our longer-term data indicates similar recurrence rates, except for higher rates in the laparoscopic converted to open group. Due to the continued recurrences over the period studied, longer-term follow-up is necessary to appreciate the true rate of hernia recurrence.
Department of Surgery, Cleveland Clinic, 9500 Euclid Avenue, Crile A-80, Cleveland, OH 44195, USA. nballem@hotmail.com
Naveen
N
Ballem
Rikesh
R
Parikh
Eren
E
Berber
Alan
A
Siperstein
D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000706:statistics & numerical data*; D007813:Laparotomy / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D013526:Surgical Mesh; D013530:Surgical Wound Infection / Q000453:epidemiology