title: Is the outcome of laparoscopic incisional hernia repair affected by defect size? A prospective study.
abstract: BACKGROUND
  This study was performed to determine if defect size after laparoscopic incisional hernia repair is predictive of recurrence during the long-term follow-up evaluation.
  
  
  METHODS
  We performed a prospective clinical study on 310 patients who underwent laparoscopic incisional hernia repair to identify predictable risk factors for hernia recurrence. Univariate and multivariate Cox regression analysis were used. The defect size was analyzed with curve receiver operating characteristic curve.
  
  
  RESULTS
  The overall recurrence rate was 6% after an average follow-up period of 60 months. On univariate analysis of the defect size (categories: <10 cm, 10-12 cm, and >15 cm), obesity, previous repairs, hernia location, surgical time, hospital stay, morbidity, and recurrences were significantly different (P < .001). By multivariate analysis, only obesity and defect size were independent prognostic factors (P < .001).
  
  
  CONCLUSIONS
  The predictive value of defect size is shown. Patients with large defects have a higher risk of recurrence. Our study recommends reserving the laparoscopic technique for hernias not exceeding 10 cm in size, where it can be put to better use.
authors.affiliation: Abdominal Wall Unit, Department of Surgery, J.M. Morales Meseguer Hospital, Avda. Primo de Rivera 7, 5°D (Edf. Berlín), 30008 Murcia, Spain. moreno-egea@ono.com
authors.forename: Alfredo
authors.initials: A
authors.lastname: Moreno-Egea
authors.forename: Andres
authors.initials: A
authors.lastname: Carrillo-Alcaraz
authors.forename: J L
authors.initials: JL
authors.lastname: Aguayo-Albasini
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D005260:Female; D046449:Hernia, Abdominal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D012008:Recurrence; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016896:Treatment Outcome