title: Laparoscopic ventral hernia repair: does primary repair in addition to placement of mesh decrease recurrence?
abstract: BACKGROUND
  The advent of laparoscopic ventral hernia repair (LVHR) not only reduced the morbidity associated with open repair but also led to a decrease in the hernia recurrence rate. However, the rate continues to remain significant.
  
  
  METHODS
  A retrospective observational study was conducted on 193 patients who were treated with LVHR by two minimally invasive surgeons in a 24-month period. The patient population was broadly divided into two groups based on the laparoscopic repair of the fascial defect with mesh underlay, or with primary suture repair and mesh underlay (PSR + MU). Patient demographics, rates of hernia recurrence, and other associated complications were compared between the two groups. Patient variables and the clinical outcomes were analyzed with descriptive statistics and chi-square test.
  
  
  RESULTS
  One hundred ninety-three consecutive patients underwent LVHR for incisional (n = 136), umbilical (n = 44), epigastric (n = 9), and parastomal (n = 4) hernia. Hernia recurrence was documented in eight patients (4.1%). The mean follow-up period was 10.5 months (range 1-36 months). Incisional hernias accounted for all eight recurrences. The rate of recurrence in those treated with PSR + MU was 3% (two of 67 cases) in comparison with 4.8% (six of 126 patients) associated with mesh alone. The rate of recurrence in the recurrent hernia group, treated with mesh only, was 10.5% (four of 38 patients) compared with 4.8% (one of 21 patients) in the PSR + MU group.
  
  
  CONCLUSIONS
  Primary laparoscopic repair along with mesh placement for the management of ventral hernia was found to be effective in selected cases as evidenced by the low rate of recurrence when compared with conventional laparoscopic repair with mesh alone. Further retrospective and prospective studies, with larger patient enrollment, are warranted to confirm the benefit of this technique over traditional repair.
authors.affiliation: Center for Minimally Invasive Surgery, The Ohio State University Medical Center, 747 Doan Hall, 410 W 10th Avenue, Columbus, OH 43210, USA.
authors.forename: Ambar
authors.initials: A
authors.lastname: Banerjee
authors.forename: Catherine
authors.initials: C
authors.lastname: Beck
authors.forename: Vimal K
authors.initials: VK
authors.lastname: Narula
authors.forename: John
authors.initials: J
authors.lastname: Linn
authors.forename: Sabrena
authors.initials: S
authors.lastname: Noria
authors.forename: Bradley
authors.initials: B
authors.lastname: Zagol
authors.forename: Dean J
authors.initials: DJ
authors.lastname: Mikami
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D013526:Surgical Mesh; D055815:Young Adult
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