title: Randomized clinical trial of mesh fixation with "double crown" versus "sutures and tackers" in laparoscopic ventral hernia repair.
abstract: BACKGROUND
  Although laparoscopic intra-peritoneal mesh repair (LVHR) is a well-established treatment option to repair ventral and incisional hernias, no consensus in the literature can be found on the best method of fixation of the mesh to the abdominal wall.
  
  
  METHODS
  Between December 2004 and July 2008, 76 patients undergoing a LVHR were randomized between mesh fixation using a double row of spiral tackers (DC) (n = 33) and mesh fixation with transfascial sutures combined with one row of spiral tackers (S&T) (n = 43), in the WoW trial (with or without sutures). Patients were clinically examined and evaluated using a visual analog scale for pain (VAS) in rest and after coughing 4 h post-operatively, after 4 weeks and 3 months after surgery. Primary endpoint of the study was abdominal wall pain, defined as a VAS score of at least 1.0 cm, at 3 months post-operative. Quality of life was quantified with the SF-36 questionnaire preoperatively and after 3 months. Secondary endpoint was the recurrence rate at 24-month follow-up.
  
  
  RESULTS
  The DC and S&T group were comparable in age, gender, ASA score, BMI, indication, hernia, and mesh variables. The DC group had a significant shorter operating time compared with the S&T group (74 vs 96 min; p = 0.014) and a significant lower mean VAS score 4 h post-operatively (in rest; p = 0.028/coughing; p = 0.013). At 3 months, there were significant more patients in the S&T group with VAS score ≥1.0 cm (31.4 vs 8.3 %; p = 0.036). Clinical follow-up at 24 months was obtained in 63 patients (82.9 %). The recurrence rate at 24 months was 7.9 % overall (5/63). There were more recurrences in the S&T group (4/36) than in the DC group (1/27), but this difference was not significant (11.1 vs 3.7 %; p = 0.381).
  
  
  CONCLUSIONS
  We found that double-crown fixation of intra-peritoneal mesh during laparoscopic ventral hernia repair was quicker, was less painful immediately post-operative and after 3 months, and did not increase the recurrence rate at 24 months. In hernias at a distance from the bony borders of the abdomen, transfascial sutures can be omitted if a double crown of tackers is placed.
authors.affiliation: Department of Surgery, AZ Maria Middelares, Kortrijksesteenweg 1026, 9000, Ghent, Belgium, filip.muysoms@azmmsj.be.
authors.forename: F
authors.initials: F
authors.lastname: Muysoms
authors.forename: G
authors.initials: G
authors.lastname: Vander Mijnsbrugge
authors.forename: P
authors.initials: P
authors.lastname: Pletinckx
authors.forename: E
authors.initials: E
authors.lastname: Boldo
authors.forename: I
authors.initials: I
authors.lastname: Jacobs
authors.forename: M
authors.initials: M
authors.lastname: Michiels
authors.forename: R
authors.initials: R
authors.lastname: Ceulemans
mesh_terms: D058107:Abdominal Wound Closure Techniques / Q000009:adverse effects; D000328:Adult; D000368:Aged; D005260:Female; D006555:Hernia, Ventral / Q000503:physiopathology / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control / Q000523:psychology; D011788:Quality of Life; D055502:Secondary Prevention; D012720:Severity of Illness Index; D013526:Surgical Mesh; D013536:Suture Techniques; D016896:Treatment Outcome
references.citation: Surg Endosc. 2011 Mar;25(3):749-55
references.pmid: 20652715
references.citation: Hernia. 2009 Feb;13(1):13-21
references.pmid: 18670733
references.citation: Hernia. 2010 Apr;14(2):123-9
references.pmid: 20155431
references.citation: Surg Endosc. 2011 May;25(5):1431-8
references.pmid: 20976495
references.citation: Am Surg. 2003 Aug;69(8):688-91; discussion 691-2
references.pmid: 12953827
references.citation: Hernia. 2009 Apr;13(2):167-72
references.pmid: 18853228
references.citation: Cochrane Database Syst Rev. 2011 Mar 16;(3):CD007781
references.pmid: 21412910
references.citation: JSLS. 2006 Jul-Sep;10(3):345-50
references.pmid: 17212893
references.citation: Int Surg. 2005 Jul-Aug;90(3 Suppl):S56-62
references.pmid: 16463950
references.citation: Hernia. 2003 Sep;7(3):118-24
references.pmid: 12942345
references.citation: J Am Coll Surg. 2008 Apr;206(4):638-44
references.pmid: 18387468
references.citation: Acta Chir Belg. 2004 Nov-Dec;104(6):705-8
references.pmid: 15663279
references.citation: Hernia. 2009 Aug;13(4):407-14
references.pmid: 19495920
references.citation: Surg Laparosc Endosc. 1993 Feb;3(1):39-41
references.pmid: 8258069
references.citation: Hernia. 2007 Apr;11(2):199-201
references.pmid: 17119854
references.citation: J Laparoendosc Adv Surg Tech A. 2008 Jun;18(3):377-82
references.pmid: 18503370
references.citation: Surg Endosc. 2010 Jun;24(6):1296-302
references.pmid: 20033726
references.citation: J Laparoendosc Adv Surg Tech A. 2010 Nov;20(9):753-5
references.pmid: 20874415
references.citation: Ann Surg. 2003 Sep;238(3):391-9; discussion 399-400
references.pmid: 14501505
references.citation: Hernia. 2012 Apr;16(2):219-21
references.pmid: 20835907
references.citation: Hernia. 2008 Feb;12(1):23-5
references.pmid: 17668146
references.citation: Am Surg. 2011 Apr;77(4):458-65
references.pmid: 21679556
references.citation: Br J Surg. 2011 Nov;98(11):1537-45
references.pmid: 21964681
references.citation: J Laparoendosc Adv Surg Tech A. 2009 Apr;19(2):175-9
references.pmid: 19216699
references.citation: Hernia. 2008 Apr;12(2):147-51
references.pmid: 18004502
references.citation: Surg Laparosc Endosc Percutan Tech. 2007 Dec;17(6):514-6
references.pmid: 18097312
references.citation: Am Surg. 2008 Mar;74(3):227-31
references.pmid: 18376688
references.citation: Surg Endosc. 2009 Apr;23(4):825-32
references.pmid: 18813986
references.citation: Br J Surg. 2009 Aug;96(8):851-8
references.pmid: 19591158
references.citation: Hernia. 2012 Jun;16(3):321-5
references.pmid: 22169984
references.citation: Surg Endosc. 2007 Apr;21(4):508-13
references.pmid: 17287923
references.citation: Surg Endosc. 2009 Jul;23(7):1620-3
references.pmid: 19444511
references.citation: Surg Endosc. 2003 Jan;17(1):118-22
references.pmid: 12399849