title: Closure versus non-closure of hernia defect during laparoscopic ventral hernia repair with mesh.
abstract: OBJECTIVE
  Laparoscopic ventral hernia repair with mesh versus laparoscopic ventral hernia defect closure with mesh reinforcement. The primary end-point was recurrence.
  
  
  METHODS
  Retrospective review of patients who underwent laparoscopic ventral hernia repair for small- and medium-sized hernias between July 2000 and September 2011. These patients were divided: (1) repair with mesh alone (non-closure group) and (2) those with hernia defect closure and mesh reinforcement (closure group). The closure group was further divided by technique: percutaneous versus intracorporeal closure of the defect.
  
  
  RESULTS
  128 patients were studied: 93 patients (72.66 %) in the non-closure group and 35 patients (27.34 %) in the closure group. Follow-up was available in 105 patients (82.03 %) at a mean of 797.2 days (range 7-3,286 days). In the non-closure group there were 14 patients (15.05 %) with postoperative complications and 8 patients (22.86 %) in the closure group, four of which were seromas. Fourteen patients (19.18 %) developed recurrent hernias in the non-closure group with an average time to presentation of 23.17 months (range 5.3-75.3). Two patients (6.25 %) developed recurrent hernias in the percutaneous group with an average time to presentation of 12.95 months (range 9.57-16.33). There have been no recurrences in patients whose defect was closed intracorporeally.
  
  
  CONCLUSIONS
  Although our study demonstrated a difference in recurrence rates of 19.18 % in the non-closure group versus 6.25 % in the closure group, the difference did not reach statistical significance. A larger series with longer follow-up may demonstrate clinical significance.
authors.affiliation: Miami International Surgical Services at Jackson South Community Hospital, 9195 SW 72nd St # 230, Miami, FL, 33173, USA, mzeichen@hotmail.com.
authors.forename: M S
authors.initials: MS
authors.lastname: Zeichen
authors.forename: H J
authors.initials: HJ
authors.lastname: Lujan
authors.forename: W N
authors.initials: WN
authors.lastname: Mata
authors.forename: V H
authors.initials: VH
authors.lastname: Maciel
authors.forename: D
authors.initials: D
authors.lastname: Lee
authors.forename: I
authors.initials: I
authors.lastname: Jorge
authors.forename: G
authors.initials: G
authors.lastname: Plasencia
authors.forename: E
authors.initials: E
authors.lastname: Gomez
authors.forename: A M
authors.initials: AM
authors.lastname: Hernandez
mesh_terms: D058107:Abdominal Wound Closure Techniques / Q000009:adverse effects; D057186:Comparative Effectiveness Research; 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; D011183:Postoperative Complications / Q000145:classification / Q000209:etiology; D055502:Secondary Prevention; D012720:Severity of Illness Index; D013526:Surgical Mesh / Q000592:standards; D016896:Treatment Outcome