title: Laparoscopic repair of primary and incisional ventral hernias: the differences must be acknowledged: a prospective cohort analysis of 1,088 consecutive patients.
abstract: BACKGROUND
  Interpretation of the outcome after laparoscopic repair (LR) of ventral hernias presented in the literature often is based on pooled data of primary ventral hernias (PVH) and incisional ventral hernias (IVH). This prospective cohort study was performed to investigate whether this pooling of data is justified.
  
  
  METHODS
  The data of 1,088 consecutive patients who underwent LR of PVH or IVH were prospectively collected and reviewed for baseline characteristics, operative findings, and postoperative complications classified as Clavien grade 3 or higher.
  
  
  RESULTS
  The PVH group consisted of 662 patients, and the IVH group comprised 426 patients. The mean Association of American Anesthesiologists classification was higher in IVH group (1.92 vs 1.68; P ≤ 0.001), as was rate of conversion to open surgery (7 vs 0.5 %; P < 0.001). The IVH group required more adhesiolysis (76 vs 0.9 %; P < 0.001), a longer procedure (73 vs 42 min; P < 0.001), and a longer hospital stay (4.53 vs 2.43 days; P < 0.001). The recurrence rate was higher in the IVH group (5.81 vs 1.37 %; P < 0.001), as was total complication rate (18.69 vs 4.55 %; P < 0.001).
  
  
  CONCLUSIONS
  This study showed significant differences in baseline characteristics and operative findings between patients undergoing PVH repair and those undergoing IVH repair. Continued pooling of data on LR of IVH and PVH combined, commonly found in the current literature, seems incorrect.
authors.affiliation: Department of Surgery, Ziekenhuis Groep Twente (ZGT) Hospital, P.O. Box 7600, 7600 SZ, Almelo, The Netherlands, vincent.stirler@gmail.com.
authors.forename: Vincent M A
authors.initials: VM
authors.lastname: Stirler
authors.forename: Ernst J P
authors.initials: EJ
authors.lastname: Schoenmaeckers
authors.forename: Robbert J
authors.initials: RJ
authors.lastname: de Haas
authors.forename: Johan T F J
authors.initials: JT
authors.lastname: Raymakers
authors.forename: Srdjan
authors.initials: S
authors.lastname: Rakic
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000209:etiology / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012008:Recurrence