title: Recurrence rate after absorbable tack fixation of mesh in laparoscopic incisional hernia repair.
abstract: BACKGROUND
  The mesh fixation technique in laparoscopic incisional hernia repair may influence the rates of hernia recurrence and chronic pain. This study investigated the long-term risk of recurrence and chronic pain in patients undergoing laparoscopic incisional hernia repair with either absorbable or non-absorbable tacks for mesh fixation.
  
  
  METHODS
  This was a nationwide consecutive cohort study based on data collected prospectively concerning perioperative information and clinical follow-up. Patients undergoing primary, elective, laparoscopic incisional hernia repair with absorbable or non-absorbable tack fixation during a 4-year interval were included. Follow-up was by a structured questionnaire regarding recurrence and chronic pain, supplemented by clinical examination, and CT when indicated. Recurrence was defined as either reoperation for recurrence or clinical/radiological recurrence.
  
  
  RESULTS
  Of 1037 eligible patients, 84·9 per cent responded to the questionnaire, and 816 were included for analysis. The median observation time for the cohort was 40 (range 0-72) months. The cumulative recurrence-free survival rate was 71·5 and 82·0 per cent after absorbable and non-absorbable tack fixation respectively (P = 0·007). In multivariable analysis, the use of absorbable tacks was an independent risk factor for recurrence (hazard ratio 1·53, 95 per cent c.i. 1·11 to 2·09; P = 0·008). The rate of moderate or severe chronic pain was 15·3 and 16·1 per cent after absorbable and non-absorbable tack fixation respectively (P = 0·765).
  
  
  CONCLUSIONS
  Absorbable tack fixation of the mesh was associated with a higher risk of recurrence than non-absorbable tacks for laparoscopic mesh repair of incisional hernia, but did not influence chronic pain.
authors.affiliation: Gastro Unit, Surgical Division, Hvidovre Hospital, Copenhagen, Denmark.
authors.forename: M W
authors.initials: MW
authors.lastname: Christoffersen
authors.forename: E
authors.initials: E
authors.lastname: Brandt
authors.forename: F
authors.initials: F
authors.lastname: Helgstrand
authors.forename: M
authors.initials: M
authors.lastname: Westen
authors.forename: J
authors.initials: J
authors.lastname: Rosenberg
authors.forename: H
authors.initials: H
authors.lastname: Kehlet
authors.forename: P
authors.initials: P
authors.lastname: Strandfelt
authors.forename: T
authors.initials: T
authors.lastname: Bisgaard
mesh_terms: D020341:Absorbable Implants; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059350:Chronic Pain / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation* / Q000379:methods; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D013525:Surgical Instruments; D013526:Surgical Mesh; D055815:Young Adult