title: Proper mesh overlap is a key determinant in hernia recurrence following laparoscopic ventral and incisional hernia repair.
abstract: BACKGROUND
  Ventral hernia can be repaired through either an open or laparoscopic approach. A major problem following hernia repair is recurrence, and the technique used for hernia repair influences the rate of hernia recurrence. Data from individual studies show that the area of mesh overlap used during hernia repair correlates with hernia recurrence, but no meta-analyses have previously been published. The aim of this review was to perform a meta-analysis to determine if the area of mesh overlap correlates with the rate of hernia recurrence after ventral and incisional hernia repair.
  
  
  METHODS
  Studies from 1990 to 2013 that used a mesh in open or laparoscopic procedures, and that reported both the area of mesh overlap beyond the fascial defect and the recurrence rate, were assessed for inclusion in the final analysis. A pooled estimation of combined overall risk was calculated according to a random effect model.
  
  
  RESULTS
  A total of 95 articles, with 111 study populations, met all criteria and were included in the final analysis. For open procedures, results showed no correlation between the pooled estimation of risk for recurrence of ventral hernia and area of mesh overlap used for hernia repair (<3 cm, incidence rate 0.065; 3-5 cm, incidence rate 0.070; >5 cm, incidence rate 0.060). In laparoscopic procedures, the pooled estimation of risk for recurrence of hernia decreased with increasing area of mesh overlap (<3 cm, incidence rate 0.086; 3-5 cm, incidence rate 0.046; >5 cm, incidence rate 0.014).
  
  
  CONCLUSIONS
  Risk of hernia recurrence decreases with increasing area of mesh overlap in laparoscopic, but not open, procedures for ventral hernia repair.
authors.affiliation: Our Lady of the Lake Physician Group, 7777 Hennessy Blvd. Suite 612, Baton Rouge, LA, 70808, USA. karl.leblanc@ololrmc.com.
authors.forename: K
authors.initials: K
authors.lastname: LeBlanc
mesh_terms: D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D000069290:Incisional Hernia / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D012008:Recurrence; D013526:Surgical Mesh / Q000009:adverse effects
keywords: Hernia repair; Laparoscopic; Mesh; Overlap; Recurrence