title: Laparoscopic ventral hernia repair with primary fascial closure versus bridged repair: a risk-adjusted comparative study.
abstract: Laparoscopy, specifically the bridged mesh technique, is a popular means used for ventral hernia repair. While laparoscopy has decreased the incidence of surgical site infection (SSI), hernia recurrence rates remain unchanged. Some surgeons advocate laparoscopic primary fascial closure (PFC) with placement of intraperitoneal mesh to decrease recurrence rates. We hypothesize that in patients undergoing laparoscopic ventral hernia repair (LVHR), PFC compared to a bridged mesh repair decreases hernia recurrence rates.
  
  
  
  A multicenter, retrospective database of all ventral hernia repairs performed from 2010-2012 was accessed. Patients who underwent LVHR with mesh were reviewed. Patients who had PFC were compared to bridged repair. Primary outcome was hernia recurrence determined by clinical examination or CT scan. Secondary outcomes included SSI and seroma formation.
  
  
  
  A total of 1594 patients were identified. Following exclusion, a total of 196 patients were left who underwent LVHR with a mean follow-up period of 17.5 months. Ninety-seven patients underwent PFC, while 99 underwent bridged repairs. Initial comparisons between both groups was negative for any significant statistical difference in terms of recurrence, seroma formation, SSI, deep/organ space SSI, reoperation, and readmission. The same initial findings held true during subgroup analysis. Propensity score analysis was then performed for recurrence, seroma, and SSI controlling for age, gender, immune status, ASA class, BMI, smoking status, and acute repair. No statistically significant differences were identified in either group.
  
  
  
  Primary fascial closure during laparoscopic hernia repairs did not result in reduced recurrence, seroma, and SSI as compared to bridge repairs in a retrospective, multi-institutional study. However, additional research is needed to further evaluate benefits to the patient in terms of pain, function, cosmesis, and overall satisfaction. Randomized, blinded, control trials should focus on these parameters in future investigations.
authors.affiliation: Department of Surgery, University of Kentucky, C-225 Chandler Medical Center, 800 Rose Street, Lexington, KY, 40536, USA. john.wennergren@gmail.com.
authors.forename: John Emil
authors.initials: JE
authors.lastname: Wennergren
authors.affiliation: Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Erik P
authors.initials: EP
authors.lastname: Askenasy
authors.affiliation: Department of Surgery, University of Wisconsin, Madison, WI, USA.
authors.forename: Jacob A
authors.initials: JA
authors.lastname: Greenberg
authors.affiliation: Department of Surgery, University of Texas Health Science Center, San Antonio, TX, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Holihan
authors.affiliation: Department of Surgery, University of Iowa, Iowa City, IA, USA.
authors.forename: Jerrod
authors.initials: J
authors.lastname: Keith
authors.affiliation: Department of Surgery, University of Texas Health Science Center, San Antonio, TX, USA.
authors.forename: Mike K
authors.initials: MK
authors.lastname: Liang
authors.affiliation: Department of Surgery, Oregon Health Science Center, Portland, OR, USA.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Martindale
authors.affiliation: Department of Surgery, University of Kentucky, C-225 Chandler Medical Center, 800 Rose Street, Lexington, KY, 40536, USA.
authors.forename: Skylar
authors.initials: S
authors.lastname: Trott
authors.affiliation: Department of Surgery, University of Kentucky, C-225 Chandler Medical Center, 800 Rose Street, Lexington, KY, 40536, USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: Plymale
authors.affiliation: Department of Surgery, University of Kentucky, C-225 Chandler Medical Center, 800 Rose Street, Lexington, KY, 40536, USA.
authors.forename: John Scott
authors.initials: JS
authors.lastname: Roth
mesh_terms: D000328:Adult; D016208:Databases, Factual; D005205:Fascia; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012306:Risk; D049291:Seroma / Q000453:epidemiology; D013526:Surgical Mesh; D013530:Surgical Wound Infection / Q000453:epidemiology; D058106:Wound Closure Techniques
keywords: Fascial closure; Hernia; Laparoscopic; Mesh; Recurrence; Seroma