title: Assessment of predictive factors for recurrence in laparoscopic ventral hernia repair using a bridging technique.
abstract: To assess the long-term incidence and predictive factors for recurrence after laparoscopic ventral hernia repair using a bridging technique.
  
  
  
  The study group consisted of 213 consecutive patients operated by laparoscopy for primary ventral (n = 158) or incisional hernia (n = 55) between 2001 and 2014. Patients had a repair without fascia closure by intra-peritoneal onlay placement of a Parietex®composite mesh centred on the defect with an overlap of at least 3 cm. Clinical outcome was assessed by a combination of office consultation, patient's electronic medical file review and telephone interview.
  
  
  
  There were 144 men and 69 women with a mean age of 55 ± 12 years and a BMI of 32 ± 6. With a mean follow-up of 69 ± 44 months, a recurrent hernia was noted in 16 patients (7.5%). Univariate analysis showed a statistically significant higher recurrence rate in the following conditions: incisional hernia (15%), BMI ≥ 35 (21%), defect width >4 cm (27%), defect area >20 cm2(27%), mesh overlap <5 cm (32%) and ratio of mesh area to defect area (M/D ratio) ≤12 (48%). Multivariate logistic analysis revealed that M/D ratio was the only independent predictive factor for recurrence (coefficient -0.79, OR 0.46, p < 0.002). With a M/D ratio ≤8, between 9 and 12, between 13 and 16, and ≥17, the recurrence rate was, respectively, 70, 35, 9 and 0% (p < 0.001).
  
  
  
  In laparoscopic repair of ventral hernia using a bridging technique, an overlap of at least 5 cm is not all that is required to prevent hernia recurrence. The M/D ratio is the most important predictive factor for recurrence. A ratio of 13 appears as the threshold under which that technique cannot be recommended and 16 as the threshold over which the risk of recurrence is virtually nil. If a satisfactory M/D ratio cannot be achieved, other surgical repair should be proposed to the patient.
authors.affiliation: Department of Surgery, CH wapi, 9 Avenue Delmée, 7500, Tournai, Belgium. ph.hauters@bipweb.be.
authors.forename: P
authors.initials: P
authors.lastname: Hauters
authors.affiliation: Department of Surgery, CH wapi, 9 Avenue Delmée, 7500, Tournai, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Desmet
authors.affiliation: Department of Surgery, CH wapi, 9 Avenue Delmée, 7500, Tournai, Belgium.
authors.forename: D
authors.initials: D
authors.lastname: Gherardi
authors.affiliation: Department of Surgery, CH wapi, 9 Avenue Delmée, 7500, Tournai, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: Dewaele
authors.affiliation: Department of Surgery, CH wapi, 9 Avenue Delmée, 7500, Tournai, Belgium.
authors.forename: H
authors.initials: H
authors.lastname: Poilvache
authors.affiliation: Department of Surgery, CH wapi, 9 Avenue Delmée, 7500, Tournai, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Malvaux
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D000069290:Incisional Hernia / Q000601:surgery*; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013526:Surgical Mesh; D016896:Treatment Outcome
keywords: Bridging technique; Laparoscopic ventral hernia repair; Mesh/defect area ratio; Predictive factors; Recurrence rate