title: Laparoscopic ventral hernia repair with composite mesh: Analysis of risk factors for recurrence in 185 patients with 5 years follow-up.
abstract: BACKGROUND
  Laparoscopic ventral hernia repair is widely used although its clinical indications are often debated. The aim of this study is to describe our surgical experience in order to establish the safety, efficacy, feasibility of laparoscopic ventral hernia repair and to identify the factors that influence the risk of recurrence in a group of patients treated with only one type of prosthetic mesh and by the same surgical team.
  
  
  METHODS
  Between January 2007 and December 2016, 512 patients were admitted to the General and Urgent Surgery Unit, with diagnosis of ventral hernia. Of these, 244 were operated laparoscopically and 268 in a traditional open surgery. In 244 patients treated by laparoscopy we always used a composite mesh: 185 Parietex™ Composite mesh (Medtronic-Covidien, Minneapolis, USA), the remaining other with other types of prosthetic mesh. The type and size of surgical defects, features of surgical technique, length of hospital stay, rate of conversion, morbidity, mortality, and rate of recurrence at 5 years follow-up were retrospective analysed on the 185 patients who underwent surgery with Parietex™ Composite mesh.
  
  
  RESULTS
  We performed 185 laparoscopic ventral hernia repair with Parietex™ Composite mesh: 108 (58%) for incisional hernias and 77 (42%) for primary abdominal wall hernias. Mean age was 58 years (19-80). The mean size of abdominal defect was 5 cm (1,5-18), mean BMI was 30,4 kg/m2(21-47), mean overlap of the mesh was 5 cm (3-6). The mean operative time was 54 min (30-180) and conversion rate was 3,2%. In 61 patients (33%) we performed a transversus abdominis plane block (T.A.P. block) to reduce postoperative pain. The mean length of hospital stay was 5 days (1-26) (2 days, mean value, in patient with preoperative T.A.P. block). The mortality rate was 0%; overall morbidity was 15,6%. At 5-year follow-up we observed 13 (7%) hernia recurrences. The features of patients with recurrence were as follows: mean age 50 years (19-74), mean ASA Score 3 (2-3), mean BMI 31 kg/m2(21-44), mean size of hernial defect 7,5 cm (larger diameter), mean overlap 4,5 cm (3-6).
  
  
  CONCLUSIONS
  Laparoscopic repair of ventral hernia using composite mesh is an effective and safe procedure particularly suitable in the following cases: median and paramedian defects, diameter of defect between 5 and 15 cm, "swiss cheese" defects, obesity. In our experience the factors related to the patient and the surgical technique that may influence the onset of early or late recurrence as the follows: a defect size >5 cm (W2 of EHS Classification), an overlap of the mesh < 5 cm, a BMI of 30 kg/m2or superior and the presence of significant comorbidities (ASA score: 3). Finally, we observed that the T.A.P. Block preoperative procedure can lead to reduced the clinical costs through a lower administration of analgesics used and a lower length of stay.
authors.affiliation: Department of Surgery, General and Urgent Surgery Unit, Regional Hospital "U. Parini", Viale Ginevra, 3, 11100 Aosta, Italy. Electronic address: marionardijr@libero.it.
authors.forename: Mario
authors.initials: M
authors.lastname: Nardi
authors.affiliation: Department of Surgery, General and Urgent Surgery Unit, Regional Hospital "U. Parini", Viale Ginevra, 3, 11100 Aosta, Italy. Electronic address: pmillo@ausl.vda.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Millo
authors.affiliation: Department of Surgery, General and Urgent Surgery Unit, Regional Hospital "U. Parini", Viale Ginevra, 3, 11100 Aosta, Italy. Electronic address: rbrachet@ausl.vda.it.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Brachet Contul
authors.affiliation: Department of Surgery, General and Urgent Surgery Unit, Regional Hospital "U. Parini", Viale Ginevra, 3, 11100 Aosta, Italy. Electronic address: rlorusso@ausl.vda.it.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Lorusso
authors.affiliation: Department of Surgery, General and Urgent Surgery Unit, Regional Hospital "U. Parini", Viale Ginevra, 3, 11100 Aosta, Italy. Electronic address: ausai@ausl.vda.it.
authors.forename: Antonella
authors.initials: A
authors.lastname: Usai
authors.affiliation: Department of Surgery, General and Urgent Surgery Unit, Regional Hospital "U. Parini", Viale Ginevra, 3, 11100 Aosta, Italy. Electronic address: mgrivon@ausl.vda.it.
authors.forename: Manuela
authors.initials: M
authors.lastname: Grivon
authors.affiliation: Department of Surgery, General and Urgent Surgery Unit, Regional Hospital "U. Parini", Viale Ginevra, 3, 11100 Aosta, Italy. Electronic address: fpersico@ausl.vda.it.
authors.forename: Fabio
authors.initials: F
authors.lastname: Persico
authors.affiliation: Department of Surgery, General and Urgent Surgery Unit, Regional Hospital "U. Parini", Viale Ginevra, 3, 11100 Aosta, Italy. Electronic address: eponte@ausl.vda.it.
authors.forename: Elisa
authors.initials: E
authors.lastname: Ponte
authors.affiliation: Department of Surgery, General and Urgent Surgery Unit, Regional Hospital "U. Parini", Viale Ginevra, 3, 11100 Aosta, Italy. Electronic address: pbocchia@ausl.vda.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Bocchia
authors.affiliation: Department of Surgery, General and Urgent Surgery Unit, Regional Hospital "U. Parini", Viale Ginevra, 3, 11100 Aosta, Italy. Electronic address: srazzi@ausl.vda.it.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Razzi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000473:pathology* / Q000601:surgery; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D000069290:Incisional Hernia / Q000473:pathology / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013526:Surgical Mesh; D016896:Treatment Outcome; D055815:Young Adult
keywords: Composite mesh; Incisional hernia; Laparoscopy; T.A.P. block; Ventral hernia