title: Primary fascial closure during laparoscopic ventral hernia repair does not reduce 30-day wound complications.
abstract: Laparoscopic ventral hernia repair (LVHR) is associated with decreased wound morbidity compared to open repair. It remains unclear whether primary fascial closure (PFC) offers any benefit in reducing postoperative seroma compared to bridged repair. We hypothesized that PFC would have no effect on seroma formation following LVHR.
  
  
  
  A retrospective cohort study was performed using data from the prospectively maintained Americas Hernia Society Quality Collaborative. All patients undergoing LVHR from 2013 to 2016 were included. The primary outcome was seroma formation, diagnosed either clinically or radiographically. Secondary outcomes included surgical site infections (SSI), surgical site occurrences (SSO), and SSO requiring intervention. Patient characteristics and outcomes were compared between groups with univariate analysis using Pearson's chi-squared or Wilcoxon tests. Multivariable logistic regression controlling for patient and hernia characteristics was then performed to investigate the independent effect of PFC on seroma formation.
  
  
  
  1280 patients were included in the study. 69% (n = 887) underwent PFC. Patients undergoing bridged repairs had slightly larger defects and were more likely to have a recurrent hernia. The overall rate of seroma formation was 10.4% (n = 133). There was no association on univariate analysis between PFC and wound complications. Similarly, on multivariable analysis, PFC had no significant effect on the risk of seroma formation (OR 0.87, 95% CI 0.58-1.31).
  
  
  
  PFC does not decrease the risk of short-term wound complications. Given that prior studies have also suggested no difference in hernia recurrence, PFC does not appear to improve postoperative outcomes for patients undergoing LVHR.
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, BX 7375 Clinical Science Center - H4, Madison, WI, 53792, USA. cpapageorge@uwhealth.org.
authors.forename: Christina M
authors.initials: CM
authors.lastname: Papageorge
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, BX 7375 Clinical Science Center - H4, Madison, WI, 53792, USA.|William S. Middleton VA, Madison, WI, USA.
authors.forename: Luke M
authors.initials: LM
authors.lastname: Funk
authors.affiliation: Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Benjamin K
authors.initials: BK
authors.lastname: Poulose
authors.affiliation: Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Phillips
authors.affiliation: Department of Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rosen
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, BX 7375 Clinical Science Center - H4, Madison, WI, 53792, USA.
authors.forename: Jacob A
authors.initials: JA
authors.lastname: Greenberg
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016208:Databases, Factual; D005205:Fascia; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies; D049291:Seroma / Q000453:epidemiology* / Q000209:etiology; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology; D016896:Treatment Outcome
keywords: Bridged repair; Laparoscopic ventral hernia repair; Primary fascial closure; Seroma; Ventral hernia; Wound complications