The pros and cons of suturing the ventral hernia defect using the intraperitoneal onlay mesh technique

Background/Aim. Laparoscopic ventral hernia surgery, including intraperitoneal onlay mesh (IPOM), is as effective and safe as open surgery, with a lower recurrence rate. Some surgeons advocate laparoscopic primary fascial closure (PFC) with intraperitoneal mesh placement to reduce recurrence rates. The aim of this study was to compare the treatment outcome between two laparo- o- scopic techniques: the PFC technique and mesh placement without suture closure (IPOM technique) for defects under 4 cm in patients with ventral hernias. Methods. The study sample was comprised of 50 patients who underwent laparoscopic ventral hernia surgery from January 1, 2018, until December 31, 2020. Half of the patients underwent only the IPOM technique (group of patients without the suture), while in others, this was preceded by the closure of the hernial ring (group of p a- tients with the suture). All hernias were midline and all defects were under 4 cm. The studied groups were h o- mogeneous according to gender and age. Comorbidities, complications, and postoperative comfort were moni- i- tored. Results. The most common (76%) hernias were primary, and the most common comorbidity was arterial hypertension (28%). One (2%) patient had intraopera- a- tive bleeding, and the most common postoperative complication was pain in 7 (14%) patients. After a threeyear follow-up, there were 10 (20%) patients with complications - one hernia recurred, while 9 (18%) patients died. There was no difference in the types of occurrence of hernias, comorbidities, and intraoperative complica- a- tions. The distribution of postoperative complications differed significantly (p p = 0.007) between the groups. Pain was statistically significantly more prevalent in p a- tients with sutures. During the first three months postoperatively, significantly more patients with sutures had chronic pain (chi 2 2 = 8.140; p = 0.004). Conclusion. We recommend the application of the PFC technique in selected ventral hernia repair cases, although it can lead to more frequent postoperative pain (which, fortunately, is easily treated).