Laparoscopic Repair of Primary Ventral Hernias : a Series of 118 Consecutive Patients

Background : The aim of that study is to assess the surgical outcomes after laparoscopic repair of primary ventral hernias (PVH). Methods : The series consisted of 118 consecutive patients presenting with PVH (13 epigastric and 105 umbilical hernias) operated between 2001 and 2010 by laparoscopy. Surgical repair consisted in intraperitoneal placement of a Parietex (R) composite mesh centred on the defect with a minimum overlapping of 3 cm. The mesh was secured to the abdominal wall with a double crown of helical tacks alone or by an association of transfascial sutures and tacks. Patients' data were recorded prospectively. All patients were checked during office visit one month and one year after surgery and thereafter periodically evaluated by phone call. Results : There were 32 women and 86 men with a mean age of 53 +/- 12 years and a body mass index (BMI) of 32 +/- 5. The median width of the defect was 2 cm (range : 1-6 cm). There was no conversion to open surgery. The mean operative time was 44 +/- 18 min. and the hospital stay 2 +/- 1 days. We noted 7 (6%) postoperative complications : 6 seromas and 1 hypodermitis. One month after surgery, no umbilical skin necrosis was observed and 102 patients (84%) considered the cosmetic result as excellent. With a mean follow-up of 66 +/- 37 months, no complication related to the use of the mesh was recorded and the recurrence rate was 3% (4/118). Predictive factors of recurrence were : BMI >= 35 (14% (4/29), p < 0.001), mesh overlapping < 5 cm (20% (3/15), p < 0.002) and mesh fixation by tacks alone (8% (4/48), p < 0.05). Conclusion : Laparoscopic PVH repair is associated with very low morbidity, excellent cosmetic result and a recurrence rate of 3%. Improvement in surgical repair technique with systematic use of transfascial sutures and mesh overlapping >= 5 cm should decrease the recurrence rate especially in obese patients.