Safety and effectiveness of self-adhesive mesh in laparoscopic ventral hernia repair using transabdominal preperitoneal route.

BACKGROUND

Laparoscopic ventral or incisional hernia repair requires intraperitoneal mesh placement. This is associated with an increase in adhesions, bowel obstruction and enterocutaneous fistula. Intraabdominal meshes are laparoscopically fixed using traumatic fixation methods that increase acute, chronic pain and adhesions to bowel loops. The aim was to check the safety and effectiveness of the laparoscopic approach in ventral or incisional hernia, using a self-adhesive mesh in the preperitoneal space without tacks or transfascial sutures, and to objectively assess its benefits and complications.

METHODS

Patients aged between 18 and 67 years old with medial, lateral ventral and incisional hernias between 3 and 8 cm in size were included in this study. Fifty patients were included in the study, which was conducted between January 2013 and March 2015.

RESULTS

The average length of surgery was 57.3 ± 18 min. The average hospital stay was 1.1 ± 0.3 days. The average time taken to return to work was 9.2 ± 2.4 days. The most common post-operative complication was seroma, which was observed in 13 patients (26 %). The average follow-up was 15.4 ± 5.5 months. Three patients were lost to follow-up during this period. There was no hernia recurrence during examination nor on CT scan during the follow-up period. The average score on the visual analogue scale before surgery was 4 ± 1. After surgery, the score was as follows: 3 ± 0.8 on the first day after surgery, 0.9 ± 0.5 after the first week, 0.4 ± 0.4 after the first month and 0 after 90 days. No patient showed chronic pain. Overall satisfaction (VAS for surgery) was 8.3 ± 0.6.

CONCLUSIONS

The use of self-adhesive meshes during the laparoscopic transabdominal preperitoneal approach in small- and medium-sized ventral or incisional hernias is safe and effective, with low post-operative pain, quick functional recovery and high overall satisfaction after surgery with no increase in recurrence in the short term.