Fixation devices in laparoscopic ventral hernia repair: a review

In laparoscopic ventral hernia repair a mesh is inserted and anchored intraperitoneally to the abdominal wall. Currently, a variety of fixation methods are being used. As a primary goal the ideal fixation method should contribute to preventing recurrences. It should also be associated with less pain, and should prevent adhesion formation, mesh migration, and shrinkage but without contributing to infection, fistula, or seroma. In this review we evaluate the evidence for using each type of available fixation device. A systematic search of the literature, including human as well as animal studies, identified 17 different fixation methods. Their role with regard to effect on major end-points in laparoscopic ventral hernia repair including postoperative pain, infection, seroma formation, adhesions, fixation strength, strength of ingrowth, shrinkage, bowel fistulas, and hernia recurrence, is described in detail. No gold standard exists currently. The vast majority of published results are based on uncontrolled series with short or incomplete follow-up. In this review only three randomized controlled trials were identified.