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Updated: Mar 30, 2026
Application of a New Mesh Fixation Method in Laparoscopic Incisional Hernia Repair
Published on: December 23, 2022
Laparoscopic ventral hernia repair with primary fascial closure versus bridged repair: a risk-adjusted comparative
John Emil Wennergren1, Erik P Askenasy2, Jacob A Greenberg3
1Department of Surgery, University of Kentucky, C-225 Chandler Medical Center, 800 Rose Street, Lexington, KY, 40536, USA. john.wennergren@gmail.com.
Background:
Laparoscopy, specifically the bridged mesh technique, is a popular means used for ventral hernia repair. While laparoscopy has decreased the incidence of surgical site infection (SSI), hernia recurrence rates remain unchanged. Some surgeons advocate laparoscopic primary fascial closure (PFC) with placement of intraperitoneal mesh to decrease recurrence rates. We hypothesize that in patients undergoing laparoscopic ventral hernia repair (LVHR), PFC compared to a bridged mesh repair decreases hernia recurrence rates.
Methods:
A multicenter, retrospective database of all ventral hernia repairs performed from 2010-2012 was accessed. Patients who underwent LVHR with mesh were reviewed. Patients who had PFC were compared to bridged repair. Primary outcome was hernia recurrence determined by clinical examination or CT scan. Secondary outcomes included SSI and seroma formation.
Results:
A total of 1594 patients were identified. Following exclusion, a total of 196 patients were left who underwent LVHR with a mean follow-up period of 17.5 months. Ninety-seven patients underwent PFC, while 99 underwent bridged repairs. Initial comparisons between both groups was negative for any significant statistical difference in terms of recurrence, seroma formation, SSI, deep/organ space SSI, reoperation, and readmission. The same initial findings held true during subgroup analysis. Propensity score analysis was then performed for recurrence, seroma, and SSI controlling for age, gender, immune status, ASA class, BMI, smoking status, and acute repair. No statistically significant differences were identified in either group.
Conclusion:
Primary fascial closure during laparoscopic hernia repairs did not result in reduced recurrence, seroma, and SSI as compared to bridge repairs in a retrospective, multi-institutional study. However, additional research is needed to further evaluate benefits to the patient in terms of pain, function, cosmesis, and overall satisfaction. Randomized, blinded, control trials should focus on these parameters in future investigations.
Insights
Primary fascial closure (PFC) in laparoscopic ventral hernia repair (LVHR) did not reduce recurrence or surgical site infections compared to bridged mesh repair. Further research is needed to assess patient outcomes like pain and satisfaction.
Area of Science:
- General Surgery
- Minimally Invasive Surgery
Background:
- Laparoscopic ventral hernia repair (LVHR) is common, with bridged mesh techniques widely used.
- While laparoscopy reduces surgical site infections (SSI), hernia recurrence rates remain a concern.
- Primary fascial closure (PFC) is proposed to decrease recurrence in LVHR.
Purpose of the Study:
- To test the hypothesis that laparoscopic primary fascial closure (PFC) decreases hernia recurrence rates compared to bridged mesh repair in LVHR patients.
- To compare recurrence, surgical site infection (SSI), and seroma formation between PFC and bridged repair groups.
Main Methods:
- A retrospective analysis of 1594 patients undergoing LVHR with mesh from 2010-2012.
- Comparison of 97 patients with PFC versus 99 patients with bridged repairs.
- Propensity score analysis controlled for multiple patient and surgical factors.
Main Results:
- No significant statistical differences were found between PFC and bridged repair groups for recurrence, seroma, SSI, reoperation, or readmission.
- Subgroup analysis and propensity score analysis confirmed these findings.
- Mean follow-up was 17.5 months.
Conclusions:
- PFC during LVHR did not reduce recurrence, seroma, or SSI compared to bridge repairs in this multi-institutional study.
- Further research, including randomized controlled trials, is needed to evaluate patient-reported outcomes such as pain, function, and cosmesis.
