Should We Routinely Close the Fascial Defect in Laparoscopic Ventral and Incisional Hernia Repair?

Closure of the hernia defect during laparoscopic ventral hernia repair (LVHR) remains controversial. We aimed to analyze whether closing hernia defects impacts in postoperative morbidity and recurrence rates after LVHR. A consecutive series of patients undergoing LVHR from January 2014 to June 2017 with a minimum follow-up of 6 months were included. The sample was divided into two groups: DC, patients with fascial defect closure and NDC, patients without closure of the defect. Postoperative morbidity and recurrence rates were compared between both groups. A total of 100 patients were included, 51 had their defects closed (DC) and the remaining 49 patients had their defects not closed (NDC). There were no significant differences between groups regarding gender, age, smoking, body mass index, or preoperative American Society of Anesthesiologists. Defect area was similar in both groups (DC: 37 cm² versus 42 cm² NDC, P = .6). Patients with defect closure had significantly longer operating time (DC: 111 and NDC: 88 minutes, P < .01). Patients without defect closure showed higher rates of postoperative seroma (DC: 10% versus NDC: 18%) and bulging (DC: 4% versus NDC: 12.2%). After a mean follow-up of 24 (6-36) months, recurrence was 6% in DC and 18% in NDC (P = .07). Closure of the defect in midline hernias showed a significant reduction of the recurrence rate (DC: 2/39 [5%] versus NDC: 5/21 [24%], P = .04). Defect closure in LVHR seems to reduce postoperative morbidity and recurrence rates, especially in midline defects. Systematic closure of the hernia defect should be encouraged to improve postoperative outcomes.