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Lap vs Open Ventral Hernia Repair:Experience and Evidence
Archana Ramaswamy MD
Surgery, Gynecology &
Obstetrics, March 1993
• 298 patients evaluated after primary hernia repair
• 36% recurred• 45% in first year, 78% by third year
• Increased recurrence rate if previous repairs• 2nd repair = 56%, • 3rd repair = 48%• 4th repair = 47%
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5
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% r
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12 mos 24 mos 36 mos 48 mos 60 mos
Risks Factors for Hernia Recurrence
Risks Factors for Hernia Recurrence
Size Recurrence rate
< 4 cm 25%> 4 cm 41%
p = 0.01
Surgery, Gynecology &
Obstetrics, March 1993
Open Repair of Ventral Herniasprimary suture repair
Suture Repair vs Mesh RepairRandomized Trial
• Hernias primary or 1st recurrence– ≤6 cm defect
• N=200 patients randomized• Suture repair
– running prolene– 1 cm bites
• Mesh repair – – 2-4 cm overlap– No transfixing sutures – Continuous suture to posterior
fascia• Mean follow up 26 months
August 10, 2000
Suture Repair vs Mesh RepairRandomized Trial
August 10, 2000
3 yr recurrence rate:
43% primary repair23% mesh repair
p = 0.005
Open Hernia RepairMesh vs Suture
• Compared only RCTs• 7 trials compared• Pooled recurrence data
– Suture repair recurrence 33.3%– Mesh repair 16.4%
Open Ventral Hernia Technique of mesh placement
• Retrospective study– 53 total patients, 3 different hospitals– Mean age 60.4– 25 women, 28 men– Unable to close fascia primarily– Each hospital performed a different technique utilizing monofilament
(heavyweight) polypropylene mesh– Mesh Overlaps of 2 cm (onlay, underlay)– 30 month average follow-up
Open Ventral Hernia Technique of mesh placement
Type of repair Number Early complications
Recurrence (%)
Onlay 13 17 3 (5.6)
Inlay 23 3 10 (18.9)
Underlay 17 2 2 (3.8)
Total 53 22 15 (28.3)
Open Ventral Hernia Technique of mesh placement
Open Ventral Hernia
Open technique # patients Mos. Follow-up
Recurrence rate
primary 1678 47 647 (39%)
Inlay 29 73 14 (48%)
Onlay 347 46 49 (14%)
Underlay (extraperitoneal) 849 50 68 (8%)
Underlay (intraperitoneal) 352 29 16 (4.5%)
• 850 consecutive cases– Follow up: 20.2 months– Laparoscopic completion: 96%– OR time: 120 mins– Blood loss: 49 ml– Hospital stay: 2.3 days– Complications: 13.2%
• Prolonged ileus: 3.0%• Prolonged seroma: 2.6%• Visceral injury: 1.7%• Mesh infection: 0.7%
– Recurrence: 4.7%
LVH outcomesCase Series
LVH outcomesCase Series
• Wound and mesh complications
LVH outcomesCase Series
• Recurrence rates
Laparoscopic vs Open Ventral Hernia Repair
Goodney, Birkmeyer, Birkmeyer. Arch Surg, 2002
LVH outcomesMeta-analysis
• Included 8 studies with comparative groups– Open repair: various techniques– Lap repair: no strict definition– 700 patients total
LVH outcomesMeta-analysis
• Perioperative complications
Goodney, Birkmeyer, Birkmeyer. Arch Surg, 2002
LVH outcomesMeta-analysis
• Operative time
Goodney, Birkmeyer, Birkmeyer. Arch Surg, 2002
LVH outcomesMeta-analysis
• Hospital stay
Goodney, Birkmeyer, Birkmeyer. Arch Surg, 2002
