Laparoscopic repair of primary and incisional ventral hernias: the differences must be acknowledged: a prospective cohort analysis of 1,088 consecutive patients

Abstract

Background: Interpretation of the outcome after laparoscopic repair (LR) of ventral hernias presented in the literature often is based on pooled data of primary ventral hernias (PVH) and incisional ventral hernias (IVH). This prospective cohort study was performed to investigate whether this pooling of data is justified.

Methods: The data of 1,088 consecutive patients who underwent LR of PVH or IVH were prospectively collected and reviewed for baseline characteristics, operative findings, and postoperative complications classified as Clavien grade 3 or higher.

Results: The PVH group consisted of 662 patients, and the IVH group comprised 426 patients. The mean Association of American Anesthesiologists classification was higher in IVH group (1.92 vs 1.68; P ≤ 0.001), as was rate of conversion to open surgery (7 vs 0.5 %; P < 0.001). The IVH group required more adhesiolysis (76 vs 0.9 %; P < 0.001), a longer procedure (73 vs 42 min; P < 0.001), and a longer hospital stay (4.53 vs 2.43 days; P < 0.001). The recurrence rate was higher in the IVH group (5.81 vs 1.37 %; P < 0.001), as was total complication rate (18.69 vs 4.55 %; P < 0.001).

Conclusions: This study showed significant differences in baseline characteristics and operative findings between patients undergoing PVH repair and those undergoing IVH repair. Continued pooling of data on LR of IVH and PVH combined, commonly found in the current literature, seems incorrect.