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Primary fascial closure during laparoscopic ventral hernia repair does not reduce 30-day wound complications

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Abstract

Background

Laparoscopic ventral hernia repair (LVHR) is associated with decreased wound morbidity compared to open repair. It remains unclear whether primary fascial closure (PFC) offers any benefit in reducing postoperative seroma compared to bridged repair. We hypothesized that PFC would have no effect on seroma formation following LVHR.

Methods

A retrospective cohort study was performed using data from the prospectively maintained Americas Hernia Society Quality Collaborative. All patients undergoing LVHR from 2013 to 2016 were included. The primary outcome was seroma formation, diagnosed either clinically or radiographically. Secondary outcomes included surgical site infections (SSI), surgical site occurrences (SSO), and SSO requiring intervention. Patient characteristics and outcomes were compared between groups with univariate analysis using Pearson’s chi-squared or Wilcoxon tests. Multivariable logistic regression controlling for patient and hernia characteristics was then performed to investigate the independent effect of PFC on seroma formation.

Results

1280 patients were included in the study. 69% (n = 887) underwent PFC. Patients undergoing bridged repairs had slightly larger defects and were more likely to have a recurrent hernia. The overall rate of seroma formation was 10.4% (n = 133). There was no association on univariate analysis between PFC and wound complications. Similarly, on multivariable analysis, PFC had no significant effect on the risk of seroma formation (OR 0.87, 95% CI 0.58–1.31).

Conclusions

PFC does not decrease the risk of short-term wound complications. Given that prior studies have also suggested no difference in hernia recurrence, PFC does not appear to improve postoperative outcomes for patients undergoing LVHR.

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Acknowledgements

The authors would like to thank all contributing members of the AHSQC for their continued support of this quality improvement initiative.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The Americas Hernia Society Quality Collaborative is a non-profit organization that receives funding from Acelity/LifeCell, Medtronic, Intuitive Surgical, and Bard Davol.

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Authors and Affiliations

  1. Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, BX 7375 Clinical Science Center – H4, Madison, WI, 53792, USA

    Christina M. Papageorge, Luke M. Funk & Jacob A. Greenberg

  2. William S. Middleton VA, Madison, WI, USA

    Luke M. Funk

  3. Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA

    Benjamin K. Poulose & Sharon Phillips

  4. Department of Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA

    Michael J. Rosen

Authors
  1. Christina M. Papageorge
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  2. Luke M. Funk
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  3. Benjamin K. Poulose
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  4. Sharon Phillips
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  5. Michael J. Rosen
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  6. Jacob A. Greenberg
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Corresponding author

Correspondence to Christina M. Papageorge.

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Disclosures

Dr. Luke M. Funk is a consultant for GLG consulting and received a VA Career Development Award. Dr. Benjamin K. Poulose is a consultant for Ariste Medical Pfizer, is employed by the AHSQC, and has received grant money from Bard Davol. Dr. Michael J. Rosen receives salary support as the medical director for the AHSQC. Dr. Jacob A. Greenberg is a consultant for Bard Davol and Medtronic and has received payment for lectures from Medtronic and W.L. Gore. Dr. Christina M. Papageorge and Ms. Sharon Phillips have no conflicts of interest or financial ties to disclose

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Papageorge, C.M., Funk, L.M., Poulose, B.K. et al. Primary fascial closure during laparoscopic ventral hernia repair does not reduce 30-day wound complications. Surg Endosc 31, 4551–4557 (2017). https://doi.org/10.1007/s00464-017-5515-z

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  • DOI: https://doi.org/10.1007/s00464-017-5515-z

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