Postoperative complications as an independent risk factor for recurrence after laparoscopic ventral hernia repair: a prospective study of 417 patients ... View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2016-08-05

AUTHORS

Henry Mercoli, Stylianos Tzedakis, Antonio D’Urso, Marius Nedelcu, Riccardo Memeo, Nicolas Meyer, Michel Vix, Silvana Perretta, Didier Mutter

ABSTRACT

BackgroundLaparoscopic ventral hernia repair (LVHR) has become widely used. This study evaluates outcomes of LVHR, with particular reference to complications, seromas, and long-term recurrence.MethodsA review of a prospective database of consecutive patients undergoing LVHR with intraperitoneal onlay mesh (IPOM) was performed at a single institution. Patient’s characteristics, surgical procedures, and postoperative outcomes were analyzed and related to long-term recurrence.ResultsFrom 2005 to 2014, 417 patients underwent LVHR. Mean age and body mass index (BMI) were 54 years and 31 kg/m2. Mesh fixation was carried out with transfascial sutures, completed with absorbable tacks (72 %), metal tacks (24 %), or intraperitoneal sutures (4 %). Intraoperative complications occurred in three patients. Overall morbidity included 8.25 % of minor complications and 2.5 % of major complications without mortality. The overall recurrence rate was 9.8 %. Median time for recurrence was 15.3 months (3–72) and median follow-up was 31.6 months (8–119). In a multivariate analysis, previous interventions (OR 1.44; CI 1.15–1.79; p = 0.01), postoperative complications (OR 2.57; CI 1.09–6.03; p = 0.03), and Clavien–Dindo score >2 (OR 1.43; CI 1.031–1.876; p = 0.02) appeared as independent prognostic factors of recurrence. Minor complications were associated with 14.7 % of recurrence and major complications with 30 % of recurrence. Emergency LVHR (6 %) did not increase the rate of complications. Overall seroma rate was 18.7 %, with 1.4 % of persisting or complicated seroma. BMI (OR 1.05; CI 1.01–1.08; p = 0.026) and vascular surgery history (OR 5.74; CI 2.11–15.58; p < 0.001) were independent predictive factors for seroma. Recurrence did not appear to be related to seroma.ConclusionLVHR combines the benefits of laparoscopy with those of mesh repair. Seroma formation should no longer be considered as a complication. It is spontaneously regressive in most cases. Postoperative complications and their degree of severity appear to be independent prognostic factors for recurrence, which can be limited with a standardized technique and may make IPOM–LVHR a reference procedure. More... »

PAGES

1469-1477

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  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s00464-016-5140-2

    DOI

    http://dx.doi.org/10.1007/s00464-016-5140-2

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1041053713

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/27495336


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    57 schema:description BackgroundLaparoscopic ventral hernia repair (LVHR) has become widely used. This study evaluates outcomes of LVHR, with particular reference to complications, seromas, and long-term recurrence.MethodsA review of a prospective database of consecutive patients undergoing LVHR with intraperitoneal onlay mesh (IPOM) was performed at a single institution. Patient’s characteristics, surgical procedures, and postoperative outcomes were analyzed and related to long-term recurrence.ResultsFrom 2005 to 2014, 417 patients underwent LVHR. Mean age and body mass index (BMI) were 54 years and 31 kg/m2. Mesh fixation was carried out with transfascial sutures, completed with absorbable tacks (72 %), metal tacks (24 %), or intraperitoneal sutures (4 %). Intraoperative complications occurred in three patients. Overall morbidity included 8.25 % of minor complications and 2.5 % of major complications without mortality. The overall recurrence rate was 9.8 %. Median time for recurrence was 15.3 months (3–72) and median follow-up was 31.6 months (8–119). In a multivariate analysis, previous interventions (OR 1.44; CI 1.15–1.79; p = 0.01), postoperative complications (OR 2.57; CI 1.09–6.03; p = 0.03), and Clavien–Dindo score >2 (OR 1.43; CI 1.031–1.876; p = 0.02) appeared as independent prognostic factors of recurrence. Minor complications were associated with 14.7 % of recurrence and major complications with 30 % of recurrence. Emergency LVHR (6 %) did not increase the rate of complications. Overall seroma rate was 18.7 %, with 1.4 % of persisting or complicated seroma. BMI (OR 1.05; CI 1.01–1.08; p = 0.026) and vascular surgery history (OR 5.74; CI 2.11–15.58; p < 0.001) were independent predictive factors for seroma. Recurrence did not appear to be related to seroma.ConclusionLVHR combines the benefits of laparoscopy with those of mesh repair. Seroma formation should no longer be considered as a complication. It is spontaneously regressive in most cases. Postoperative complications and their degree of severity appear to be independent prognostic factors for recurrence, which can be limited with a standardized technique and may make IPOM–LVHR a reference procedure.
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