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Postoperative complications as an independent risk factor for recurrence after laparoscopic ventral hernia repair: a prospective study of 417 patients with long-term follow-up

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Abstract

Background

Laparoscopic ventral hernia repair (LVHR) has become widely used. This study evaluates outcomes of LVHR, with particular reference to complications, seromas, and long-term recurrence.

Methods

A 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.

Results

From 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.

Conclusion

LVHR 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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Acknowledgments

The authors are grateful to Guy Temporal for his proofreading assistance.

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Authors and Affiliations

  1. Digestive and Endocrine Surgery Department, Nouvel Hôpital Civil, Strasbourg University Hospital, Institut de Recherche contre les Cancers de l’Appareil Digestif (IRCAD), Institute of Image-Guided Surgery (IHU Mix-Surg), 1 place de l’Hôpital, 67000, Strasbourg, France

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

  2. Biostatistics and Public Health Department, Hôpital Civil, Strasbourg University Hospital, Strasbourg, France

    Nicolas Meyer

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  1. Henry Mercoli
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Correspondence to Didier Mutter.

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Henry Mercoli, Stylianos Tzedakis, Antonio D’Urso, Marius Nedelcu, Riccardo Memeo, Nicolas Meyer, Michel Vix, Silvana Perretta, Didier Mutter declare no financial conflicts of interest or conflicts of any other type in relation to the content of this article.

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Mercoli, H., Tzedakis, S., D’Urso, A. et al. Postoperative complications as an independent risk factor for recurrence after laparoscopic ventral hernia repair: a prospective study of 417 patients with long-term follow-up. Surg Endosc 31, 1469–1477 (2017). https://doi.org/10.1007/s00464-016-5140-2

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