Comparative study between Primary Fascial Closure versus Non Closure in Laparoscopic ventral hernia repair with mesh

Background: Laparoscopic ventral hernia repair (LVHR) is widely acknowledged to achieve lower rates of recurrence and shorter lengths of hospital stays compared to open repair. However, the surgical community is yet to reach a consensus on the techniques used in LVHR especially regarding outcomes such as seroma formation, bulging of tissue or mesh (eventration) and hernia recurrence. Our objective was to evaluate outcomes of LVHR with mesh with primary fascial closure & LVHR with mesh, without primary fascial closure regarding the fore mentioned complication.Methods: We randomized 2 groups of patients (group A and group B), Group A underwent LVHR without fascial closure and Group B underwent LVHR with primary fascial closure. Operative time, hospital stay, hematoma, seroma, early VAS (Visual Analogue Scale) pain scoring & chronic pain were measured post operatively. Recurrence, bulging & patient satisfaction with regard to cosmosis was followed up for up to 1 year. Results: 50 patients were included, 25 patients in each group. We reported a recurrence rate of 16 % (n=4) in the Non-closure group (Group A) in comparison to a recurrence rate of 4 % (n=1) in the closure group (Group B) with a p-value 0.157 which was not statistically significant. Patient satisfaction to the cosmotic outcome (using a 10 point Likert-type scale) results were 7.04 ± 2.24 in Non- closure group vs 9.08 ± 1.15, p-value <0.001 & bulging was 40 % in Group A & 8 % in group B, p-value = 0.008, both showing statistically significant difference.Conclusions: This trial demonstrated that the modification of the classic LVHR technique to include primary fascial closure yielded better results with regard to bulging & cosmosis. Lower recurrence rates were reported but confirmation of results warrants Randomized Controlled Trials (RCTs) with larger patient enrollment & longer follow up periods.