Barbed suture vs preperitoneal ventral patch in medium size ventral hernia repair: a randomised control trial

Abstract Introduction: Aim To compare preperitoneal ventral mesh patch with barbed suture in ventral hernia repair, evaluating recurrence rates and complications, and to assess the safety and efficacy of standardised preperitoneal patch placement. Methods In this randomised controlled trial, 205 adult patients undergoing ventral hernia repair were randomised 1:1 to either a ventral mesh patch repair group (n=103) or a 2.0 non-absorbable barbed suture repair group (n=102), blinded to patients and outcome assessors. Primary outcome was recurrence one year after surgery. Pain, nausea, and surgical site events were assessed on four occasions up to one year. Results 205 patients were randomised to ventral mesh patch repair (n=103) or barbed suture repair (n=102). Hernia recurrence at one year was lower in the ventral patch group (1.9% vs. 5.9%), though not statistically significant (p=0.14). Surgical site infection rate at one month was significantly less in the ventral patch group (0.9% vs. 6.9%; p=0.02). At one month, the ventral patch group had higher "Pain right now" scores on the VHPQ (p=0.02), this difference had disappeared by one year. Discussion Conclusion: Preperitoneal ventral hernia patch repair is a safe and effective technique that results in a lower recurrence rate (though not statistically significant) than barbed suture. While postoperative pain scores at one month were higher in the patch group, this difference had disappeared by one year.