Fascial Defect Should Be Closed During Hernia Repair

Patients who have a primary fascial closure (PFC) before mesh placement during laparoscopic ventral hernia repair (LVHR) enjoy better long-term quality of life, claims a new study.

Researchers at George Washington University (Washington, DC, USA), the University of Texas Health Science Center (UTHSCSA; Houston, USA), and other institutions conducted a blinded, multicenter study involving 129 patients scheduled for elective LVHR, who were randomized to PFC versus bridged repair. All patients had hernia defects that ranged from 3 to 12 cm on computerized tomography (CT); most were obese, had one or more comorbid conditions, and had prior abdominal surgery. In all, 107 (83%) patients completed two year follow-up.

The primary outcome was change in quality of life; secondary outcomes included postoperative surgical site occurrences (hematoma, seroma, surgical site infection [SSI], and wound dehiscence), abdominal eventration, and hernia recurrence. The results revealed that patients treated with PFC had, on average, a 12-point higher improvement in quality of life, compared to bridged repair. There were no differences in surgical site occurrence, eventration, or hernia recurrence between groups. The study was published in the March 2020 issue of Annals of Surgery.

“This study provides the high-quality evidence that primary fascial closure significantly improves patients’ quality of life and function,” said lead author Karla Bernardi, MD, of the McGovern Medical School at UTHSCSA. “Among patients undergoing elective LVHR, the fascial defect should be closed.”

Most laparoscopic ventral hernia repairs are bridged repairs, where surgical mesh spans an unclosed fascial defect. Primary fascial closure involves closing the fascial defects that underlie ventral hernias prior to mesh placement using a percutaneous technique. Sutures are placed one centimeter apart; every four sutures, the abdomen is desufflated and the sutures are tied extra-corporeally approximating the fascial edges in the midline. This is repeated to the caudal ends of the hernia. The mesh is then secured in four corners and tacked into position.

Related Links:
George Washington University
University of Texas Health Science Center