Peritoneal bridging versus fascial closure in laparoscopic intraperitoneal onlay ventral hernia mesh repair: a randomized clinical trial

F Ali, G Wallin, B Fathalla, G Sandblom, F Ali, G Wallin, B Fathalla, G Sandblom

Abstract

Background: Many patients develop seroma after laparoscopic ventral hernia repair. It was hypothesized that leaving the hernial sac in situ may cause this complication.

Methods: In this patient- and outcome assessor-blinded, parallel-design single-centre trial, patients undergoing laparoscopic intraperitoneal onlay mesh ventral hernia repair were randomized (1 : 1) to either conventional fascial closure or peritoneal bridging. The primary endpoint was the incidence of seroma 12 months after index surgery detected by CT, evaluated in an intention-to-treat analysis.

Results: Between September 2017 and May 2018, 62 patients were assessed for eligibility, of whom 25 were randomized to conventional closure and 25 to peritoneal bridging. At 3 months, one patient was lost to follow-up in the conventional and peritoneal bridging groups respectively. No seroma was detected at 6 or 12 months in either group. The prevalence of clinical seroma was four of 25 (16 (95 per cent c.i. 2 to 30) per cent) versus none of 25 patients in the conventional fascial closure and peritoneal bridging groups respectively at 1 month after surgery (P = 0·110), and two of 24 (8 (0 to 19) per cent) versus none of 25 at 3 months (P = 0·235). There were no significant differences between the groups in other postoperative complications (one of 25 versus 0 of 25), rate of recurrent hernia within 1 year (none in either group) or postoperative pain.

Conclusion: Conventional fascial closure and peritoneal bridging did not differ with regard to seroma formation after laparoscopic ventral hernia repair.

Trial registration: ClinicalTrials.gov (NCT03344575).

© 2020 The Authors. BJS Open published by John Wiley & Sons Ltd on behalf of British Journal of Surgery Society.

Figures

Figure 1
Figure 1
Schematic diagram of laparoscopic hernia repair methodsa In the defect closure approach, the hernia is reduced, the fascial defect is closed with suture and the fascial closure reinforced with mesh. b In the peritoneal bridging approach, the hernia is reduced, the peritoneal layer in the hernia sac is dissected, and the protrusion of the hernia wall reduced and reinforced with mesh.
Figure 2
Figure 2
CONSORT diagram for the trial

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Source: PubMed

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