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P055: IS PERCUTANEOUS TRANSFASCIAL SUTURE FIXATION NECESSARY IN OPEN RETROMUSCULAR VENTRAL HERNIORRHAPHY?
David J Morrell, MD; Justin A Doble, MD; Eric M Pauli, MD; Penn State Health Milton S. Hershey Medical Center
Introduction: Optimizing surgical technique while improving patient outcomes remains a point of continual emphasis in ventral hernia repair (VHR). Percutaneous transfascial suture mesh fixation (PTSMF) is a common and well-accepted method—however, its necessity to prevent mesh migration and reduce hernia recurrences following retromuscular hernia repairs has been challenged.
Objective: To compare outcomes of patients undergoing open retromuscular VHR with and without PTSMF.
Methods: A retrospective analysis was performed on data prospectively collected between 2012-2020. All patients undergoing open retromuscular VHR (posterior rectus sheath and/or transversus abdominis release) with uncoated permanent synthetic sublay mesh by a single surgeon were identified. Patients undergoing parastomal hernia repairs and those without at least 30 days of follow-up were excluded. We defined PTSMF as mesh secured to the myofascial abdominal wall via percutaneous incisions. Suture fixation to Cooper’s ligament (non-percutaneous ligamentous fixation) and/or adhesive mesh fixation (AMF) were included in the non-PTSMF group. Patients were stratified based on whether mesh was secured via any PTSMF or without PTSMF.
Results: A total of 202 patients met inclusion criteria (112 PTSMF, 90 no PTSMF). Of patients without PTSMF fixation, most (n=64, 71.1%) had AMF using fibrin sealant alone. The remaining patients had AMF and non-percutaneous ligamentous fixation (n=22, 24.4%) or no fixation (n=4, 4.4%). Lightweight polypropylene mesh was more commonly used in the AMF group (81.3% PTSMF vs 95.6% AMF, p=0.002). There were no statistically significant differences in patient demographics, comorbidities, modified ventral hernia working group (mVHWG), type of myofascial release, hernia area (403.2 cm2 PTSMF vs 341.7 cm2 no PTSMF, p = 0.1286), or 30-day outcomes between the groups. Patients in the PTSMF group had a mean follow-up period of 26.8±1.6 months compared to 11.1±0.8 months (p < 0.0001). For patients with at least one year of follow-up (103 PTSMF, 57 no PTSMF), the hernia recurrence (2.6% PTSMF vs 0% no PTSMF, p = 0.1930) and surgical site occurrence (29.1% PTSMF vs 22.8% no PTSMF, p = 0.3880) rates were not significantly different. Only one recurrence was noted during the first postoperative year (PTSMF group).
Conclusion: PTSMF may not be necessary to prevent hernia recurrence in open retromuscular hernia repairs. Other factors, such as wide mesh overlap and ability to achieve fascial closure may be more critical in the development of recurrences. Further study is necessary to determine the cost effectiveness of non-PTSMF fixation methods relative to PTSMF.
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