Morbidity associated with laparoscopic repair of suprapubic hernias

Brandon Varnell, Sharon Bachman, Jacob Quick, Michelle Vitamvas, Bruce Ramshaw, Dmitry Oleynikov
American Journal of Surgery 2008, 196 (6): 983-7; discussion 987-8

BACKGROUND: Laparoscopic suprapubic hernia repair (LSHR) is frequently a technically difficult procedure. This is often due to extensive adhesions from multiple previous operations, the necessary wide pelvic dissection, and adequate mesh coverage with transfascial suture fixation. The aim of the current study was to document the complications and morbidity associated with the repair of suprapubic hernias.

METHODS: A retrospective review of patients with complex suprapubic ventral hernias undergoing laparoscopic repair between 2003 and 2007 at 2 university-based practices by 1 surgeon at each facility was conducted. The operative techniques were similar and included dissection into the space of Retzius to mobilize the dome of the bladder, intraperitoneal onlay of mesh using a barrier mesh, careful tack fixation to the pubic bone and Cooper's ligaments, and extensive transfascial suture fixation of the mesh.

RESULTS: A total of 47 patients were reviewed, 29 women and 18 men, with a mean age of 54 years. Patients averaged 3.5 previous abdominal surgeries (SD +/-2.3) and had a mean body mass index (BMI) of 35.1 (SD +/-7.5). Previous ventral hernia repairs had been performed in 57% of patients. Average defect size was 139.8 cm(2) (SD +/-126) and average mesh size was 453.8 (SD +/-329.0), with an average hernia-to-mesh ratio of 3.2. Median length of stay was 3 days with a mean follow-up of 2.6 months (SD +/-3.1). There were 18 complications (38%): symptomatic seroma (n = 4), prolonged ileus (n = 2), chronic pain (n = 2), postoperative urinary retention (n = 2), enterotomy (n = 1), intraoperative bladder injury (n = 1), postoperative urinary tract infection (n = 1), mesh infection (n = 1), rapid ventricular rate (n = 1), small bowel obstruction (n = 1), pulmonary embolism (n = 1), and pneumonia (n = 1). One patient required conversion to open ventral hernia repair, no injury was identified. Recurrence occurred in 3 patients (6.3%). The mechanisms of recurrence included reherniation at the level of the pubic tubercle, a lateral mesh recurrence in a patient with a high BMI and small abdominal excursion, and in a pregnant patient who developed a fixation suture hernia.

CONCLUSIONS: Laparoscopic suprapubic hernia repair is safe and effective with a relatively low recurrence rate, considering the complexity of the repair.

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