Seroma formation and method of mesh fixation in laparoscopic ventral hernia repair--highlights of a case series.

INTRODUCTION: Laparoscopic ventral hernia repair (LVHR) is gaining popularity amongst minimally invasive surgeons, promising shorter lengths of hospital stay and decreased morbidity compared to conventional open repair. We aim to report our experience of LVHR performed at a single institution and analyse morbidity to improve outcome.

METHODS: A retrospective analysis using a prospectively collected database and patient re-cords was performed on all patients that underwent LVHR. Patient demographics, morbidity and mortality were recorded. Patients with recurrences underwent further analysis.

RESULTS: There were a total of 55 laparoscopic ventral hernia operations performed on 50 patients. 24 (48%) were male, and the median BMI was 31 (range 20-41). The median operating time was 50 mins (range 30-120), the median length of stay (LOS) was one day (range 1-14) and the median follow-up period was 14 months (range 3-31). Operative complications occurred in two (3.6%) patients. Minor morbidity occurred in 12 (21.8%) patients. Eight (14.5%) patients developed seromas within the residual hernia sac post-operatively. There were six recurrences following LVHR in five patients. At re-operation, all recurrences appeared to be due to mesh detachment.

CONCLUSION: LVHR is safe and the results are comparable to published series. We are encouraged by a shorter LOS and operative time compared to most published data. Post-operative se-roma formation is common. If there is a suspicion of recurrence, these should all be imaged appropriately to avoid unnecessary operative intervention. A higher BMI is an independent risk factor for recurrence in LVHR. Consideration should be given to using transfascial sutures or other fixation methods to improve recurrence rates in this difficult patient group.