Bridging Versus Closing the Defect During Laparoscopic Ventral Hernia Repair

Abstract

Traditional laparoscopic ventral hernia repair (LVHR) relies on intraperitoneal “patching” of defects as an underlay. However, such bridging technique fails to close the actual defect and may result in adynamic areas of abdominal wall. Clinically, this may lead to bulging at the site of hernia repair, especially in the long term. Moreover, significant seromas often occur in the created “dead” space above the mesh patch. Closing the hernia defect and achieving medialization of the rectus muscles eliminates “dead” space and allows for a better functional and cosmetic reconstruction. In this chapter, several techniques for laparoscopic defect closure are presented and discussed. While objective data are lacking, I propose that most defects in younger, active patients should be closed routinely. In addition, thinner patients are more likely to notice persistent defects and bulging and would also benefit from defect closure during LVHR. Older and obese patients, on the other hand, are unlikely to derive any benefits from a routine defect closure and are likely best served by a traditional LVHR. As defect closure gains wider implementation and the benefits and disadvantages of this approach should become clearer, clinical quality improvement research principles can be applied in order to determine the subgroup of patients who stand to benefit most from this modification of a traditional LVHR technique.