Laparoscopic Ventral Hernia Repair: Primary Versus Secondary Hernias

Background: Most studies regarding laparoscopic ventral hernia repair (LVHR) have merged primary hernias (PHs) and secondary (incisional) hernias (SHs) into one group of ventral hernias. This grouping could produce falsely favorable results for LVHR. Our objective was to review and compare the outcomes of laparoscopic repair of PHs and SHs.

Methods: A retrospective chart review of patients from 2000 to 2010 identified the cases of LVHR at two affiliated institutions. The demographics, comorbidities, type of hernia (PH versus SH), and short- and long-term complications were analyzed. The postoperative pain, cosmetic satisfaction, and Activities Assessment Scale scores were assessed by telephone survey.

Results: A total of 201 cases of LVHR were identified: 73 PHs (36%) and 128 SHs (64%). No difference was found in the mean age between the two groups. The PH group had a greater percentage of black patients (34% versus 14%; P < 0.05), and the SH group had a greater percentage of white patients (85% versus 65%; P < 0.05). More female patients had SHs (34% versus 14%; P < 0.05), and more male patients had PHs (86% versus 66%; P < 0.05). More patients in the SH group had chronic obstructive pulmonary disease (19% versus 7%; P < 0.05) and prostate disease (32% versus 9%; P < 0.05). Overall, the SHs were larger (37.9 ± 4.9 cm(2)versus 11.5 ± 1.9 cm(2); P < 0.01). No differences were found in early postoperative complications, including pneumonia, urinary tract infection, surgical site infection, and seromas between the two groups. However, those with SHs had a greater incidence of recurrence (16% versus 5%; P < 0.05) and mesh explantation (7% versus 0%; P < 0.05). The patients who also underwent SH repairs had greater postoperative pain scores when followed up for a median of 25 mo than those who underwent PH repairs when followed up for a median of 24 mo (3.5 ± 0.4 versus 1.8 ± 0.4; P < 0.05). More patients in the SH group had chronic pain issues (26% versus 5%; P = 0.0003) and had lower satisfaction scores (7.5 ± 0.3 versus 8.6 ± 0.3; P < 0.05). Overall, the Activities Assessment Scale scores were not significantly different.

Conclusions: Our data have demonstrated that PHs and SHs are different. LVHR of SHs is associated with increased recurrence, greater postoperative pain scores, chronic pain issues, and lower patient satisfaction scores. We recommend that future studies evaluate LVHR for PHs separate from those for SHs.