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A comparative study of closure versus non-closure of hernial defect in laparoscopic ventral hernia mesh repair

Ventral hernias, whether naturally occurring or the result of previous surgery, comprise one of the most common problems confronting general surgeons, with overall incidence between 2 and 13%. The introduction of the anterior positioning of prosthesis has allowed to greatly reduce the recurrence. While laparoscopic ventral hernia repair (LVHR) has gained popularity in recent years, there is still significant controversy about the optimal approach to ventral hernia repair. Reasons to close the defect during LVHR prior to mesh insertion include the possibility of reduced seroma rate, reduced recurrence rate, improved abdominal wall function, and improved abdominal wall contour postoperatively. 1,2 Indeed, the International Endohernia Society guidelines for laparoscopic hernia repair recommend primary closure of the fascial defect with mesh underlay for defects of limited size. But none of these outcomes have been rigorously studied, and there is no general agreement on the definition of the term abdominal wall function. 3