A prospective observational study on intraperitoneal mesh repair for small ventral hernias: Why open prevails over laparoscopic approach.

Introduction: With the ever-increasing demand for laparoscopic hernia repair, it is important to scrutinise the benefit in terms of recurrence, pain and cosmesis with the open technique for small ventral hernias. The objective is to compare the outcomes of open and laparoscopic intraperitoneal onlay mesh (IPOM) repair for small ventral hernias (defect size <3 cm).

Patients and methods: A prospective analysis of patients who underwent surgical mesh repair for ventral hernias with defects smaller than 3 cm between January 2021 and September 2022. Ventral patch composite mesh (VentralexTM) and composite Prolene-cellulose mesh (ProceedTM) were utilised. We collected and analysed patient characteristics, operative findings and post-operative data, including recurrence rates, pain scores and cosmetic satisfaction over a 12-month follow-up period.

Results: Among the 116 patients included in the study, 54 underwent laparoscopic IPOM repair, while 62 underwent open IPOM repair. The laparoscopic group had an average hernia defect size of 2.7 cm (±0.3), while for the open repair group, it was 2.4 cm (±0.4). The duration of open repair was notably shorter than that of laparoscopic repair (54 min [±16] vs. 94 min [±27]; P = 0.001). Postoperatively, there were significant differences between the groups in terms of VAS scale pain score on post-operative day 1 ([7 ± 2 vs. 4 ± 2]; P = 0.008). Eight cases developed surgical site infections requiring oral antibiotics in the open group, whereas the laparoscopic group had 3 cases (P = 0.6).

Conclusion: Open IPOM repair can be considered as a favourable option for ventral hernias <3 cm when compared to laparoscopic IPOM repair, primarily due to its shorter operative time, ease of spinal anaesthesia, single incision, shorter learning curve and absence of risks associated with port-site hernias. Higher initial pain in the laparoscopic group can be attributed to the use of absorbable tacks and transfascial sutures. No discernible disparities were observed in terms of chronic pain or recurrence rates between these surgical approaches.