Comparison of two different concepts of mesh and fixation technique in laparoscopic ventral hernia repair: a randomized controlled trial Maciej Pawlak 1,2 • Ralf-Dieter Hilgers 3 • Kamil Bury 2 • Andrzej Lehmann 1 • Radoslaw Owczuk 4 • Maciej S ´ mietan ´ski 5 Received: 14 March 2015 / Accepted: 9 June 2015 Ó Springer Science+Business Media New York 2015 Abstract Background Patients’ need to improve outcomes and to reduce the number of complications triggers the develop- ment of new materials and surgery concepts. Currently, there are many implants and fixation systems dedicated for intraperitoneal onlay mesh procedure. The aim of this study was to compare two different mesh/fixation system con- cepts (PH: Physiomesh/Securestrap and VS: Ventralight ST/SorbaFix) for laparoscopic ventral hernia repair with respect to pain. Methods A single-center, prospective, randomized study was designed to include 50 patients per group with a planned interim analysis for safety after 25 patients. The endpoints were pain occurrences and intensity, which was measured with the visual analogue scale 7 days, 30 days, 3 months and 6 months after surgery. The safety parame- ters included the number of recurrences and postoperative complications. Results During the interim analysis, the study was stop- ped due to safety reasons. We observed five (20 %) recurrences in the PH group in first 6 months and none in the VS group. We observed a significantly higher pain rate in the PH group after 3 months (p \ 0.0001) and no dif- ference after 7 days (p = 0. 7019). The pain intensity decreased significantly over time (p \ 0.0001) and was significantly higher in the PH group (p \ 0.0001). Conclusions Although this clinical trial was terminated prior to the preplanned recruitment goal, the obtained results from the enrolled patients indicate that the PH system associated with significantly greater hernia recur- rences and postoperative pain compared with the VS sys- tem. This confirms the superiority of the elastic mesh concept, which may be a safer and more efficacious option for laparoscopic ventral hernia repairs. Keywords Laparoscopic abdominal wall hernia repair Á Ventral hernia Á Incisional hernia Á Intraperitoneal onlay mesh Background Many recently published articles consistently report good laparoscopic ventral and incisional hernia repair (LVIHR) outcomes [1–4]. LVIHR continues to demon- strate low rates of wound complications and short hos- pital stays [5]. However, the optimal fixation techniques, mesh design, and other issues, such as the hernia recur- rence mechanism and pain pathophysiology, require additional appraisal. Until now, many publications have observed high postoperative pain in patients undergoing LVIHR [1, 6–8]. In search of possible factors that induce pain, authors have tried to demonstrate that various The study was registered on ClinicalTrials.gov under the identifier: NCT02233569. & Maciej Pawlak pawlakmd@gmail.com 1 Department of General Surgery, Ceynowa Hospital, Wejherowo, Poland 2 Department of Cardiac and Vascular Surgery, Medical University of Gdan ´sk, Gdan ´sk, Poland 3 Department of Medical Statistics, RWTH Aachen University, Aachen, Germany 4 Department of Anesthesiology and Intensive Care, Medical University of Gdan ´sk, Gdan ´sk, Poland 5 II Department of Radiology, Medical University of Gdan ´sk, Gdan ´sk, Poland 123 Surg Endosc DOI 10.1007/s00464-015-4329-0 and Other Interventional Techniques