Laparoscopic ventral hernia repair: Does primary repair in addition to placement of mesh decrease recurrence? Ambar Banerjee • Catherine Beck • Vimal K. Narula • John Linn • Sabrena Noria • Bradley Zagol • Dean J. Mikami Received: 21 February 2011 / Accepted: 22 June 2011 / Published online: 15 November 2011 Ó Springer Science+Business Media, LLC 2011 Abstract Background The advent of laparoscopic ventral hernia repair (LVHR) not only reduced the morbidity associated with open repair but also led to a decrease in the hernia recurrence rate. However, the rate continues to remain significant. Methods A retrospective observational study was con- ducted on 193 patients who were treated with LVHR by two minimally invasive surgeons in a 24-month period. The patient population was broadly divided into two groups based on the laparoscopic repair of the fascial defect with mesh underlay, or with primary suture repair and mesh underlay (PSR ? MU). Patient demographics, rates of hernia recurrence, and other associated complica- tions were compared between the two groups. Patient variables and the clinical outcomes were analyzed with descriptive statistics and chi-square test. Results One hundred ninety-three consecutive patients underwent LVHR for incisional (n = 136), umbilical (n = 44), epigastric (n = 9), and parastomal (n = 4) her- nia. Hernia recurrence was documented in eight patients (4.1%). The mean follow-up period was 10.5 months (range 1–36 months). Incisional hernias accounted for all eight recurrences. The rate of recurrence in those treated with PSR ? MU was 3% (two of 67 cases) in comparison with 4.8% (six of 126 patients) associated with mesh alone. The rate of recurrence in the recurrent hernia group, treated with mesh only, was 10.5% (four of 38 patients) compared with 4.8% (one of 21 patients) in the PSR ? MU group. Conclusions Primary laparoscopic repair along with mesh placement for the management of ventral hernia was found to be effective in selected cases as evidenced by the low rate of recurrence when compared with conventional laparoscopic repair with mesh alone. Further retrospective and prospective studies, with larger patient enrollment, are warranted to confirm the benefit of this technique over traditional repair. Keywords Laparoscopic ventral hernia repair Á Primary repair with mesh Á Recurrence Ventral hernias are defects of the anterior abdominal wall. They can be classified into congenital (epigastric, umbili- cal, and Spigelian) and acquired (incisional) [1]. Incisional hernia is a frequent complication of laparotomies with overall incidence between 2 and 13% [2–4]. Laparoscopic ventral hernia repair (LVHR) was first described by Leblanc in 1993 [5]. This repair was based upon the same surgical principles as the open underlay procedure described by Stoppa [6] and Rives et al. [7]. It was not only found to reduce the morbidity associated with open repair (shorter hospital stay, decreased complication rate, and improved patient outcome) but also led to a decrease in the overall recurrence of the hernia as well. The recurrence rate after LVHR with mesh ranges between 2.9 and 17.7%, compared with open repair with mesh where the rate is between 12 and 32% [8–15]. Despite its popularity, LVHR continues to have signif- icant recurrence rates. Several surgeons prefer closure of the abdominal wall defect with nonabsorbable sutures prior Presented at the SAGES 2011 Annual Meeting, March 30–April 2, 2011, San Antonio, TX. A. Banerjee Á C. Beck Á V. K. Narula Á J. Linn Á S. Noria Á B. Zagol Á D. J. Mikami (&) Center for Minimally Invasive Surgery, The Ohio State University Medical Center, 747 Doan Hall, 410 W 10th Avenue, Columbus, OH 43210, USA e-mail: dean.mikami@osumc.edu 123 Surg Endosc (2012) 26:1264–1268 DOI 10.1007/s00464-011-2024-3 and Other Interventional Techniques