Meta-analysis of closure of the fascial defect during laparoscopic incisional and ventral hernia repair

Background: Laparoscopic incisional and ventral hernia repair (LIVHR) is being used increasingly, with reported outcomes equivalent to those of open hernia repair. Closure of the fascial defect (CFD) is a technique that may reduce seroma formation and bulging after LIVHR. Non-closure of the fascial defect makes the repair of larger defects easier and reduces postoperative pain. The aim of this systematic review was to determine whether CFD affects the rate of adverse outcomes, such as recurrence, pseudo-recurrence, mesh eventration or bulging, and the rate of seroma formation. Methods: A systematic search was performed of PubMed, Ovid, the Cochrane Library, Google Scholar and Scopus to identify RCTs that analysed CFD with regard to rates of adverse outcomes. A meta-analysis was done using fixed-effect methods. The primary outcome of interest was adverse events. Secondary outcomes were seroma, postoperative pain, mean hospital stay, mean duration of operation and surgical techniques employed. Results: A total of 16 studies were identified involving 3638 patients, 2963 in the CFD group and 675 in the non-closure of facial defect group. Significantly fewer adverse events were noted following CFD than non-closure (4.9 per cent (79 of 1613) versus 22.3 per cent (114 of 511)), with a combined risk ratio (RR) of 0.25 (95 per cent c.i. 0.18 to 0.33; P < 0.001). CFD resulted in a significantly lower rate of seroma (2.5 per cent (39 of 1546) versus 12.2 per cent (47 of 385)), with a combined RR of 0.37 (0.23 to 0.57; P < 0.001), and shorter duration of hospital stay. No significant difference was noted in postoperative pain. Conclusion: CFD during LIVHR reduces the rate of seroma formation and adverse hernia-site events.