Recurrence rate after absorbable tack fixation of mesh in laparoscopic incisional hernia repair

Background: The mesh fixation technique in laparoscopic incisional hernia repair may influence the rates of hernia recurrence and chronic pain. This study investigated the long-term risk of recurrence and chronic pain in patients undergoing laparoscopic incisional hernia repair with either absorbable or non-absorbable tacks for mesh fixation. Methods: This was a nationwide consecutive cohort study based on data collected prospectively concerning perioperative information and clinical follow-up. Patients undergoing primary, elective, laparoscopic incisional hernia repair with absorbable or non-absorbable tack fixation during a 4-year interval were included. Follow-up was by a structured questionnaire regarding recurrence and chronic pain, supplemented by clinical examination, and CT when indicated. Recurrence was defined as either reoperation for recurrence or clinical/radiological recurrence. Results: Of 1037 eligible patients, 84.9 per cent responded to the questionnaire, and 816 were included for analysis. The median observation time for the cohort was 40 (range 0-72) months. The cumulative recurrence-free survival rate was 71.5 and 82.0 per cent after absorbable and non-absorbable tack fixation respectively (P = 0.007). In multivariable analysis, the use of absorbable tacks was an independent risk factor for recurrence (hazard ratio 1.53, 95 per cent c.i. 1.11 to 2.09; P = 0.008). The rate of moderate or severe chronic pain was 15.3 and 16.1 per cent after absorbable and non-absorbable tack fixation respectively (P = 0.765). Conclusion: Absorbable tack fixation of the mesh was associated with a higher risk of recurrence than non-absorbable tacks for laparoscopic mesh repair of incisional hernia, but did not influence chronic pain.