Laparoscopic ventral hernia repair: A surgeon's insights into defect closure.

Introduction: Laparoscopic ventral hernia repair (LVHR) is favored over open-repair methods due to reduced pain, shorter hospital stays, and lower recurrence rates. However, whether to close the hernial defect before placing the mesh remains debated. This study compares LVHR outcomes with and without defect closure. Methods: A retrospective analysis was conducted on 108 patients undergoing LVHR from 2018 to 2022. Group A (49 patients) underwent LVHR without defect closure, and Group B (59 patients) underwent LVHR with defect closure. Data on demographics, operative time, complication rates, postoperative pain, and hernia recurrence were analyzed. Patients were followed for at least 1 year after surgery. Results: Closing the hernial defect significantly reduced seroma formation (P = 0.04) and mesh bulge (P = 0.04). However, it was associated with longer operative times and higher immediate postoperative pain. Group A had shorter operative times and lower initial pain but higher rates of seroma formation (18.4 %) and mesh bulge (6.1 %). Group B had fewer seromas (5.1 %) and no mesh bulges but required longer surgeries and reported higher immediate postoperative pain. No significant differences were observed in hernia recurrence rates, hospital stays, or chronic pain levels. Mesh infections were only noted in the non-closure group (2.0 %). Conclusions: Defect closure during LVHR reduces seroma formation and mesh bulge but increases operative time and immediate postoperative pain. Further randomized controlled trials are necessary to optimize LVHR protocols.