Buttressing Sutures at the Center of the Mesh May Reduce the Probability of Recurrence in Onlay Incisional Hernia Repair: A Single-Center Study

TL;DR

Adding a buttressing suture in the center of a mesh during hernia repair may reduce recurrence without increasing pain or surgery time.

Contribution

The study introduces the use of a central buttressing suture in mesh repair to reduce hernia recurrence.

Findings

Buttressing sutures reduced hernia recurrence from 13.1% to 3.1%.

Operative time was slightly longer but not significantly different between groups.

Chronic pain incidence was similar in both groups.

Abstract

Introduction: An incisional hernia is a common complication after abdominal surgery. Mesh fixation and fascial closure are crucial aspects of repairing incisional hernias. The aim of this study is to investigate the effect of adding a buttressing suture in the center of the mesh in onlay incisional hernia repair on recurrence.

Methods: This retrospective study analyzed 157 patients who underwent elective repair of incisional hernia at Tokat State Hospital between January 2013 and January 2020. The study examined age, gender, comorbidity, smoking, hernia type, defect size, operative time, follow-up time, recurrence, and chronic pain. The patients were divided into two groups based on the type of buttressing suture used: normal and buttressing suture. Recurrence was defined as the reappearance of a hernia at the site of a previous surgery.

Results: The study included 126 patients, with 61 (48.4%) in the control group and 55 (51.6%) in the buttressing suture group. Ten patients reported recurrence, with eight (13.1%) in the control group and two (3.1%) in the buttressing suture group. The difference in recurrence between the groups was statistically significant (p=0.038). The control group had an operative time of 58.79±13.23 minutes, while the buttressing suture group had an operative time of 62.12±13.51 minutes. The statistical analysis did not reveal any significant difference between the two groups (p=0.091). Out of the patients with chronic pain, two (33%) were in the control group and four (66%) were in the buttressing suture group. The incidence of chronic pain did not differ significantly between the two groups (p=0.52).

Conclusion: In incisional hernia repair, the use of buttressing sutures with mesh in incisional hernia repair resulted in decreased recurrence rates without increasing chronic pain or affecting operative time.

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