Preperitoneal Versus Retromuscular Mesh Repair for Ventral Abdominal Hernias: A Propensity Matched Analysis

To compare retromuscular and preperitoneal mesh positioning in open ventral hernia mesh repair, we performed a retrospective and comparative study of patients who underwent retromuscular mesh repair (RMMR) and preperitoneal mesh repair (PPMR) for ventral abdominal hernias between January 2012 and December 2016. We used propensity score matching to adjust for potential baseline confounders between two groups. After propensity score matching, 68 patients who underwent RMMR were compared with 92 patients treated with PPMR. There was no difference between RMMR and PPMR regarding operative time (85.24 vs 65.34 min, p = 0.120), drainage duration, hospital stay (3.12 vs 1.7 days, p = 0.226), morbidity (20.5% vs 11.9%, p = 0.129), superficial abscess (p = 0.056), deep abscess (p = 0.188), hematoma (p = 0.220), and seroma (p = 0.593). PPMR was superior to RMMR in term of drainage rate, drainage quantity (128 ml vs 36 ml, p = 0.001), drainage duration (3.6 vs 4.14 days, p = 0.068), and re-hospitalisation rate (7 vs 1 patient, p = 0.011). The mean follow-up in RMMR group was 42.6 months and 35.9 months in PPMR group. Nineteen patients were lost in follow-up (10.3%). Median delay of recurrence was 20.3 months in RMMR group and 11.1 months in PPMR group. At 3-year follow-up, there was no statistically difference between the two groups regarding the recurrence (11 vs 9 patients, p = 0.33) and delay of recurrence (20.3 vs 11.1 months, p = 0.175). RMMR and PPMR present a good alternative for open sublay mesh repair. They are safe, efficient, and associated with comparable complication and recurrence rates.