Laparoscopic incisional hernia mesh repair with the "double-crown" technique: a case-control study

BACKGROUND: Incisional hernia is a main complication of abdominal surgery. Laparoscopic hernia mesh repair has been demonstrated to be as effective as open repair. However, the mesh fixation method is, to date, a matter of debate, and there are few clinical studies evaluating a single technique. This was a case-control study to assess the "double-crown" fixation method. METHODS: From March 2000 to November 2005, we prospectively collected operative and outcome data on 94 laparoscopic mesh repairs of large incisional hernias performed by using the double-crown technique. The data were compared with those from a retrospective review of 87 matched open incisional hernia repairs done from January 1995 to January 2000. RESULTS: The open and laparoscopic repair groups were comparable in patient age, sex, and hernia size. Operative time was significantly longer in the laparoscopic group; the duration of hospitalization and number of early postoperative complications (e.g., wound infection and prolonged ileus) were significantly greater in the open group. Recurrence rate after a mean follow-up of 38 months (range, 12-72) was 2.1% in the laparoscopic group and 6.9% in the open repair group (mean follow-up, 8 years; range, 5-10) (P > 0.05). CONCLUSIONS: Medium-term results indicate that laparoscopic incisional hernia repair with the double-crown technique has a low complication rate and a comparable recurrence rate to open repair.