Long term outcomes of laparoscopic transabdominal Retro-Rectus Onlay Mesh (RROM) repair for ventral abdominal wall hernias.

BACKGROUND

Ventral abdominal wall hernias are common, with approximately 1 in 5 adults experiencing a primary ventral hernia in their lifetime, while intraperitoneal onlay mesh (IPOM) repair is considered the standard laparoscopic repair despite challenges like high costs and complications. This study evaluates the long-term outcomes of the Retro-Rectus Onlay Mesh (RROM) technique, to address the shortcomings of IPOM repair, a new innovative technique called Recto rectus Onlay mesh (RROM) has been described.

METHODS

A retrospective review of prospectively collected data (January 2007-June 2020) included 262 patients with midline ventral hernias (umbilical, epigastric, incisional) undergoing RROM. Exclusion criteria included emergencies, open and other laparoscopic techniques, and lateral hernias. Surgical approaches (craniocaudal or caudocranial) involved retro-rectus mesh placement, defect closure, and transversus abdominis release (TAR) if needed. Primary endpoint was recurrence; secondary endpoints included surgical site infections (SSI), morbidity, and mesh-related complications. Follow-up spanned 4 years or more.

RESULTS

Out of 262 Patients (164 females, 98 males; mean BMI 25.4 kg/m²) included 158 umbilical, 15 epigastric, and 89 incisional hernias, with 30 cases of rectus divarication. TAR was performed in 45 patients. Comorbidities included Type II diabetes (49 patients), hypertension (38 patients), and COPD (8 patients). Operative times averaged 72-116 min, increasing with hernia complexity and TAR. Concomitant procedures (24 cases) extended time by an average of 23 min. Mean hospital stay was 1.6 days. At a minimum of four years of follow-up (documented in 191 patients), one recurrence (0.38%) at 15 years, two rectus divarications (0.76%), and four superficial port infections (1.53%) were documented. No mesh infections were reported.

CONCLUSION

The RROM technique demonstrates safety and efficacy for ventral hernias, with low recurrence, minimal complications, and affordability. Its approach reduces mesh-bowel interaction and infection risks, offering a durable, cost-effective alternative to IPOM. While technically demanding, RROM provides favorable long-term outcomes, and significant advancement in global hernia care. Further studies should optimize patient selection and surgical approaches to enhance favourable outcomes.