Ventral hernias constitute a substantial challenge in general surgical practice. Although prosthetic mesh reinforcement has markedly decreased recurrence rates, postoperative complications such as seroma formation, surgical site infections, and extended hospital stays remain significant concerns [1]. Introduced in 1993, the laparoscopic intraperitoneal only mesh technique for ventral hernia repair has achieved broad acceptance. Proponents highlight reduced wound-related morbidity and expedited recovery, whereas opponents underscore risks including bowel injury, mesh-associated issues, and seroma development. Importantly, seroma rates reported in the literature show marked variability attributable to inconsistent diagnostic criteria and detection modalities [2].

Furthermore, recent meta-analyses indicate that while some studies associate laparoscopy with lower seroma rates, the causal relationship remains subject to ongoing debate due to conflicting reports in current surgical literature [3]. Specifically, while some investigations emphasize the role of cauterization and suture-based dead space reduction in minimizing fluid accumulation, others suggest that the intraperitoneal only mesh technique may introduce unique risks related to material-intestine contact [4,5]. Comparative evidence consistently indicates that laparoscopic repair is associated with a significantly lower frequency of wound dehiscence and surgical site infections compared to traditional open techniques [6,7].

Robust comparative data from the Indian subcontinent, especially using combined clinical and ultrasonographic assessment, remain limited. This study was designed to evaluate the incidence of postoperative seroma and other complications, along with key perioperative outcomes, between open and laparoscopic ventral hernia repair [8]. The primary objective of this study was to compare the incidence of postoperative seroma and overall complications between open and laparoscopic ventral hernia repair, as well as the duration of surgery and length of hospital stay.

MATERIALS AND METHODS

Two hundred consecutive patients undergoing elective ventral hernia repair with mesh reinforcement were included.

Inclusion Criteria

• Age 18–80 years
• Elective repair of primary or incisional ventral hernias
• Mesh repair

Exclusion Criteria

• Emergency surgery
• Active infection or infected mesh
• Decompensated liver disease
• Presence of stoma
• Chronic pain syndrome
• Inability to comply with follow-up

Surgical Procedures

Open Repair: Performed predominantly under spinal or combined spinal-epidural anesthesia. Following sac reduction or excision, polypropylene mesh was placed using the only or inlay technique. Drains were used selectively.

Laparoscopic Repair: Performed under general anesthesia using a composite microporous polypropylene mesh. Fixation was achieved with trans fascial sutures and/or tacks in a double-crown fashion. Postoperative compression dressings and abdominal binders were applied.

Outcome Assessment

Seroma:

Clinical: Visible or palpable fluid collection

Ultrasonographic: Fluid collection detected on ultrasound on postoperative day 2 and at discharge

Other Complications: Wound infection, postoperative ileus, hematoma, etc.

Length of Hospital Stay: Calculated from the day of surgery to the day of discharge.

The study protocol was approved by the Institutional Ethics Committee. Written informed consent was obtained from all participants. Categorical data were analyzed using the chi-square or Fisher’s exact test. Continuous data were compared using the independent t-test or Mann-Whitney U test, as appropriate. A p-value <0.05 was considered statistically significant.

RESULTS

Table 1: Age Distribution of Patients Studied

#p = 0.558; Not significant

Most common age group in open group is 41 – 50 yrs contributing to 27.2% and in laparoscopy group is 31 – 40 yrs contributing to 37%. Mean age was 46.54 ± 12.48 years (open) vs 45.04 ± 11.47 years (laparoscopic, p = 0.558).

Table 2: Sex Distribution of Patients Studied

p = 0.465; Not significant

Females are most common in both open and laparoscopic group compared to male contributing to 73.4% in open group and 66.7% in laparoscopy group. Females predominated in both groups (73.4% open vs 66.7% laparoscopic, p = 0.465).

Table 3: Etiologial Distribution of Ventral Hernias in Open Group

Most common type of hernia which requires open surgery is incisional hernia corresponding to 46.8% followed by paraumbilical hernia corresponding to 28.3%.

Table 4: Etiologial Distribution of Ventral Hernias in Laparoscopic Group

Most common type of hernia which requires laparoscopic surgery is umbilical hernia corresponding to 37% followed by paraumbilical hernia corresponding to 29.6%.

Table 5: Distribution of Duration of Surgery

#p = 0.322; Not significant

In most of the patients it took 61 to 80 min for open surgery and 81 to 100 minutes to complete surgery in laparoscopy group. Mean duration was 84.48 ± 27.54 minutes in open group vs 90.00 ± 21.88 minutes in laparoscopic group (p = 0.322) not statistically significant.

Table 6: Distribution of Postoperative Seroma

Postoperative seroma is more common in open group contributing to 27.74% compared to laparoscopy group which accounts to 14.81%. Seroma was more frequently detected in the open group, particularly on radiological evaluation.

Table 7: Distribution of Postoperative Complications

Overall complications were more in open group accounting to 30.05% compared to laparoscopy group which accounts only to 22.2% among all seroma is most common complication in both open and laparoscopy groups. Wound infections were markedly more common after open repair.

Table 8: Distribution of Length of Hospital Stay

Most of the patients in open group (46.82%) have taken 6 to 10 days to get    discharged whereas in laparsocopy group (74.07%) only 1 to 5 days. Length of hospital stay was shorter in the laparoscopic group (mean ≈4.07 days vs 5.06 days).

DISCUSSION

This prospective study demonstrates that laparoscopic ventral hernia repair is associated with a lower incidence of seroma formation, reduced wound infection rates, and shorter hospital stay compared to conventional open mesh repair, with no significant increase in operative time. Furthermore, these findings align with observations that laparoscopic techniques yield faster recovery periods while maintaining equivalent surgical safety profiles [9,10]. Although open repair remains a traditional standard for specific complex abdominal defects, the reduced postoperative pain scores and improved recovery metrics observed in this cohort corroborate the clinical utility of a laparoscopic approach [11,12]. Furthermore, while wound infection and seroma rates remain clinical focus, the implementation of minimally invasive techniques may significantly mitigate the burden of postoperative morbidity [13,14].

The lower seroma rate in the laparoscopic group is likely attributable to minimal subcutaneous dissection, smaller incisions, and the use of compression dressings/abdominal binders. Conversely, the higher incidence of wound infections observed in the open group is primarily linked to more extensive tissue trauma and the larger skin incisions required for prosthetic mesh placement [15,16]. Additionally, the laparoscopic approach facilitates a more rapid restoration of bowel function, contributing to the observed trend of shorter hospital stays compared to the open technique [17,18]. Consistent with these outcomes, existing literature indicates that laparoscopic ventral hernia repair often results in a significantly faster return to daily activities compared to open approaches [19].

Wound infection remains a significant problem in open repairs due to larger incisions and greater tissue trauma. The observed trend toward fewer infections in the laparoscopic group (3.7% vs 17.34%) is clinically meaningful, although statistical significance was borderline due to the smaller sample in the laparoscopic arm. Moreover, several comparative investigations have documented similar advantages, reinforcing the potential for improved patient outcomes when utilizing minimally invasive hernia management [20,21]. Furthermore, the laparoscopic approach has been consistently associated with lower rates of chronic postoperative pain and a reduced risk of long-term complications compared to conventional open techniques [22,23].

Operative time was comparable between groups, reflecting the institutional learning curve. The significantly shorter hospital stay in the laparoscopic group translates into reduced healthcare costs and faster return to normal activity. Furthermore, these findings emphasize that minimally invasive techniques are effective in decreasing both wound-related morbidity and the duration of hospitalization [24,25].

CONCLUSION

The findings of this study reinforce that laparoscopic ventral hernia repair provides superior clinical outcomes, specifically regarding reduced wound complications and accelerated recovery compared to open surgical approaches. Both modalities remain safe and credible options for abdominal wall reconstruction, with long-term follow-up data suggesting that recurrence rates are statistically equivalent regardless of the chosen technique. Future research should prioritize long-term prospective trials focusing on quality of life metrics to further elucidate the nuances between these surgical modalities. Additionally, emerging evidence suggests that robotic-assisted platforms may further optimize these outcomes by offering enhanced ergonomics and precision in complex abdominal wall reconstructions, potentially bridging the recovery gap between minimally invasive and open techniques.

Funding: No external funding. 

Conflict of Interest: None declared. 

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