Open suture repair versus Permacol™ mesh repair of small ventral hernias in patients with end-stage kidney disease

Background: Ventral hernia is a common surgical problem among patients with end-stage kidney disease (ESKD), while the optimal repair technique for small ventral hernias is controversial. This study aimed to compare the outcomes of open suture repair versus biological mesh repair of small ventral hernias with defect size <= 2 cm in ESKD patients. Method: Data from consecutive ESKD patients who underwent elective ventral hernia repair with defect size <= 2 cm at a single institution from January 2012 to January 2022 were retrospectively reviewed. Outcomes of open suture repair were compared to Permacol (TM) mesh repair. The primary outcome was recurrence rate. Secondary outcomes included post-operative complications, peri-operative and post-operative dialysis regimen. Results: Forty-seven ventral hernia repairs were included, with 20 being suture repairs and 27 being Permacol (TM) mesh repairs. Median age at hernia repair was 60 (range 32-81) years old. Pre-operatively, 42 patients (89.4%) were on peritoneal dialysis (PD). Paraumbilical hernia (59.6%) was most common. Median hernia defect size was 15 mm (range 2-20 mm). Upon median follow-up of 56 (range 9-119) months, more patients in the suture repair group developed recurrence (30% vs. 0%, p = 0.004). Median time to recurrence was 10 (range 5-16) months. There was no wound or mesh infection. The majority of patients underwent intermittent PD peri-operatively and were able to resume on PD in the long run. Conclusion: Ventral hernia repair is indicated in ESKD patients even for small defects; repair with Permacol (TM) mesh was associated with a lower recurrence rate when compared to suture repair and post-operative morbidity was low.