Laparoscopic ventral and incisional hernia repair: An 11-year experience

Abstract

Incisional hernias develop in 2%-20% of laparotomy incisions, necessitating approximately 90000 ventral hernia repairs per year. Although a common general surgical problem, a "best" method for repair has yet to be identified, as evidenced by documented recurrence rates of 25%-52% with primary open repair. The aim of this study was to evaluate the efficacy and safety of laparoscopic ventral and incisional herniorrhaphy. From February 1991 through November 2002, a total of 384 patients were treated by laparoscopic technique for primary and recurrent umbilical hernias, ventral incisional hernias, and spigelian hernias. The technique was essentially the same for each procedure and involved lysis of adhesions, reduction of hernia contents, closure of the defect, and 3-5 cm circumferential mesh coverage of all hernias. Of the 384 patients in our study group, there were 212 females and 172 males with a mean age of 58.3 years (range 27-100 years). Ninety-six percent of the hernia repairs were completed laparoscopically. Mean operating time was 68 min (range 14-405 min), and estimated average blood loss was 25 mL (range 10-200 mL). The mean postoperative hospital stay was 2.9 days and ranged from same-day discharge to 36 days. The overall postoperative complication rate was 10.1%. There have been 11 recurrences (2.9%) during a mean follow-up time of 47.1 months (range 1-141 months). Laparoscopic ventral and incisional hernia repair, based on the Rives-Stoppa technique, is a safe, feasible, and effective alternative to open techniques. More long-term follow-up is still required to further evaluate the true effectiveness of this operation.

Minimal adhesions to ePTFE mesh after laparoscopic ventral incisional hernia repair: reoperative findings in 65 cases

“…Holzman et al 23 observed that efforts to separate the peritoneum of the hernia sac might produce a large peritoneal defect and leave the mesh exposed. They suggested omental interposition, as did Franklin et al, 24 and others have reported that this technique can reduce or eliminate adhesion of viscera to polypropylene. 20,22 However, in the series of 19 reoperative cases described by Franklin et al, 24 in which this omental protection technique had presumably been used during the previous hernia repair, one third of patients had severe adhesions to the polypropylene mesh.…”

Laparoscopic intra-peritoneal onlay mesh plus repair for ventral abdominal wall hernias - is there substance to the hype?

“…The closure of the fascial defect has been described by various techniques -interrupted or continuous, intracorporeal or extracorporeal [15] . The extracorporeal technique consists of placing multiple stab wounds on either side of the defect to pass the suture material and take interrupted stitches [16] . This may increase the risk of suture granuloma, infection or cosmetic dissatisfaction [17] .…”

Single-Port Repair of Diastasis Recti and Umbilical Hernia Combined with Abdominoplasty

“…The practice of defect closure has become increasingly more widely practiced, and it is known to reduce seroma formation in addition to improving abdominal wall functioning. 10 To our knowledge, we report the first case of singleincision laparoscopic repair of diastasis of the recti and umbilical hernia combined with abdominoplasty. This article aims to illustrate the important principles of SILS, defect closure under direct vision, prosthetic mesh reinforcement of the defect, and an attempt to reduce intraperitoneal adhesions and postoperative seroma formation with fibrin sealant while achieving the desired result with excision of unsightly skin excess.…”

“…9 The laparoscopic ventral hernia repair has continued to evolve from a concept of tension-free repair to the realization that defects, if their diameter is small enough (ie, Ͻ6 cm), should now be closed because this not only improves abdominal wall functioning but also allows wider overlap of the "defects." The technique of defect closure both in an extracorporeal manner and in an intraperitoneal manner is well described, 10 and theoretically, this can be used to repair diastasis of the recti.…”