Laparoscopic ventral hernia repair during the learning curve

Abstract

Large series of laparoscopic ventral hernia repair have shown excellent results. However, published comparative studies have had conflicting outcomes. We retrospectively reviewed the first 29 laparoscopic ventral hernia repairs performed at a VA Medical Center from January 2000 to June 2001. The outcome was compared to that of open repairs performed during the same time period. Outcomes between the groups were similar in all respects, except for the length of stay. The conversion rate for the laparoscopic approach was 13.8%. There was one death in the laparoscopic group due to an unrecognized enterotomy. There were three recurrences in the open group and one in the laparoscopic group with a mean follow up of 13 months. In our series, laparoscopic hernia repair resulted in a shorter hospital stay but no other significant benefits, along with a risk of missed enterotomy. The risk-benefit ratio for this procedure may be high during the learning curve.

Laparoscopic repair of incisional hernia: Outcomes of 100 consecutive cases comprising 25 wall defects larger than 15 cm

“…Obesity does not represent a contraindication for laparoscopic approach for treating fascial defects [20,25], and in our series 38 patients were obese. The overall mean duration of surgery in this study was 152 min, comparable with the 50-149 min reported in other studies that included hernias of smaller mean size [20,22,[26][27][28]. Laparoscopic division of adhesions represents a very important step in incisional hernia repair.…”

“…Laparoscopic division of adhesions represents a very important step in incisional hernia repair. Intestinal injury during adhesiolysis ranges from 0% to 6% and such a complication is more frequent during the learning phase and can jeopardize the procedure when not recognized intraoperatively [4,28]. We currently use laparoscopic scissors and avoid coagulation by both ultrasonic scalpel and bipolar forceps close to the intestinal loops.…”

Long-term results of laparoscopic repair of incisional hernias using an intraperitoneal composite mesh

“…Any intervention, e.g., simple insertion of a clamp in a trocar without adequate vision, can be the cause of this complication. This aspect should make surgeons aware of correctly indicating the laparoscopic approach and offering patients and their relatives complete information (informed consent); it should keep surgeons alert throughout the operation and ensure that they have sufficient experience and resources to act appropriately in any suspicious situation [6,28,35].…”

A simplified laparoscopic ventral hernia repair: the scroll technique

“…During laparoscopic ventral hernia repair, mesh manipulation and placement can be time consuming and, if not performed properly, can result in recurrence [11][12][13].…”