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Laparoscopic repair of ventral incisional hernia
Keith B Kua1, Mark Coleman, Ian Martin
1Department of Surgery, Royal Brisbane Hospital, Brisbane, Queensland, Australia. boonkaren@yahoo.com
Background:
Laparoscopic repair of ventral incisional hernias was first reported in 1993. Since then, there have been sporadic case reports and small series published about this procedure, but it has not been widely adopted. Newer types of composite prosthetic mesh may reduce the potential problem of bowel adhesion.
Methods:
Thirty cases of laparoscopic ventral incisional hernia repairs (carried out by two surgeons or their senior registrars) have been retrospectively reviewed and reported in this article. The data were obtained from patient records and subsequent phone surveys.
Results:
Thirty patients between 29 and 82 years (mean: 58 years) underwent this procedure. There were 14 men and 16 women. The average weight of the patients was 81 kg. The hernias were up to 6 or 7 cm in diameter. Mesh was used in 28 cases (polypropylene in 25 cases, expanded polytetrafluoroethylene in two cases and composite mesh in one case). Most meshes were laid intraperitoneally and fixed into position with laparoscopic spiral tacks. Twenty-nine cases were completed laparoscopically. One operation (3.3%) was converted to an open procedure because of severe bowel adherence to the hernia sac. The mean operating time was 52 min for laparoscopic ventral incisional hernia repairs only. All but two patients tolerated an oral diet within 24 h. The postoperative hospital stay ranged from 0 to 11 days, with 17 patients (57%) staying overnight and eight patients (27%) staying another day. Over 80% of the patients returned to house duties within a week. There was no mortality, and minor complications occurred in four patients (14%). One patient had a small bowel obstruction treated successfully by repeat laparoscopy with division of fibrinous adhesions to polypropylene mesh on day four. Follow up ranged from 1 to 69 months (mean: 12 months). One patient did not attend follow-up appointments. There were three cases of hernia recurrence (10%).
Conclusion:
The results suggest that laparoscopic repair of ventral incisional hernias is a safe, effective and technically feasible operation for small- to medium-sized hernias allowing shorter hospital stay, early recovery and resumption of normal activities. However, recurrence rates are comparable to open mesh hernioplasty especially for larger hernias.
Insights
Laparoscopic ventral incisional hernia repair is safe and effective for small to medium hernias, offering faster recovery. However, recurrence rates are similar to open surgery, particularly for larger hernias.
Area of Science:
- General Surgery
- Minimally Invasive Surgery
- Abdominal Wall Reconstruction
Background:
- Laparoscopic ventral incisional hernia repair was introduced in 1993 but has seen limited adoption.
- Advancements in prosthetic mesh materials may mitigate issues like bowel adhesion.
Purpose of the Study:
- To evaluate the safety and efficacy of laparoscopic ventral incisional hernia repair.
- To assess outcomes including operative time, recovery, complications, and recurrence rates.
Main Methods:
- Retrospective review of 30 laparoscopic ventral incisional hernia repairs performed by two surgeons.
- Data collected from patient records and phone surveys.
- Analysis of hernia characteristics, mesh type, operative details, and patient outcomes.
Main Results:
- 30 patients (mean age 58 years) underwent the procedure, with mesh used in 28 cases.
- 29 repairs (96.7%) were completed laparoscopically; one conversion to open surgery due to adhesions.
- Mean operating time was 52 minutes, with most patients discharged within 2 days and early return to normal activities. No mortality occurred, and complication rates were low (14%).
- Follow-up averaged 12 months, with a hernia recurrence rate of 10%.
Conclusions:
- Laparoscopic ventral incisional hernia repair is a safe, feasible option for small to medium hernias, enabling shorter hospital stays and quicker recovery.
- Recurrence rates are comparable to open mesh hernioplasty, especially for larger hernias.