[Laparoscopic repair of incisional hernias]

The rationale for laparoscopic repair of incisional hernias lies in the fact that any kind of incisional hernia is caused by an intrinsic defect of wound healing. This means that the abdominal wall needs to be reinforced with foreign nonresorbable material. During laparoscopic repair a nonresorbable mesh with the characteristic feature that its two surfaces are quite different is used to completely cover the original incision. One surface is designed to ensure stable incorporation into the abdominal wall and the other, to keep adhesions between the mesh and the bowel to a minimum. Experience reported since its first description in 1993 has clearly shown that the main advantage of the laparoscopic technique over conventional methods is that it involves an extremely low risk of mesh infection. The reported recurrence rates of 1-11% are mainly attributable to technical error and demonstrate that in this way too, the laparoscopic technique is at least as good as the open techniques. Up to now, no mesh-related complications in the form of fistula or mesh migration have been described. In conclusion, then, laparoscopic repair of ventral hernia is an important addition to the surgical armamentarium, which at least in our hands has almost completely replaced conventional techniques.