Long-term complications of laparoscopic ventral and incisional hernia repair

To date, there have been no long-term follow-up studies of the results of laparoscopic ventral and incisional hernia repair. We evaluated the long-term complications of these repairs over a mean follow-up period of 64 months. Between March 1993 and April 2000, we retrospectively evaluated 9 patients who underwent ventral or incisional hernia repair with prosthetic material and one patient who received laparoscopic primary closure of a hernia defect. The prosthetic material polypropylene was used in one patient and an expanded-polytetrafluoroethylene patch was used in the other 8. In one patient, the hernia was closed directly. In 7 patients, the prosthesis was fixed by stapling or tacking with no transfacial suture fixation and a 2-cm prosthesis overlap. In 2 later patients, we modified our technique by fixing the prosthesis by stapling or tacking with transfacial suture fixation and using prosthesis overlap of more than 3 cm. There were 2 episodes of hernia recurrence (20%), one of which required reoperation. Both occurred in patients in whom we used the unmodified repair technique. One of the patients in whom we used the unmodified technique developed a seroma which resolved spontaneously without antibiotic therapy. One patient in whom we used the modified technique developed infection (10%) requiring removal of the prosthetic material. The 2 episodes of hernia recurrence occurred 40 months after laparoscopic treatment, and the case of infection occurred 11 months after treatment. There were no episodes of recurrence in patients who received the unmodified surgery and had hernia defects less than 42 cm2. To perform safe and effective laparoscopic repair of ventral or incisional hernias, it is necessary to use a prosthetic overlap of more than 3 cm from the edge of the hernia gate and to use transfacial suture fixation with nonabsorbable sutures. In addition, patients who undergo laparoscopic ventral or incisional hernia repair should be observed for more than 5 years.