Laparoscopic repair of primary versus incisional ventral hernias: time to recognize the differences?

To elucidate the differences in the pathology of incisional and primary ventral hernias and the outcomes of their laparoscopic repair.

An operating room database of all laparoscopic ventral hernias performed between 2001 and 2009 was analyzed retrospectively. Patients were divided into two main groups: Group 1 (incisional hernias) and Group 2 (primary hernias). All P-values < 0.05 were considered to be significant.

There were 121 patients in Group 1 (mean age: 60.35 years) and 100 patients in Group 2 (mean age: 51.94 years). There was a significantly higher percentage of females in Group 1 (70 vs. 28%, P < 0.0001). There were significantly more complex hernias (defined as multiple points of weakness on the anterior abdominal wall) in Group 1 (37 vs. 10%, P < 0.0001). A total of 89% of patients required lysis of adhesions in Group 1 as compared with 73% in Group 2 (P = 0.007). There was a significantly higher percentage of conversions in Group 1 (9%) compared with Group 2 (2%, P = 0.02). The mean mesh size was significantly larger in Group 1 (243.22 vs. 131.46 cm(2)). The mean length of procedure (LOP) was significantly longer in Group 1 (113.94 min) as compared with Group 2 (70.96 min). The overall morbidity rate was not significantly different between the two groups (23 vs. 16%). The mean length of stay (LOS) was significantly longer for Group 1 (2.2 vs. 0.75 days, P < 0.0001). Finally, 22.3% of the patients in Group 1 were discharged on the same day as compared with 59% of the patients in Group 2 (P < 0.0001).

The LOP and LOS are longer after the laparoscopic repair of incisional than for primary ventral hernias. This disparity should be kept in mind when counseling patients and while designing trials investigating laparoscopic ventral hernia repairs (LVHRs).