Laparoscopic management of nonmidline ventral hernia

Ventral hernias may be primary or incisional and classified as midline ventral hernias (MVHs) or non-MVHs (NMVHs). NMVHs are rarer, and their laparoscopic management is technically challenging because of varied anatomic locations, differences in patient positioning at time of surgery, and lack of adequate lateral space for mesh fixation, compounded by the proximity of major organs and bony landmarks. A retrospective review of all the NMVHs operated on in a clinical unit is presented.

One hundred eighty-three cases met the criteria of ventral hernia, with 25 cases (13.66%) as NMVH. These NMVHs included lumbar (n=5), suprapubic (n=7), iliac (n=10), and subcostal (n=3). Univariate and multivariate analyses were done using SPSS version 19 software (IBM, Armonk, NY). Continuous data were analyzed using the Mann-Whitney U test/t test, and categorical data were analyzed using the chi-squared test. A P value of ≤.05 was considered significant.

Demographic profile and presentation were similar in all groups. One case each had seromuscular intestinal injury in the iliac group (P=.668), splenic injury in the lumbar group, and liver injury in the subcostal group (P=.167). In the iliac group there was 1 patient with hematoma (P=.668), whereas seroma was seen in 1 lumbar group patient and 2 iliac group patients (P=.518). Persistent cough impulse was seen in 1 case each in the iliac and lumbar groups (P=.593). One case in the iliac group recurred after primary surgery (P=.668).

NMVHs have a similar spectrum of difficulty and complication profile as those of laparoscopic MVH repairs. Laparoscopic repair of a non-midline hernia is technically challenging but definitely feasible. The incidence of complications and recurrence rate might be more than those for MVHs, but its actual validation needs a much larger comparative study having a longer follow-up.