Controversies in laparoscopic ventral hernia repair

The introduction of laparoscopy as a surgical technique provided a method preventing major abdominal wall incisions and improving recovery of the patient after surgery. In abdominal wall surgery laparoscopic ventral hernia repair has proven to be at least as save as open repair. However, the technique of laparoscopic ventral hernia repair has not been standardized. Despite all the research that has been conducted and all the articles that were published, there still seems to be absence of consensus about the best method to repair a ventral hernia.

To review knowledge on incisional hernias and discuss several controversies regarding the laparoscopic management of ventral hernias.

A review of the literature was undertaken.

A search identified twenty records: six RCTs on incisional hernias, five RCTs on ventral hernias and nine reviews or meta-analyses. Interpretation of the scientific data is difficult because the outcomes in literature are often based on pooled data of primary ventral hernias and incisional ventral hernias. Controversy remains regarding the optimal laparoscopic management of ventral hernias in terms of selection of patients for laparoscopic repair, optimal technique, outcomes and cost-efficacy.

Lack of evidence allows persisting controversies in laparoscopic ventral hernia repair. RCTs and registries are necessary to document efficacy, morbidity, quality of life and costs during a sufficient period of time to provide clinicians with the evidence required to make the right choice for the best surgical technique.