Outcomes after laparoscopic ventral hernia repair: does the number of previous recurrences matter? A prospective...

It is not yet clearly known whether laparoscopic ventral hernia repair (LVHR) is superior to the open approach in recurrent hernias. The aim of this study is to determine the safety and efficacy of laparoscopic technique for ventral hernias and investigate whether these outcomes are affected by the number of previous failed repairs.

Data from 124 consecutive patients who underwent LVHR using a standardized technique between September 2007 and June 2014 were collected prospectively. In all repairs, a composite prosthesis was tailored to overlap the defect by at least 5 cm and fixed with a double crown of spiral tacks. Clinical follow-up visits were performed at 1 week, 1, 6, and 12 months, and yearly thereafter. Patients were classified in 3 groups (0, 1, and ≥ 2) according to the number of previous hernia repairs for further statistical analysis.

Long-term surveillance was available in 116 (93%) patients. Of these, 96 (82.8%) were recurrent hernias. There were 2 (1.7%) conversions, both in recurrent cases, and in 3 (2.6%) patients a hybrid access was used. Mean operating time was 55 min. There was an overall postoperative complication rate of 16%, with no mortality. During a mean follow-up of 30 (range 20-90) months, 3 (2.6%) recurrences were diagnosed 6, 8, and 9 months after surgery, respectively. A univariate analysis related to demographic, clinical, and perioperative variables did not find any significant relationship between the number of previous recurrences and operating time, conversion rate, hospital length of stay, overall morbidity, or recurrence.

This study suggests that laparoscopic approach in recurrent incisional hernias is a safe and feasible alternative to open techniques. Furthermore, our experience supports the idea that LVHR may be the best option for recurrent cases in properly selected patients, independently of the number of previous recurrences.