Incisional Hernia Following Laparoscopy: A Survey of the American Association of Gynecologic Laparoscopists

In order to estimate the risk factors and incidence of post-laparoscopy incisional hernias a one-page questionnaire was sent to all individuals on a mailing list purchased from the AAGL. Adequately completed responses were entered into a computer-based data bank for analysis. Of the 11,500 surveys mailed, 3293 were returned of which 3217 (28%) were evaluable. A total of 933 hernias were reported from an estimated 4,385,000 laparoscopic procedures (21 per 100,000). Of these, 167 (17.9%) were reported to have occurred despite fascial closure. Symptoms or hernia-related morbidity occurred in 648 cases (69.5%), with 157 instances (16.8%) of direct involvement of the large or small intestine. Six hundred sixty-five patients (71.3%) underwent subsequent surgical repair. Of the 840 hernias in which the size of the initial fascial defect was noted, 725 (86.3%) occurred in sites where 10 mm or greater ports had been placed. Respondents reported hernia location in 152 cases with the umbilical locale being the most common (75.7%). Lateral hernias comprised 23.7% of these cases and the suprapubic site was involved only once. In conclusion, post-laparoscopy incisional hernias are uncommon, but far from rare. They are most likely to occur when large ports are used and at the umbilical site. Closure as currently practiced is not completely protective. Further methods and/or devices must be developed so as to minimize the risk of hernia formation.