Abdominal Wall Hernia

Midline versus nonmidline laparoscopic incisional hernioplasty: a comparative study

BACKGROUND

Nonmidline incisional hernia is a surgical problem of major interest, but to date, little information on this problem is available. This study aimed to analyze the results of nonmidline laparoscopic incisional hernioplasty in a multidisciplinary abdominal wall unit over the past 10 years.

METHODS

This prospective study examined a series of 199 patients undergoing surgery for incisional hernia via the laparoscopic approach: 146 midline and 53 nonmidline. A comparative analysis compared midline and nonmidline defects, and a descriptive analysis compared four nonmidline types: 18 lumbar, 11 subcostal, 14 inguinal, and 10 lateral. Clinical and follow-up parameters were assessed during a mean follow-up period of 64 months (range, 12-120 months).

RESULTS

The nonmidline incisional hernias were significantly larger, involved more preoperative pain, and required a longer hospital stay than the midline incisional hernias (p < 0.001). Also, the intraoperative complications and the consumption of analgesics were more frequent in the nonmidline group (p < 0.05). The postoperative morbidity and recurrence rates were similar in the two groups. No statistical differences were noted between the four types of nonmidline incisional hernias. The most common nonmidline type was lumbar hernia (34%). Hematomas (17%) predominated in the inguinal types, and pain predominated in the lumbar types. Two early recurrences were diagnosed for poor mesh placement: one subcostal and one lumbar.

CONCLUSIONS

Laparoscopic incisional hernioplasty can be applied to nonmidline defects with the same rates of morbidity and recurrence as for patients with midline defects. The four types of nonmidline defects seem to have their own evolutionary characteristics.

Tratamiento de la eventración no medial: experiencia de una unidad de pared abdominal y revisión de la literatura

INTRODUCTION

Lateral ventral hernia is an interesting surgical problem. However, few data are available on this entity.

OBJECTIVE

To review current knowledge of lateral ventral hernia and present our experience of this entity in a multidisciplinary abdominal wall unit.

PATIENTS AND METHOD

A.

LITERATURE REVIEW

a search of Spanish (Cirugía Española) and international literature was performed through MEDLINE using the key words "lateral incisional/ventral hernia". B. Clinical study: a series of 53 patients who underwent endoscopic surgery for non-midline ventral hernia were prospectively studied. Clinical parameters, postoperative complications and the recurrence rate were evaluated. The mean follow-up was 64 months (range, 12-120 months).

RESULTS

A.

LITERATURE REVIEW

we found a ratio between chapters on inguinal hernia and ventral hernia of 3.8:1 and a complete absence of chapters on lateral ventral hernia. Only two articles specifically dealt with ventral hernia. B. Clinical study: the most frequent location was lumbar (34%), followed by iliac and subcostal. A total of 37.7% of patients could be treated without admission and the remaining patients had a mean length of hospital stay of 2.7 days. Hematoma (17%) predominated in iliac ventral hernias and pain was transitory in two patients with lumbar ventral hernia. There were two early recurrences due to incorrect mesh fixation in subcostal and lumbar ventral hernias.

CONCLUSIONS

Non-midline ventral hernia is a little known entity. Future treatment should be individualized in each patient and should be based on common classification of the type of defect to correctly evaluate the results. The laparoscopic route provides competitive results in selected patients.