Laparoscopic incisional and ventral hernia repair

Sutureless "Slim-Mesh" Technique for the Repair of Abdominal-Wall Hernias in the Obese Population

Background and Objectives

In 2009, we designed the sutureless "Slim-Mesh" laparoscopic technique to facilitate and promote repair of ventral hernias in the obese/superobese populations, including cases with large-giant/massive and multiple widely-spaced hernias. We also aimed to reduce surgical time and intra- and postoperative complications.

Methods

Cases were divided into Class I (body mass index [BMI] 30.0-34.9 kg/m2), II (35.0-39.9 kg/m2), III (40.0-49.9 kg/m2), and superobese (50.0-59.9 kg/m2). A ventral hernia was small-medium (∅ 2-9.9 cm), or large (∅ 10-14.9 cm)-giant (∅ 15-19.9 cm)/massive (∅ ≥ 20 cm). Between September 2009 and May 2023, 64 obese/superobese ventral-hernia patients were enrolled prospectively (81%)-retrospectively and treated with the Slim-Mesh technique.

Results

We operated on 35 males and 29 females. Mean age and BMI were 60 years old and 33 kg/m2, respectively. Class I cases numbered 48, II 13, III 2, with 1 superobese case. Small-medium, large-giant, and massive ventral hernias were found intraoperatively in 40, 21, and 3 cases, respectively. Mean surgical time for all cases was 104 minutes. Mean length of hospital stay was 2 days and mean follow-up time was 5 years. We had 1 case of chronic abdominal-wall pain and 6 late postoperative-complications: 4 (6%) hernia recurrences, and 2 trocar-site hernias.

Conclusion

The sutureless "Slim-Mesh" technique implements the laparoscopic approach to repair ventral hernias in the obese/superobese populations rather than open surgery or traditional transfixation suture-based laparoscopy, including cases with large-giant/massive and multiple widely-spaced hernias. This study proves that "Slim-Mesh" is safe, straightforward, quick, easy-to-reproduce, and economical.

The Evolving Applications of Laparoscopic Intracorporeal Rectus Aponeuroplasty (LIRA) in Ventral Hernia Repair-A Systematic Review

Purpose

Laparoscopic intracorporeal rectus aponeuroplasty (LIRA), emerged as a method that combines benefits from minimally invasive and abdominal wall reconstruction with defect closure, restoring the midline without tension by folding the posterior aponeurosis of both abdominal rectus muscles and using intraperitoneal mesh repair. We aimed to perform a systematic review of the existing evidence on LIRA results and potential applications.

Source

A thorough search of Cochrane Central, Scopus, SciELO, LILACS, and PubMed/MEDLINE, focusing on studies that explored LIRA's possible applications and results was performed. Key outcomes evaluated included recurrence, seroma, hematoma, surgical site infection (SSI), and length of hospital stay. We included both analytic data and descriptive studies.

Principal Findings

Out of 128 screened studies, three met the inclusion criteria and comprised 113 patients, of which 69 (61.1%) were operated using LIRA. Three studies comprised two case series of conventional and robotic LIRA repair, and one comparative study of LIRA versus intraperitoneal underlay mesh repair (IPUM plus). No surgical site infections were reported. Seroma rates ranged between 11.1% and 50%, while no bleeding or hematoma was noted. There were no patients presenting recurrence in a median follow-up ranging from 12 to 15 months, despite the comparative study reporting a 4.4% rate of bulging without clinical recurrence. The mean length of hospital stay ranged from 12 to 36 h. LIRA presented no differences in postoperative complications compared to the IPUM plus technique.

Conclusion

LIRA is linked to low recurrence and postoperative complications. It is a novel approach with potential applications in various types of primary and incisional ventral hernias.

Pitfalls and complications of enhanced-view totally extraperitoneal approach to abdominal wall reconstruction

BACKGROUND

The enhanced-view totally extraperitoneal access technique (eTEP) to minimally invasive retromuscular abdominal wall reconstruction is a relatively novel technique that has continued to gain popularity. There is a paucity of information regarding the prevention and management of eTEP complications. We reviewed the literature to evaluate the complications reported with eTEP ventral hernia repair and discuss the main complications associated with this technique.

METHODS

A literature search via PubMed was performed focusing on eTEP ventral hernia repair. Based on the available literature and own practice experience, the authors discuss key strategies for preventing and managing complications associated with the eTEP approach.

RESULTS

One hundred fifty studies were identified. Forty-seven studies were fully reviewed and twenty-four were included in this review. The technical details of the technique were described as performed by the authors. Postoperative complications were classified into different categories and discussed separately.

CONCLUSION

As the eTEP approach continues to gain popularity, it is essential to consider its unique complications. A focus on prevention with anatomical bearings and sound surgical technique is paramount.

Long-term outcomes of seromas after ventral hernia repair: a propensity score-matched analysis of the Abdominal Core Health Quality Collaborative

PURPOSE

Seromas can occur after ventral hernia repairs (VHR), but little is known about their relevance to short- and long-term outcomes. We aimed to determine if there is a correlation between seroma occurrence after clean VHR with mesh and patient-reported and clinical outcomes.

METHODS

Patients with and without seromas in the Abdominal Core Health Quality Collaborative registry were compared using a propensity score-matched analysis. Outcomes included hospital readmissions, postoperative antibiotics use, and procedural interventions. Pain and hernia-related quality of life were assessed at 30 days and 1 year. Composite hernia recurrence rates were compared at 1 year.

RESULTS

Propensity score matching compared 218 patients with a seroma to 649 without a seroma. At 30 days, patients with seromas were more likely to be readmitted (27 (12%) vs 28 (4%), respectively; P < 0.001), receive postoperative antibiotics (25 (12%) vs 18 (3%), respectively; P < 0.001), and undergo procedural interventions (41 (19%) vs 23 (4%), respectively; P < 0.001) than patients without seromas. Surgical site occurrences were more common in patients with seromas than those without seromas at 1 year (12 (11%) vs 12 (4%), respectively; P = 0.01).Pain and hernia-related quality of life were similar for both groups at 30 days and 1 year. Composite hernia recurrence rates were similar for both groups at 1 year (37 seroma (17%) vs 115 no seroma (18%); P = 0.80).

CONCLUSION

Seromas after clean VHR with mesh were associated with short- and long-term morbidity, but they did not significantly impact quality of life or hernia recurrences at 1 year.

Intraperitoneal versus extraperitoneal mesh in minimally invasive ventral hernia repair: a systematic review and meta-analysis

PURPOSE

The ideal location for mesh placement in minimally invasive ventral hernia repair (VHR) is still up for debate. We undertook a systematic review and meta-analysis (SRMA) to evaluate the outcomes of patients who received intraperitoneal mesh versus those that received extraperitoneal mesh in minimally invasive VHR.

METHODS

We searched PubMed, EMBASE, Cochrane, and Scopus from inception to May 3, 2021. We selected studies comparing intraperitoneal mesh versus extraperitoneal mesh placement in minimally invasive VHR. A meta-analysis was done for the outcomes of surgical site infection (SSI), seroma, hematoma, readmission, and recurrence. A subgroup analysis was conducted for a subset of studies comparing patients who have undergone intraperitoneal onlay mesh (IPOM) versus extended totally extraperitoneal approach (e-TEP).

RESULTS

A total of 11 studies (2320 patients) were identified. We found no statistically significant difference between patients who received intraperitoneal versus extraperitoneal mesh for outcomes of SSI, seroma, hematoma, readmission, and recurrence [(RR 1.60, 95% CI 0.60-4.27), (RR 1.39, 95% CI 0.68-2.81), (RR 1.29, 95% CI 0.45-3.72), (RR 1.40, 95% CI 0.69-2.86), and (RR 1.22, 95% CI 0.22-6.63), respectively]. The subgroup analysis had findings similar to the overall analysis.

CONCLUSION

Based on short-term results, extraperitoneal mesh does not appear to be superior to intraperitoneal mesh in minimally invasive ventral hernia repair. The choice of mesh location should be based on the current evidence, surgeon, and center experience as well as individualized to each patient.

Hybrid approach for ventral incisional hernias of the abdominal wall: A systematic review of the literature

With increasing complexity of ventral incisional hernias being operated on, the treatment strategy has also evolved to obtain optimal results. Hybrid ventral hernia repair is a promising technique in management of complex/difficult ventral incisional hernias. The aim of this article is to review the literature and analyse the results of hybrid technique in management of ventral incisional hernia and determine its clinical status and ascertain its role. We reviewed the literature on hybrid technique for incisional ventral hernia repair on PubMed, Medline and Google Scholar database published between 2002 and 2019 and out of 218 articles screened, 10 studies were included in the review. Selection of articles was in accordance with the PRISMA guideline. Variables analysed were seroma, wound infection, chronic pain and recurrence. Qualitative analysis of the variables was carried out. In this systematic review, the incidence of complications associated within this procedure were seroma formation (5.47%), wound infections (6.53%) and chronic pain (4.49%). Recurrence was seen in 3.29% of patients. Hybrid ventral hernia repair represents a natural evolution in advancement of hernia repair. The judicious use of hybrid repair in selected patients combines the safety of open surgery with several advantages of the laparoscopic approach with favourable surgical outcomes in terms of recurrence, seroma and incidence of chronic pain. However, larger multi-centric prospective studies with long term follow up is required to standardise the technique and to establish it as a procedure of choice for this complex disease entity.

Seroma prevention strategies in laparoscopic ventral hernia repair: a systematic review

BACKGROUND

Laparoscopic ventral hernia repair (LVHR) has been increasing in popularity over the years. Seroma formation is a common complication of LVHR. The aim of this study is to review the current evidence on seroma prevention strategies following LVHR.

METHODS

A systematic search of PubMed, Embase (1946-13 February 2019) and Medline (1946-13 February 2019) databases was conducted using terms which include "seroma", "hernia, ventral" and "laparoscopy". All studies are comparative retrospective or prospective human adult studies in peer-reviewed journals describing at least one intra-operative intervention designed to decrease the rate of seroma formation in laparoscopic ventral hernia repair.

RESULTS

The database searches identified 3762 citations, and 21 studies were included for final analysis. Five studies compared the different methods of mesh fixation, nine studies compared primary defect closure (PFC) and bridged repair, two studies compared the effect of different types of meshes, two studies looked into the use of electrical cauterization, one study compared single- site laparoscopy with conventional laparoscopy, one study looked into the use of fibrin sealant and one study compared transabdominal preperitoneal placement of mesh with conventional repair. PFC appears to be the most promising with large studies showing a low rate of seroma formation with additional benefits of decreasing wound infection and recurrence rate. Cauterisation of hernia sac and injection of fibrin sealant also show promising results but are mainly derived from small studies. Other strategies did not demonstrate benefit.

CONCLUSION

Currently, primary fascial closure appears to be the most promising strategy available to decrease seroma formation after LVHR based on the results of large studies. Other promising strategies that decrease dead space such as cauterisation of the sac and fibrin sealant injection will require further multicentre trials to confirm benefit before an increase in operative time and cost can be justified for their routine use.

Laparoscopic Incisional and Ventral Hernia Repair with Absorbable Tacks in a Long Term Follow-up: A Retrospective Control Study

BACKGROUND

Laparoscopic Incisional and Ventral Hernia Repair (LIVHR) is a safe and worldwide accepted procedure performed using absorbable tacks. The aim of the study was to evaluate recurrence rate in a long term follow-up and whether the results of laparoscopic IVH repair in the elderly (≥65 years old) are different with respect to results obtained in younger patients.

METHODS

One hundred and twenty-nine consecutive patients (74 women and 55 men, median age 67 years, range = 30-87 years) with ventral (N = 42, 32.5%) or post incisional (N = 87, 67.5%) hernia were enrolled in the study. Patients were divided into two groups according to their age: group A (N = 55, 42.6%) aged <65 years and group B (N = 74, 57.4%) aged ≥65 years.

RESULTS

The mean operative time was not significantly different between groups (66.7 ± 37 vs. 74 ± 48.4 min, p = 0.4). To the end of 2016, seven recurrences had occurred (group A = 3, group B = 4, p = 1). Complications occurred in 8 (16%) patients in group A and 21 (28.3%) patients in group B.

CONCLUSION

In conclusion, our results confirm that the use of absorbable tacks does not increase recurrence frequency and laparoscopic incisional and ventral repair is a safety procedure also in elderly patients.

The use of adjuncts to reduce seroma in open incisional hernia repair: a systematic review

BACKGROUND

Seroma formation remains a common complication after an incisional hernia repair. The use of surgical drains is widespread, but evidence for their use and other adjuncts is limited. Our aim was to perform a systematic review of the literature on techniques used to reduce the incidence of post-operative seroma formation.

METHODS

A systematic search of PubMed and Embase databases was conducted using terms including "incisional hernia" and "seroma". All studies on adults undergoing open incisional hernia repair with at least one intervention designed to reduce seroma formation were included.

RESULTS

Of the 1093 studies identified, 9 met the inclusion criteria. Medical talc: one cohort study of 74 patients undergoing talc application following pre-peritoneal mesh placement found a significantly decreased rate of seroma formation of 20.8 versus 2.7% (p < 0.001), but a retrospective study including 21 patients with onlay mesh found an increased rate of 76% seroma formation from 9.5% (p = 0.001). Fibrin glue: one comparative study including 60 patients found a reduction in seroma formation from 53 to 10% (p = 0.003), whereas a retrospective study of 250 patients found no difference (11 vs. 4.9% p = 0.07). Negative pressure wound therapy: four retrospective studies including a total of 358 patients found no difference in seroma outcome. Others: one randomised study of 42 patients undergoing either suction drainage or "quilting" sutures found no difference in seroma formation.

CONCLUSIONS

There is currently insufficient quality evidence to recommend any of the investigated methods, some of which incur significant additional cost.

Laparoscopic repair of ventral/incisional hernias with the "Slim-Mesh" technique without transabdominal fixation sutures: preliminary report on short/midterm results

This study details our experience with a new laparoscopic technique called "Slim-Mesh" without using transabdominal full-thickness stitches, to treat ventral and incisional hernias (V/IH). Since 2009-May 2015, 28 consecutive patients with V/IH were treated in our center, with this new SM technique. Fifty percent males were included in this retrospective study, averaging 59 years (range 31-81 years). Mean body mass index was 26 and VH size was <10 cm in 24 cases and in 4 cases was larger, up to 22 cm. Mean operative time in the 28 V/IH patients was 97 min (range 57-160 min) and in those with V/IH larger than 10 cm it was 135 min. In 14.2% of patients laparoscopy diagnosed others V/IH previously undetected by physical examination and CT-scan. In all patients a composite mesh was used, up to 30 cm in size. In this series we had one intraoperative complication (3.6%) with transient bradycardia, but no conversion occurred; no early postoperative complication was detected. Mean length of hospital stay was 3.0 days. Mean follow-up time was 40 months (range 13-78 months). Late surgical complications included one case (3.6%) of incisional hernia recurrence and one case of 10 mm trocar site incisional hernia. This new surgical technique for V/IH repair, makes easy the handling and fixation of the composite mesh without using transabdominal fixation sutures, and appears in our experience fast, and simple.

Abdominal wall reconstruction

Abdominal wall hernias can be challenging and complicated to manage. The techniques to deal with them are evolving rapidly with increasing adaptation and utilization in general surgery.

Prosthetic mesh "slim-cigarette like" for laparoscopic repair of ventral hernias: a new technique without transabdominal fixation sutures

Prosthetic mesh rolled up and fixed with stitches like a slim cigarette ("slim-mesh") for laparoscopic ventral hernia (VH) repair is an new technique which allows an easy intraperitoneally introduction, distension and circumferential fixation of a prosthetic mesh without transabdominal fixation sutures even for meshes larger than 16 cm up to 30 cm for the "slim-mesh" repair of wide ventral hernias. We report the technique of laparoscopic repair of VH with "slim-mesh". This technique enables an easy intra-peritoneally introduction of the mesh through the trocar because it reduces consistently its size, it allows a rapid intra-abdominal handling of the mesh and a fast and easy fixation for VH repair. The average time of surgery with "slim-mesh" for treatment of all 28 VH was 97 min ranging from 57 to 160 min. The average time for the repair of the 24 VH smaller than 10 cm was 91 and 135 min for the four VH larger than 10-22 cm. This new surgical technique leads to a reduction of surgical risks avoiding the use of transfascial sutures with the associated complications. This new surgical procedure in our experience is fast, safe, simple and also easily reproducible by surgeons in laparoscopic training. This technique may be used in wide VH (larger than 10-22 cm) that generally require open surgery.

The usefulness of laparoscopic hernia repair in the management of incisional hernia following liver transplantation

INTRODUCTION

The reported incidence of incisional hernia following orthotopic liver transplantation (OLT) varies from 4% to 23%. Postoperative wound complications are less frequent after laparoscopic repair while maintaining low recurrence rates. We present our experience in managing this complication.

MATERIALS AND METHODS

Retrospectively, collected data of all patients who underwent liver transplant and developed incisional hernias were analyzed. Patients' demographic data, anthropometric data, transplantation-related data, and repair-related operative and postoperative data were collected. Risk factors for post-transplant incisional hernia were appraised in our patients. Patients were divided into two groups: Group A included patients who had their incisional hernia repaired through the laparoscopic approach, and Group B included patients who had their incisional hernia repaired through open conventional approach.

RESULTS

A total of 488 liver transplantations were performed at our institution between May 2001 and end of December 2012. Thirty-three patients developed incisional hernias after primary direct closure of the abdominal wall with an overall incidence of 6.9%. Hernia repair was done in 25 patients. Follow-up ranged from 6.4 to 106.1 months with a mean of 48.3 ± 28.3 months. All patients were living at the end of the follow up except four patients (16%). Group A included 13 patients, and Group B included 12 patients. The size of defects and operative time did not differ significantly between both the groups. On the other hand, hospital stay was significantly shorter in laparoscopic group. Complication rate following laparoscopic repair was insignificantly different for open repair.

CONCLUSION

In experienced hands, laparoscopic incisional hernia repair in post-liver transplant setting proved to be a safe and feasible alternative to open approach and showed superior outcome expressed in shorter hospital stay, with low recurrence and complication rate.

Proposal of ecographic classification for seroma after laparoscopic ventral hernia repair

INTRODUCTION

Seroma is one of the most common complications after laparoscopic ventral hernia repair (LVHR), even if the incidence brought in literature is varying because definition and criterions of evaluation employed in the different studies are not always the same. This study proposes a classification for seroma after LVHR based on ultrasound findings, useful for an assessment of this complication.

MATERIALS AND METHODS

On 93 patients submitted to LVHR an ultrasound of the abdominal wall after 3, 7, 15, 21 and 28 days and subsequently at a distance of 3 and 6 months was performed postoperatively. At each control site, sonomorphology characteristics and size of seroma (if present) were noted.

RESULTS

At the end of the study using ultrasound findings obtained, a classification scheme for seroma articulated into three groups based on the parameters detected (site, sonomorphology character and volume) was developed, each of which is subdivided into five different classes to which a precise score is assigned. From the sum of the scores assigned, a value (between 3 and 15) that represents a prognostic index (PI) is obtained. A low PI is typical of small asymptomatic seroma that resolves spontaneously in a short time and without the need for invasive therapies; a high PI is typical of more or less symptomatic voluminous seroma that tends to persist for long periods and which often requires an interventional therapeutic approach.

CONCLUSIONS

This proposed classification helps to perform a precise nosological assessment of seroma after LVHR, allowing the surgeon to predict the clinical and temporal evolution of this complication and to plan appropriate therapy from time to time. Furthermore this classification can represent a tool to assess the uniqueness of seroma formation in relation to surgical technique used, to the type of material employed and to the method of mesh fixing.

Correspondence: Laparoscopic repair of abdominal wall hernia--"How I do it"--synopsis of a seemingly straightforward technique

Abdominal wall hernia repairs are commonly performed worldwide in general surgery. There is still no agreed consensus on the optimal surgical approach. Since the turn of the twenty-first century, minimally invasive techniques have gained in popularity as they combine the advantages of limited abdominal wall dissection, reduced post-operative pain and risk of complications, and shorter hospital stay. Although the added cost incurred by using sophisticated laparoscopic instruments may be quite substantial, it is precisely counterbalanced by an improved morbidity rate, faster discharge home and time to return to work. Laparoscopic abdominal wall hernia repair is often challenging, as it requires good anatomical knowledge, eye-hand coordination and diversified laparoscopic skills. The objective of this article is not to present another set of personal data and to compare it with already published results on this matter, but simply to offer comprehensive guidelines on the practical aspects of this relatively new technique. Some of these steps have already been discussed but most of the time in a scattered way in the surgical literature, while others are the fruit of a personal expertise grasped over the years.

A new classification for seroma after laparoscopic ventral hernia repair

INTRODUCTION

Laparoscopic techniques are being used increasingly in the repair of ventral hernias, but different incidences and complications have been described as potential risks of this approach. Seroma formation has been documented as one of the most common complication, although most of the time remains asymptomatic and it can be considered just an incident. The incidence of seroma after laparoscopic ventral hernia repair has not been properly documented and analyzed since the definition used by different authors is not the same from one series to another. We present a new classification of clinical seroma in order to try to establish the real incidence of this potential complication.

CLINICAL CLASSIFICATION

Clinical seromas could be detected during physical examination in many patients after LVHR, but in most of the cases they do not cause any problem or just a minimum discomfort that allows normal activity. Based on this fact and on the need of carrying out a medical or an invasive therapy to treat them, five groups can be established in order to classified this entity: Type 0, no clinical seroma (being 0a no seroma after clinical examination and radiological examinations and 0b those detected radiologically but not detected clinically); Type I, clinical seroma lasting less than 1 month; Type II (seroma with excessive duration), clinical seroma lasting more than 1 month (being IIa between 1 and 3 months and IIb between 3 and 6 months); Type III (symptomatic seromas that may need medical treatment), minor seroma-related complications (seroma lasting more than 6 month, esthetic complaints of the patient due to seroma, discomfort related to the seroma that does not allow normal activity to the patient, pain, superficial infection with cellulites); and Type IV (seroma that need to be treated), mayor seroma-related complications (need to puncture the seroma, seroma drained spontaneously, applicable to open approach, deep infection, recurrence and mesh rejection). It is important to differentiate between a complication and an incident, being considered seroma as an incident if it is classified as seroma Type I or II, and a complication if it is included in group III and IV. The highest classification is the one that should be used in order to describe the type of seroma.

CONCLUSIONS

Seroma is one of the most common complications after laparoscopic ventral hernia repair although its real clinical incidence is variable since it has been described in the literature following different parameters. It is observed in almost all cases by radiological examinations, but it is not determined if must be considered an incident or a complication. For these reasons, a new classification of seroma has been proposed in order to unify criteria among surgeons when describing their experience. This classification could be also used in the future to measure the effect of new methods proposed to reduce seroma formation to evaluate the incidence of seroma depending on the mesh used, and it could be also proposed to be used to describe the incidence of seroma after open ventral hernia repair.

Laparoscopic versus open surgical techniques for ventral or incisional hernia repair

BACKGROUND

There are many different techniques currently in use for ventral and incisional hernia repair. Laparoscopic techniques have become more common in recent years, although the evidence is sparse.

OBJECTIVES

We compared laparoscopic with open repair in patients with (primary) ventral or incisional hernia.

SEARCH STRATEGY

We searched the following electronic databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, metaRegister of Controlled Trials. The last searches were conducted in July 2010. In addition, congress abstracts were searched by hand.

SELECTION CRITERIA

We selected randomised controlled studies (RCTs), which compared the two techniques in patients with ventral or incisional hernia. Studies were included irrespective of language, publication status, or sample size. We did not include quasi-randomised trials.

DATA COLLECTION AND ANALYSIS

Two authors assessed trial quality and extracted data independently. Meta-analytic results are expressed as relative risks (RR) or weighted mean difference (WMD).

MAIN RESULTS

We included 10 RCTs with a total number of 880 patients suffering primarily from primary ventral or incisional hernia. No trials were identified on umbilical or parastomal hernia. The recurrence rate was not different between laparoscopic and open surgery (RR 1.22; 95% CI 0.62 to 2.38; I(2) = 0%), but patients were followed up for less than two years in half of the trials. Results on operative time were too heterogeneous to be pooled. The risk of intraoperative enterotomy was slightly higher in laparoscopic hernia repair (Peto OR 2.33; 95% CI 0.53 to 10.35), but this result stems from only 7 cases with bowel lesion (5 vs. 2). The most clear and consistent result was that laparoscopic surgery reduced the risk of wound infection (RR = 0.26; 95% CI 0.15 to 0.46; I(2)= 0%). Laparoscopic surgery shortened hospital stay significantly in 6 out of 9 trials, but again data were heterogeneous. Based on a small number of trials, it was not possible to detect any difference in pain intensity, both in the short- and long-term evaluation. Laparoscopic repair apparently led to much higher in-hospital costs.

AUTHORS' CONCLUSIONS

The short-term results of laparoscopic repair in ventral hernia are promising. In spite of the risks of adhesiolysis, the technique is safe. Nevertheless, long-term follow-up is needed in order to elucidate whether laparoscopic repair of ventral/incisional hernia is efficacious.

Laparoscopic repair of incisional hernias located on the abdominal borders: a retrospective critical review

BACKGROUND

The aim of this study was to assess feasibility and results of laparoscopic approach to repair incisional hernias of the abdominal borders, the weakest points of abdominal wall.

METHODS

Since 2002 through 2008 a total of 39 patients with fascial defects of the abdominal borders underwent laparoscopic repair. The defects were suprapubic (n=18), subxiphoidal (n=15), and lateral sided (n=6). The body mass index was >oe=30 Kg/m2 in 19 patients. The parietal defects was measured both externally and from within the peritoneal cavity and 56% of meshes were fixed only by tacks, especially in suprapubic site.

RESULTS

The mean operating time was 161.8+/-25 minutes. There was 1 intraoperative complication, an intestinal injury repaired laparoscopically. Conversion was needed in 1 patient for massive adhesions. Postoperative early surgical complications were 7 (1 seroma). Morbidity in obese and nonobese patients showed no statistically relevant difference (P>0.05). There was no postoperative death. Mean hospital stay was 5.1+/-3 days. The mean follow-up was 37 months and recurrence was observed in 3 cases.

CONCLUSIONS

The onlay laparoscopic approach for repair of incisional hernias of the abdominal borders can warrant good results. Obesity is not a contraindication to laparoscopic repair. Anyway, further experiences are necessary to confirm these results.