Abstract
Background
The role of the laparoscopic approach in the repair of non-midline incisional hernias is controversial due to the absence of adequate scientific studies. This study aimed to determine the safety and efficacy of laparoscopic repair for non-midline incisional hernias.
Methods
This prospective clinical study was conducted in an abdominal wall unit of a teaching hospital. Patients underwent surgery for non-midline incisional hernias using the laparoscopic approach (n = 73) and were classified into three groups: subcostal, iliac, and lumbar. The primary end point was recurrence. The secondary end points were intraoperative parameters, comorbidity, and patient outcomes. The median follow-up period was 62 months (range, 36–170 months).
Results
No hospital stay was needed for 34% of the patients. The remaining patients needed an average hospital stay of 2.7 days. The most frequent morbidity was hematoma. The overall recurrence rate was 8.2% and was higher for the subcostal hernias (25%). The three groups differed in size, local morbidity, and recurrence (P < 0.05). The independent risk factors for recurrence were size (hazard ratio [HR], 2.16; 95% confidence interval [CI], 1.08–4.33) and local morbidity (HR 30.62; 95% CI 1.22–768-82). The best predictor of recurrence was a hernia diameter greater than 15 cm. The only predictive factor of local morbidity was obesity (P < 0.007).
Conclusions
The laparoscopic approach is a safe and effective treatment for non-midline incisional hernias. Caution should be taken with subcostal hernias, obese patients, and a defect size greater than 15 cm. An algorithm is suggested to guide the “rational” treatment of non-midline incisional hernias.
Similar content being viewed by others
References
Goodney PP, Birkmeyer CM, Birkmeyer JD (2002) Short-term outcomes of laparoscopic and open ventral hernia repair: a meta-analysis. Arch Surg 137:1161–1165
Park AE, Roth JS, Kavic SM (2006) Abdominal wall hernia. Curr Probl Surg 43:326–375
Korenkov M, Paul A, Sauerland S, Neugebauer E, Arndt M, Chevrel JP, Corcione F, Fingerhut A, Flament JB, Kux M, Matzinger A, Myrvold HE, Rath AM, Simmermacher RKJ (2001) Classification and surgical treatment of incisional hernia: results of an experts’ meeting. Langenbecks Arch Surg 386:65–73
Tagaya N, Mikami H, Aoki H, Kubota K (2004) Long-term complications of laparoscopic ventral and incisional hernia repair. Surg Laparosc Endosc Percutan Tech 14:5–8
Bingener J, Buck L, Richards M, Michalek J, Schwesinger W, Sirinek K (2007) Long-term outcomes in laparoscopic vs open ventral hernia repair. Arch Surg 142:562–572
Itani KM, Hur K, Kim L, Anthony T, Berger DH, Reda D, Neumayer L (2010) Comparison of laparoscopic and open repair with mesh for the treatment of ventral incisional hernia: a randomized trial. Arch Surg 145:322–328
Rudmik LR, Schieman C, Dixon E, Debru E (2006) Laparoscopic incisional hernia repair: a review of the literature. Hernia 10:110–119
Chevrel JP, Rath AM (2000) Classification of incisional hernias of the abdominal wall. Hernia 4:7–11
Forbes SS, Eskicioglu C, McLeod RS, Okrainec A (2009) A meta-analysis of randomized controlled trials comparing open and laparoscopic ventral and incisional hernia repair with mesh. Br J Surg. 96:851–858
Sajid MS, Bokhari SA, Mallick AS, Cheek E, Baig MK (2009) Laparoscopic versus open repair of incisional/ventral hernia: a meta-analysis. Am J Surg 197:64–72
Park A, Birch DW, Lovrics P (1998) Laparoscopic and open incisional hernia repair: a comparison study. Surgery 124:816–822
Ramshaw BJ, Esartia P, Schwab J (1999) Comparison of laparoscopic and open ventral herniorrhaphy. Am Surg 65:827–831
Carbajo MA, Martín del Olmo JC, Blanco JI, de la Cuesta C, Toledano M, Martin F (1999) Laparoscopic treatment vs open surgery in the solution of major incisional and abdominal wall hernias with mesh. Surg Endosc 11:32–35
Heniford BT, Park A, Ramshaw BJ, Voeller G (2003) Laparoscopic repair of ventral hernias. Nine years’ experience with 850 consecutive hernias. Ann Surg 238:391–400
Moreno-Egea A, Carrillo A, Aguayo JL (2008) Midline versus nonmidline laparoscopic incisional hernioplasty: a comparative study. Surg Endosc 22:744–749
Chowbey P, Khullar R, Mehrotra M, Khullar R, Soni V, Baijal M (2006) Sir Ganga Ram hospital classification of groin and ventral abdominal wall hernias. J Minim Access Surg 2:106–109
Moreno-Egea A, Guzmán P, Morales G, Carrillo A, Aguayo JL (2007) Treatment of non-midline ventral hernia: experience in an abdominal wall unit and literature review. Cir Esp 81:330–334
Dietz UA, Hamelmann W, Winkler MS, Debus ES, Malafaia O, Czeczko NG, Thiede A, Kuhfuss I (2007) An alternative classification of incisional hernias enlisting morphology, body type, and risk factors in the assessment of prognosis and tailoring of surgical technique. J Plast Reconstr Aesthet Surg 60:383–388
Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E, Dietz UA, Eker HH, Nakadi IE, Hauters P, Pascual MH, Hoeferlin A, Klinge U, Montgomery A, Simmermacher RK, Simons MP, Smietański M, Sommeling C, Tollens T, Vierendeels T, Kingsnorth A (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13:407–414
Craft RO, Harold KL (2009) Laparoscopic repair of incisional and other complex abdominal wall hernias. Permanente J 13:38–42
Ventral Hernia Working Group, Breuing K, Butler CE, Ferzoco S, Franz M, Hultman CS, Kilbridge JF, Rosen M, Silverman RP, Vargo D (2010) Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery 148:544–558
Moreno-Egea A, Mengual-Ballester M, Cases-Baldó MJ, Aguayo-Albasini JL (2010) Repair of complex incisional hernias using double prosthetic repair: single-surgeon experience with 50 cases. Surgery 148:140–144
Moreno-Egea A, Aguayo-Albasini JL (2010) Historic analysis of complex incisional hernia: to an understanding of the double prosthetic repair technique. Cir Esp 88:292–298
Stumpf M, Conze J, Prescher A, Junge K, Krones CJ, Klinge U, Schumpelick V (2009) The lateral incisional hernia: anatomical considerations for a standardized retromuscular sublay repair. Hernia 13:293–297
Disclosures
Alfredo Moreno Egea and Andres Carrillo Alcaraz have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Moreno-Egea, A., Carrillo-Alcaraz, A. Management of non-midline incisional hernia by the laparoscopic approach: results of a long-term follow-up prospective study. Surg Endosc 26, 1069–1078 (2012). https://doi.org/10.1007/s00464-011-2001-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-011-2001-x