Abstract
Incisional hernias develop in 2%–20% of laparotomy incisions, necessitating approximately 90,000 ventral hernia repairs per year. Although a common general surgical problem, a "best" method for repair has yet to be identified, as evidenced by documented recurrence rates of 25%–52% with primary open repair. The aim of this study was to evaluate the efficacy and safety of laparoscopic ventral and incisional herniorrhaphy. From February 1991 through November 2002, a total of 384 patients were treated by laparoscopic technique for primary and recurrent umbilical hernias, ventral incisional hernias, and spigelian hernias. The technique was essentially the same for each procedure and involved lysis of adhesions, reduction of hernia contents, closure of the defect, and 3–5 cm circumferential mesh coverage of all hernias. Of the 384 patients in our study group, there were 212 females and 172 males with a mean age of 58.3 years (range 27–100 years). Ninety-six percent of the hernia repairs were completed laparoscopically. Mean operating time was 68 min (range 14–405 min), and estimated average blood loss was 25 mL (range 10–200 mL). The mean postoperative hospital stay was 2.9 days and ranged from same-day discharge to 36 days. The overall postoperative complication rate was 10.1%. There have been 11 recurrences (2.9%) during a mean follow-up time of 47.1 months (range 1–141 months). Laparoscopic ventral and incisional hernia repair, based on the Rives-Stoppa technique, is a safe, feasible, and effective alternative to open techniques. More long-term follow-up is still required to further evaluate the true effectiveness of this operation.
Similar content being viewed by others
References
Hesselink VJ, Luijendik RW, De Wilt JHW, Heide R (1993) An evaluation of risk factors in incisional hernia recurrence. Surg Gynecol Obstet 176:228–234
Israelsson LA (2002) Wound failure and incisional hernia: mechanisms and prevention. In: Fitzgibbons RJ, Greenburg AG (eds) Nyhus & Condon's Hernia. Lippincott Williams & Wilkins, Philadelphia, PA, pp 327–340
Mudge M, Hughes LE (1985) Incisional hernia: a 10-year prospective study of incidences and attitudes. Br J Surg 72:70–71
Santora TA, Roslyn JJ (1993) Incisional hernia. Surg Clin North Am 73:557–570
Linden van der FT, Vroonhoven van TJ (1988) Long-term results after surgical correction of incisional hernia. Neth J Surg 40:127–129
Stoppa RE (1989) The treatment of complicated groin and incisional hernias. World J Surg 13:545–554
Bauer JJ, Harris MT, Kreel I, Gelernt IM (1999) Twelve-year experience with expanded polytetrafluoroethylene in the repair of abdominal wall defects. Mt Sinai J Med 66:20–25
Condon RE, Debord JR (1995) Expanded polytetrafluoroethylene prosthetic patches in repair of large ventral hernia. In: Nyhus LM, Condon RE, (eds) Hernia 4th ed. Philadelphia: Lippincott Williams and Wilkins; 20:328–336
Koller R, Miholic J, Jalk RJ (1997) Repair of incisional hernias with expanded polytetrafluoroethylene. Eur J Surg 163:261–266
Gillion JF, Bégin GF, Marecos C, Fourtanier G (1997) Expanded polytetrafluoroethylene patches used in the intraperitoneal or extraperitoneal position for repair of incisional hernias of the anterolateral abdominal wall. Am J Surg 174:16–19
Heniford BT, Park A, Ramshaw BJ, Voeller G (2000) Laparoscopic ventral and incisional hernia repair in 407 patients. J Am Coll Surg 190:645–650
Leblanc KA, Booth WV (1993) Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: preliminary findings. Surg Laparosc Endosc 3:39–41
Park A, Gagner M, Pomp A (1996) Laparoscopic repair of large incisional hernias. Surg Laparosc Endosc 6:123–128
Sewell RW (1996) Ventral hernia repair. In: MacFadyen BV, Ponsky JL eds. Operative Laparoscopy & Thoracoscopy. Philadelphia: Lippincott—Raven Publishers; 46:807–826
Franklin ME, Gonzalez JJ, Michaelson RP, Glass JL, Chock DA (2002) Preliminary experience with new bio-active prosthetic material for repair of hernias in infected fields. Hernia 6:171–174
Rives J, Pire JC, Flament JB, Palot JP, Body C (1985) Treatment of large eventrations. New therapeutic indications apropos of 322 cases. Chirurgie 111:215–225
Leber GE, Garb JL, Albert AI, Reed WP (1998) Long-term complications associated with prosthetic repair of incisional hernias. Arch Surg 132:1141–1144
Sampsel J (1976) Delayed and recurring infection in postoperative abdominal wounds. Am J Surg 132:316–319
Temudom T, Siadati M, Sarr MG (1996) Repair of complex giant or recurrent ventral hernias by using tension-free intraparietal prosthetic mesh (Stoppa technique): lessons learned from our initial experience (fifty patients). Surgery 120:738–744
White TJ, Santos MC, Thompson JS (1998) Factors affecting wound complications in repair of ventral hernias. Am Surg 64:276–280
Costanza MJ, Heniford BT, Arca MJ, Mayes JT, Gagner M (1998) Laparoscopic repair of recurrent ventral hernia. Am Surg 64:1121–1127
Toy FK, Bailey RW, Carey S, Chappuis CW, Gagner M, Josephs LG, Mangiante EC, Park AE, Pomp A, Smoot RT Jr, Uddo JF Jr, Voeller GR (1998) Prospective, multicenter study of laparoscopic ventral hernioplasty: preliminary results. Surg Endosc 12:955–959
Leblanc KA, Booth WV, Whitaker JM, Bellanger DE (2001) Laparoscopic incisional and ventral herniorrhaphy: our initial 100 patients. Hernia 5:41–45
Roth JS, Park AE, Witzke D, Mastrangelo MJ (1999) Laparoscopic incisional/ventral herniorrhaphy: a five-year experience. Hernia 3:209–214
Langer S, Christiansen J (1985) Long-term results after incisional hernia repair. Acta Chir Scand 151:217–219
Bauer JJ, Salky BA, Gelernt IM, Kreel I (1987) Repair of large abdominal wall defects with expanded polytetrafluoroethylene (ePTFE). Ann Surg 206:765–769
Kaufman Z, Engelberg M, Zager M (1981) Fecal fistula: a late complication of Marlex mesh repair. Dis Colon Rectum 24:543–544
Law NW (1990) A comparison of polypropylene mesh, expanded polytetrafluoroethylene, and polyglycolic acid mesh for the repair of experimental abdominal wall defects. Acta Chir Scand 156:759–762
Law NH, Ellis H (1988) Adhesion formation and peritoneal healing on prosthetic materials. Clin Mater 3:95–101
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Franklin, M.E., Gonzalez, J.J., Glass, J.L. et al. Laparoscopic ventral and incisional hernia repair: An 11-year experience. Hernia 8, 23–27 (2004). https://doi.org/10.1007/s10029-003-0163-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10029-003-0163-8