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Invited Commentary
R Scott Jones, MD, FACS
Charlottesville, VA
General surgeons are indebted to Drs Heniford, Park, Ramshaw,
and Voeller for this excellent article. Although this was an
uncontrolled study, the excellent results almost certainly are
better with laparoscopic surgery than with open surgery. The
short hospitalization, low mortality, low morbidity, and formidable
2-year cure rate are all superior to results obtained with open
surgery. The authors' conversion rate was surprisingly favorable.
I had one question for the authors' consideration. Their technique
leaves the hernia sac in place. Has that caused any problems
in their patients?
As the role for minimally invasive surgery evolves, some diseases
lend themselves very favorably to those techniques and others
are still in question. The present study supports the assertion
that laparoscopic surgery is the treatment of choice for ventral
hernias.
Reply
B Todd Heniford, MD, FACS
Charlotte, NC
The authors appreciate Dr Jones's review of our article and
his kind comments. We agree that our early results with laparoscopic
surgery for ventral hernias appear to be promising. With the
standardization of our technique to include a full dissection
of the internal aspect of the anterior abdominal wall, wide overlap
of the hernia defects with the appropriate mesh, and the use
of numerous transabdominal sutures, we believe that our outcomes
will change very little. In response to Dr Jones's question concerning
our leaving the hernia sac in place, this does not appear to
cause problems other than to allow the formation of a seroma.
As mentioned in the article, formation of a seroma during the
first month or so was quite common in our patients. But within
approximately 6 weeks nearly all seromas had resolved. We appreciate
the American College of Surgeons allowing us to present our article.
No competing interests declared.
Presented at the American College of Surgeons 85th Annual
Clinical Congress, San Francisco, CA, October 1999.
Received October 20, 1999; Revised January 27, 2000; Accepted
February 7, 2000.
From the Department of Surgery, Carolinas Medical Center,
Charlotte, NC, USA (Heniford), the Department of General Surgery,
University of Kentucky, Lexington, KY, USA (Park), the Department
of General Surgery, Georgia Baptist Hospital, Atlanta, GA, USA
(Ramshaw), and the Department of General Surgery, University
of Tennessee, Memphis, TN, USA (Voeller).
Correspondence address: B Todd Heniford, MD, FACS, Carolinas
Medical Center, PO Box 32861, Charlotte, NC 28232.
Introduction
| Methods
| Results
| Discussion
| References
| Commentary
JACS |
