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Original Scientific Article
Laparoscopic Ventral and Incisional Hernia Repair in 407
Patients
B Todd Heniford, MD, FACS, Adrian Park, MD, FACS, Bruce J
Ramshaw, MD, FACS, Guy Voeller, MD, FACS
Background: Recurrence rates after primary repair of
ventral and incisional hernias range from 25% to 52%. Recurrence
after open surgery is less likely if mesh is used, but the wide
fascial dissection and required flap creation increase complication
rates. Laparoscopic techniques offer an alternative.
Study Design: To assess the safety and efficacy of
laparoscopic ventral and incisional herniorrhaphy, we reviewed
the records of all our patients who underwent such a procedure
from November 1993 to August 1999. A laparoscopic approach was
attempted in all patients considered to require a mesh repair.
Patient demographic characteristics, operative details, and outcomes
were recorded.
Results: Of 415 patients scheduled to undergo laparoscopic
ventral or incisional herniorrhaphy, conversion to an open procedure
was necessary in 8. All the remaining 407 patients (205 men and
202 women; mean age 53.2 years; range 13 to 88 years) were included
in the study. Mean fascial defect size was 100.1cm2 (range 1
to 480cm2). In 97% of patients, expanded polytetrafluoroethylene
mesh was used. Mean operating time was 97 minutes (range 11 to
270 minutes). Mean estimated blood loss was 35mL (range 10 to
150mL). Average hospital stay was 1.8 days (range 0 to 17 days).
There were 53 complications (13.0%), including cellulitis of
a trocar site, infection requiring mesh removal, prolonged suture
pain, persistent seroma, intestinal injury, hematoma or postoperative
bleeding, prolonged ileus, urinary retention, respiratory distress,
fever, intraabdominal abscess, and trocar site herniation. There
were no deaths. During a mean followup time of 23 months (range
1 to 60 months), there were 14 hernia recurrences (3.4%), 6 in
patients in whom only a stapling device (no sutures) had been
used to secure the mesh to the abdominal wall.
Conclusions: Laparoscopic repair was completed in 98.1%
of patients in whom it was attempted. The complication rate was
acceptable. A short hospital stay and minimal blood loss were
documented. The recurrence rate was 3.4%. Laparoscopic ventral
and incisional hernia repair appear to be safe and effective.
Introduction
| Methods
| Results
| Discussion
| References
| Commentary
JACS |
