Laparoscopic repair of postoperation ventral hernia - Early postoperation results

Background: Laparoscopic repair is a new alternative approach to postoperat ion ventral hernia (POVH). Whether this procedure is accompanied with accep table operation risk and recurrence rate is not yet established. Methods: During 1996, we performed laparoscopic repair of POVH in 53 patien ts. Twenty-nine (55%) of these patients had a history of at least one faile d hernia repair. The size of the abdominal wall defect varied from 4 x 5 cm to 15 x 20 cm (median, 13 x 9 cm). All operations were performed with the patient under general anesthesia. In all cases, the Gore-Tex(R) Dual Mesh C N. L. Gore & Associates, Flagstaff, AZ, USA) was used in sizes varying from 5 x 7 cm to 20 x 30 cm (median, 15 x 12 cm). Results: No deaths occurred as a result of the operations. Intraoperative s mall bowel injury occurred in two patients (3.6%), which necessitated conve rsion to laparotomy and performance of small bowel resection in one case an d simple suture in the other. Small bowel obstruction developed during the immediate postoperation period in two patients (3.6%). In one of these pati ents, laparoscopic lysis of adhesions had to be performed. Graft infection with subsequent graft removal occurred in one patient (1.8%), and abdominal wall hematoma developed in another patient (1.8%). Length of hospital stay varied from 2 to 8 days (median, 3.3 days). Follow-up period ranged from 1 0 to 22 months (median, 17 months). During this period, recurrence of herni a occurred only in one patient in which the mesh had been removed. Conclusions: Laparoscopic repair of POVH is technically feasible. According to our experience, it is the preferred method for patients who have had an earlier failed open repair and patients in whom it is the first repair. Ca ses with a high likelihood for small bowel injury must be recognized and co nverted to routine open repair.