Five-year experience with the "four-before" laparoscopic ventral hernia repair

Between 1993 and 1998, we performed a linear study of laparoscopic ventral hernia repair performed in a standard fashion using expanded polytetrafluor oethylene on 49 patients. Eighteen patients had recurrent hernias and 30 pa tients were morbidly obese with a body mass index >30. Conversion to open p rocedure was required in two patients. Patients were observed a mean of 27 months. Three patients died of unrelated causes during the observation peri od. Three patients developed recurrent hernias. By a follow-up survey, we f ound that 90 per cent of patients were "satisfied" with their operation and results. Because of decreased complications, postoperative pain, hospital stay, and hernia recurrence, the "four-before" laparoscopic repair is our p reference for ventral hernias. It has been particularly useful for obese pa tients and patients with recurrent ventral hernias.