Laparoscopic ventral hernia repair - Report of 100 consecutive cases

Introduction: Effective surgical therapy for ventral and incisional hernias is problematic. Recurrence rates following primary repair range as high as 25-49%, and breakdown following conventional treatment of recurrent hernia s can exceed 50%. As an alternative, laparoscopic techniques offer the pote ntial benefits of decreased pain and a. shorter hospital stay. This study e valuates the efficacy of the laparoscopic approach for ventral herniorrhaph y. Methods: A retrospective review was performed for 100 consecutive patients with ventral hernias who underwent laparoscopic repair at our institutions between November 1995 and May 1998. All patients who presented during this period and were candidates for a mesh hernia repair were treated via an end oscopic approach. Results: One hundred patients underwent a laparoscopic ventral hernia repai r. There were 48 men and 52 women. The patients were typically obese, with a mean body mass index (BMI) of 31 kg/m(2). Each had undergone an average o f 2.5 (range; 0-8) previous laparotomies. Forty-nine rer pairs were perform ed for recurrent hernias. An average of two patients (range; 1-7) had previ ously failed open hemiorhaphies; in 20 cases, intraabdominal polypropylene mesh was present. There were no conversions to open operation. The mean siz e of the defects was large at 87 cm(2) (range; 1-480). In all cases, the me sh (average, 287 cm(2)) was secured with transabdominal sutures and metal t acks or staples. Operative time and estimated blood loss averaged 88 min (r ange; 18-270) and 30 cc (range; 10-150). Length of stay averaged 1.6 days ( range; 0-4). There were 12 minor and (two) major complications: cellulitis of the trocar site (two), seroma lasting >4 weeks (three), postoperative il eus (two), suture site pain > 2 weeks (two), urinary retention tone), respi ratory distress tone), serosal bowel injury (one), and skin breakdown tone) and bowel injury tone). Both of the latter complications required mesh rem oval. With an average follow-up of 22.5 months (range; 7-37), there have be en (three) recurrences. Conclusion: The laparoscopic approach to the repair of both primary and rec urrent ventral henias offers a low conversion rate, a, short hospital stay, and few complications. At 23 months of follow-up, the recurrence rate has been 3%. Laparoscopic repair should be considered a viable option for any v entral hernia.