Pitfalls and complications with laparoscopic intraperitoneal expanded polytetrafluoroethylene patch repair of postoperative ventral hernia.
BACKGROUND
This study reviewed our experience with laparoscopic ventral postoperative (incisional) hernia repair.


METHODS
Clinical data from the first 100 cases were analyzed retrospectively.


RESULTS
Between 1997 and 2000, 64 women and 36 men (mean age, 58.4 +/- 13.6 years; range, 27-87 years) underwent laparoscopic hernioplasty. Hernias (mean diameter, 6.2 +/- 3.7 cm) were in a midline (74%), subcostal (10%), or other incision location, and were recurrent in 25%, of the patients. The mean operative time was 119 +/- 77 min. Extensive adhesiolysis was necessary in 37 cases. There was no mortality. The recorded complications included inadvertent enterotomies (n = 6), seromas (n = 11), prolonged ileus (n = 4), and prolonged fever (n = 3). Seven cases were converted; to repair accidental enterotomies (n = 4) due to difficult adhesiolysis (n = 2), or to control bleeding (n = 1). Six patients underwent reoperation because of enetric leak (n = 3) or bowel obstruction (n = 3). There were two documented recurrences (2%). The mean follow-up period was 19 months (range, 12-54 months).


CONCLUSIONS
Laparoscopic intraperitoneal approach to postoperative ventral (incisional) hernia repair may be associated with significant complications and morbidity, which can be prevented in part by meticulous technique and liberal conversions. The justification of this procedure is the low recurrence rate, according to preliminary results.
Ben-Haim
M
M
Department of Surgery and Transplantation, Chaim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Israel.
Kuriansky
J
J
Tal
R
R
Zmora
O
O
Mintz
Y
Y
Rosin
D
D
Ayalon
A
A
Shabtai
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006555:Hernia, Ventral / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010537:Peritoneum / Q000601:surgery*; D011138:Polytetrafluoroethylene / Q000009:adverse effects / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D013526:Surgical Mesh / Q000009:adverse effects; D017211:Treatment Failure; D016896:Treatment Outcome
D011138:Polytetrafluoroethylene