Laparoscopic ventral hernia repair: an initial institutional experience.
BACKGROUND
Ventral and incisional hernias remain a problem for surgeons with reported recurrence rates of 25-50% for open repairs. Laparoscopic approaches offer several theoretical advantages over open repairs.


METHODS
All patients undergoing a laparoscopic ventral hernia repair from April to December 2000 were prospectively entered in a database. Patients underwent repair with expanded polytetrafluoroethylene dual mesh. Full-thickness abdominal wall nonabsorbable sutures and 5-mm tacks were placed circumferentially.


RESULTS
Of 32 patients, 15 underwent incisional repair, 13 had repair of a recurrent incisional hernia, and 4 had repair of a primary abdominal wall defect. Two procedures [2/32; 6.3%] were converted to open, one for loss of abdominal domain and one for neovascularization due to cirrhosis. There were two early recurrences [2/30; 6.7%]. Both of these failures occurred in patients with hernia defects extending to the inguinal ligament, preventing placement of full-thickness abdominal wall sutures inferiorly. Average operating time was 128 +/- 42 min (range 37-225 min). Average length of stay was 1.8 days [range 0-7 days]. There were no transfusion requirements or wound infections. One patient underwent a small bowel resection after completion of repair. One patient required drainage of a seroma 4 weeks after the procedure.


CONCLUSIONS
Laparoscopic ventral hernia repair can be safely performed with an acceptable early recurrence rate, operative time, length of stay, and morbidity. Securing the mesh with full-thickness abdominal wall sutures in at least four quadrants remains a key factor in preventing early recurrence.
Varghese
Thomas K
TK
Department of Surgery, VA Chicago Health Care System-Lakeside Division, Northwestern University Medical School, Chicago, IL 60611, USA.
Denham
Daphne W
DW
Dawes
Lillian G
LG
Murayama
Kenric M
KM
Prystowsky
Jay B
JB
Joehl
Raymond J
RJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011446:Prospective Studies; D012086:Reoperation; D055502:Secondary Prevention; D013526:Surgical Mesh; D013536:Suture Techniques
D011138:Polytetrafluoroethylene