Laparoscopic repair of large incisional hernias.
BACKGROUND
Traditional approaches to incisional hernias (IH)--particularly in cases with large fascial defects--are plagued by a significant recurrence rate as well as frequent wound infections. The laparoscopic repair of incisional hernias was designed to offer a minimally invasive and tension-free technique that yields less morbidity and fewer recurrences than the standard open repair. Several years ago, we adopted the laparoscopic technique in our department and set out to appraise its touted advantages.


METHODS
During the years 1997-2000, 103 patients underwent laparoscopic IH repair with implanted Dual Gore-tex mesh. Forty percent of them were obese, and 41% had undergone more than one previous attempt at conventional repair. All patients were discharged home within 24-72 hs.


RESULTS
In three patients, the operation was converted to open surgery due to severe adhesions and technical difficulties. In two cases, inadvertent enterotomies were repaired laparoscopically, and since there was no major spillage, the repair was continued as planned, with no adverse consequences. Twelve patients underwent additional laparoscopic procedures at the initial operation. Two graft infections and four recurrences were observed during the 1-49 month follow-up period.


CONCLUSIONS
Laparoscopic IH repair is technically feasible and safe in patients with large fascial defects as well as in obese patients. This operation decreases postoperative pain, hastens the recovery period, and reduces postoperative morbidity and recurrence.
Kirshtein
B
B
Department Surgery A, Soroka University Medical Center, Faculty of Health Science, Ben Gurion University of the Negev, PO Box 151, Beer Sheva, Israel 84101. borkirsh@bgumail.bgu.ac.il
Lantsberg
L
L
Avinoach
E
E
Bayme
M
M
Mizrahi
S
S
D034861:Abdominal Wall / Q000601:surgery; D000328:Adult; D000368:Aged; D000071938:Fasciotomy; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000150:complications / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D011138:Polytetrafluoroethylene / Q000627:therapeutic use; D011183:Postoperative Complications; D019736:Prostheses and Implants; D013526:Surgical Mesh / Q000592:standards; D000267:Tissue Adhesions / Q000473:pathology / Q000601:surgery
D011138:Polytetrafluoroethylene