Learning curve for laparoscopic ventral hernia repair.
OBJECTIVE
To test if there was any difference in the indications and early outcomes of laparoscopic ventral hernia repair (LVHR) during a 36-month period at a single institution.


METHODS
From August 1999 to August 2002, 64 consecutive, unselected patients underwent attempted LVHR. The patients were retrospectively divided into two groups: group 1 included the first 32 patients, and group 2 included the second 32 patients. Data regarding patient demographics, results, and postoperative follow-up were compared between the groups.


RESULTS
Demographic characteristics, types of hernia, preoperative records, and hernia defects were well matched between the groups. Four patients in group 1 required conversion to laparotomy for bowel injuries, whereas no conversion was required in group 2 (12% vs 0%, P = 0.11 [NS]). The operative times and complication rates were similar, but bowel injuries were significantly more common in group 1 (19% vs 0%, P = 0.02), including the patients who were converted. The analgesic requirement was small and the hospital stay short in both groups; the differences were not significant. Three recurrences were noted in group 1 and none were noted in group 2, although follow-up was not comparable in the second group.


CONCLUSIONS
A learning curve is needed to decrease conversions and bowel injuries during LVHR. The improved experience could permit the treatment of larger defects laparoscopically.
Bencini
Lapo
L
First Divison of General Surgery and Transplantation, Careggi, Florence Main Academic and Teaching Hospital, Viale Morgagni 85, 50134 Florence, Italy. lapbenc@tin.it
Sánchez
Luis José
LJ
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D007558:Italy; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D013526:Surgical Mesh; D016896:Treatment Outcome