title: Mortality following laparoscopic ventral hernia repair: lessons from 90 consecutive cases and bibliographical analysis.
abstract: The popularity of laparoscopic repair of ventral hernias is increasing due to the apparent advantages of the procedure, but this approach is still a controversial technique. The aim of our study was to evaluate the mortality rate of laparoscopic ventral hernia repair and analyse the literature. The authors performed a prospective study in 90 patients with ventral hernia who were treated by laparoscopic repair. Clinical parameters and intra- and postoperative complications were evaluated. A case of mortality was reported due to a nonrecognised bowel injury. The mean follow-up (100%) was 42 months (range: 1-5 years). A bibliographical analysis was carried out (MEDLINE). Four bowel injuries were presented (4.4%): three recognised, which required conversion (two treated with minilaparotomy and completed afterwards by laparoscopy, and one by laparotomy); and one nonrecognised, which was re-operated on but evolved to sepsis and multiorgan failure and resulted in death in 48 h (1.1%). Four further mortality rates have been documented in the literature (0.6%, 1.1%, 3.1%, and 3.4% of their series). Bowel injury and mortality show a statistically significant tendency to decrease with the number of operations ( P<0.05). In conclusion, in our study the risk of mortality with laparoscopic ventral hernia repair has been higher than 1%, which must be made known. It is a risk that depends on the surgeon's experience but which does not seem to be predictable.
authors.affiliation: Abdominal Wall Unit, Departments of Surgery Anaesthesia and Radiology, Morales Meseguer Hospital, Murcia, Spain. amorenoe@worldonline.es
authors.forename: D A Moreno
authors.initials: DA
authors.lastname: Egea
authors.forename: J A Torralba
authors.initials: JA
authors.lastname: Martinez
authors.forename: G Morales
authors.initials: GM
authors.lastname: Cuenca
authors.forename: J De
authors.initials: JD
authors.lastname: Miquel
authors.forename: J G Martín
authors.initials: JG
authors.lastname: Lorenzo
authors.forename: J L Aguayo
authors.initials: JL
authors.lastname: Albasini
authors.forename: M Canteras
authors.initials: MC
authors.lastname: Jordana
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D017809:Fatal Outcome; D005260:Female; D006555:Hernia, Ventral / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis* / Q000601:surgery; D010535:Laparoscopy / Q000379:methods / Q000401:mortality*; D016014:Linear Models; D009102:Multiple Organ Failure; D011336:Probability; D018570:Risk Assessment; D012720:Severity of Illness Index; D013030:Spain; D014057:Tomography, X-Ray Computed