title: Laparoscopic ventral incisional hernia repair: a more effective alternative to conventional repair of recurrent incisional hernia.
abstract: Conventional repair of recurrent ventral incisional hernia is associated with a higher recurrence rate (30%-50%) than repair of primary incisional hernia (11%-20%). Laparoscopic incisional hernia repair (LIHR) can significantly reduce the recurrence rate of primary hernia to less than 5%. In this study, we evaluate the efficacy of repairing recurrent incisional hernia laparoscopically. One-hundred and seventy consecutive patients undergoing LIHR between January 1995 and December 2002 were prospectively reviewed. Patients with recurrent incisional hernia (n=69) were compared to patients with primary incisional hernia (n=101). Patient demographics and perioperative and postoperative data were recorded prospectively. Follow-up was obtained from office visits and telephone interviews. Statistical analysis was performed using the Student t test and the chi(2) test. Results are expressed as means +/- standard deviation. The patients with recurrent incisional hernia had a mean of 1.9 +/- 1.3 previous repairs, higher body mass index (BMI) (34 +/- 6 kg/m(2) vs. 33 +/- 8 kg/m(2), P=0.46), larger defect size (123 +/- 115 cm(2) vs. 101 +/- 108 cm(2), P=0.06), and longer operative time (119 +/- 61 minutes vs. 109 +/- 44 minutes, P=0.11). The complication rate was higher in the recurrent group (28% vs. 11%, P=0.01), but the recurrence rate was not different (7% vs. 5%, P=0.53). The mean time to recurrence was significantly shorter in the recurrent group (3 +/- 2 months vs. 14 +/- 7 months, P < 0.0001). The mean follow-up interval was 19 +/- 18 months in the recurrent group and 27 +/- 20 months in the primary group. Although laparoscopic repair of recurrent incisional hernia resulted in a higher recurrence and complication rate than laparoscopic repair of primary incisional hernia, the rates were lower than those reported for conventional repair of recurrent incisional hernia. Laparoscopic repair of recurrent incisional hernia is an effective alternative to conventional repair.
authors.affiliation: Department of Surgery, University of Maryland College of Medicine, Baltimore, Maryland 21202, USA.
authors.forename: Rodrick D
authors.initials: RD
authors.lastname: McKinlay
authors.forename: Adrian
authors.initials: A
authors.lastname: Park
mesh_terms: D016009:Chi-Square Distribution; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D011183:Postoperative Complications; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome