title: Laparoscopic ventral hernia repair in obese patients: a new standard of care.
abstract: OBJECTIVE
  Ventral abdominal hernias represent a frequent and often formidable clinical problem, especially in obese patients. Because laparoscopic ventral hernia repair (LVHR) results in few complications and a low recurrence rate, the use of minimally invasive techniques in this subgroup of patients may minimize perioperative complications and failure rates.
  
  
  METHODS
  Retrospective review of prospectively collected data.
  
  
  METHODS
  Tertiary care hospital.
  
  
  METHODS
  One hundred sixty-three obese patients (body mass index [calculated as weight in kilograms divided by the square of height in meters], > or =30) who underwent LVHR at our institution between July 1, 1998, and December 31, 2003.
  
  
  METHODS
  Laparoscopic ventral hernia repair with an expanded polytetrafluoroethylene mesh.
  
  
  METHODS
  Patient age, sex, body mass index, size of fascial defect and mesh, operating time, operative blood loss, length of hospitalization, complications, and hernia recurrences.
  
  
  RESULTS
  Ninety-eight women and 65 men, with a mean body mass index of 38, underwent LVHR. Twenty patients (12.3%) had 21 postoperative complications. There was no perioperative mortality. The mean length of hospital stay was 2.6 days. The recurrence rate was 5.5% at a mean follow-up of 25 months (range, 1-73 months).
  
  
  CONCLUSIONS
  A low rate of conversion to laparotomy, minimal perioperative morbidity, and the absence of perioperative mortality in this series indicate the safety of LVHR in obese patients with complex hernias. In addition, a success rate of more than 94.5% suggests improved efficacy of LVHR compared with the historical rates among control subjects undergoing open surgery. In experienced hands, LVHR may be the approach of choice for most patients with a body mass index of 30 or more.
authors.affiliation: Carolinas Laparoscopic and Advanced Surgery Program, Department of General Surgery, Carolinas Medical Center, PO Box 32861, Charlotte, NC 28232, USA.
authors.forename: Yuri W
authors.initials: YW
authors.lastname: Novitsky
authors.forename: William S
authors.initials: WS
authors.lastname: Cobb
authors.forename: Kent W
authors.initials: KW
authors.lastname: Kercher
authors.forename: Brent D
authors.initials: BD
authors.lastname: Matthews
authors.forename: Ronald F
authors.initials: RF
authors.lastname: Sing
authors.forename: B Todd
authors.initials: BT
authors.lastname: Heniford
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D005260:Female; D006555:Hernia, Ventral / Q000150:complications / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications; D013526:Surgical Mesh
chemical_list: D011138:Polytetrafluoroethylene