Comparison of laparoscopic and open repair of incisional and primary ventral hernia: results of a prospective randomized study.
BACKGROUND
Incisional hernia is an important complication of abdominal surgery. Its repair has progressed from a primary suture repair to various mesh repairs and laparoscopic repair. Laparoscopic mesh repair is a promising alternative, and in the absence of consensus, needs prospective randomized controlled trials.


METHODS
Between April 2003 and April 2005, 66 patients with incisional, primary ventral and recurrent hernias were randomized to receive either open retro-rectus mesh repair or laparoscopic mesh repair. These patients were followed up at 1-, 3-, and 6-month intervals thereafter for a mean of 12.17 months (open repair group) and 13.73 months (laparoscopic repair group).


RESULTS
Lower abdominal hernias after gynecologic operations constituted the majority of the hernias (approximately 50%) in both groups. There was no significant injury to viscera or vessel in either group and no conversions. The defect size was 42.12 cm in the open (group 1) and 65.66 cm2 in the laparoscopic group (group 2), and the prosthesis sizes were, respectively, 152.67 cm2 and 203.83 cm2. The hospital stay was 3.43 days in open group and 1.47 days in laparoscopic group (p = 0.007). There was no significant difference in the pain scores between the two groups. More wound-related infectious complications occurred in the open group (33%) than in the laparoscopic group (6%) (p = 0.013). There was one recurrence in the open repair group (3%) and two recurrences in laparoscopic group (6%) (p = 0.55).


CONCLUSIONS
Laparoscopic repair of incisional and ventral hernias is superior to open mesh repair in terms of significantly less blood loss, fewer complications, shorter hospital stay, and excellent cosmetic outcome.
Misra
M C
MC
Department of Surgical Disciplines and Anaesthesiology, All India Institute of Medical Sciences, 5th Floor Room No. 5031, Teaching Block, New Delhi 110029, India.
Bansal
V K
VK
Kulkarni
M P
MP
Pawar
D K
DK
D000328:Adult; D000368:Aged; D005260:Female; D006555:Hernia, Ventral / Q000209:etiology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000379:methods*; D013526:Surgical Mesh; D016896:Treatment Outcome