Characterizing laparoscopic incisional hernia repair.
BACKGROUND
Laparoscopic repair of ventral and incisional hernias (LVIHRs) is feasible; however, many facets of this procedure remain poorly defined. The indications, essential technical features and postoperative management should be standardized to optimize outcomes and facilitate training in this promising approach to incisional hernia repair.


METHODS
All patients referred to one surgeon at a tertiary care centre for LVIHR from 1999 to 2004 were analyzed. Patient records were analyzed and perioperative outcomes were documented.


RESULTS
Of the 69 patients who were referred for management of incisional hernia, 64 underwent LVIHR. The mean age of patients selected for surgery was 61.4 years (28% of patients over age 70 years); their mean body mass index (BMI) was 32.8 kg/m2 and mean American Association of Anaesthetists (ASA) score was 2.5 (52% of patients had an ASA score equal to 3). The mean operating time was 130.7 minutes for a mean abdominal wall defect of 123.9 cm2 and a mean prosthetic mesh size of 344 cm2. Patients with recurrent incisional hernias and previous prosthetic mesh were the most challenging, with a mean BMI of 39 kg/m2, mean operating time of 191 minutes, mean defect of 224 cm2 and mean prosthetic mesh size of 508 cm2. One patient was converted to open surgery and, in 2 patients, small bowel injuries were repaired laparoscopically without adverse sequelae. The mean length of stay was 4.5 days (median 3.0 d). Postoperatively, 78% of patients developed seromas within the residual hernia sac. All seromas were managed nonoperatively; one-half resolved by 7 weeks, and larger seromas persisted for up to 24 weeks. There was an 18.7% rate of minor complications and a 3.1% rate of major complications (no deaths). After a mean follow-up of 7.7 months, 2 recurrent hernias (3.1%) were identified in patients with multiple previous open mesh repairs.


CONCLUSIONS
Although LVIHR may be challenging, it has the potential to be considered a primary approach for most ventral and incisional hernias, regardless of patient status or hernia complexity.
Birch
Daniel W
DW
Centre for the Advancement of Minimally Invasive Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada. dbirch@ualberta.ca
D015746:Abdominal Pain / Q000188:drug therapy / Q000209:etiology; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012008:Recurrence; D049291:Seroma / Q000209:etiology; D013526:Surgical Mesh; D013997:Time Factors; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal