title: Midline versus nonmidline laparoscopic incisional hernioplasty: a comparative study.
abstract: BACKGROUND
  Nonmidline incisional hernia is a surgical problem of major interest, but to date, little information on this problem is available. This study aimed to analyze the results of nonmidline laparoscopic incisional hernioplasty in a multidisciplinary abdominal wall unit over the past 10 years.
  
  
  METHODS
  This prospective study examined a series of 199 patients undergoing surgery for incisional hernia via the laparoscopic approach: 146 midline and 53 nonmidline. A comparative analysis compared midline and nonmidline defects, and a descriptive analysis compared four nonmidline types: 18 lumbar, 11 subcostal, 14 inguinal, and 10 lateral. Clinical and follow-up parameters were assessed during a mean follow-up period of 64 months (range, 12-120 months).
  
  
  RESULTS
  The nonmidline incisional hernias were significantly larger, involved more preoperative pain, and required a longer hospital stay than the midline incisional hernias (p < 0.001). Also, the intraoperative complications and the consumption of analgesics were more frequent in the nonmidline group (p < 0.05). The postoperative morbidity and recurrence rates were similar in the two groups. No statistical differences were noted between the four types of nonmidline incisional hernias. The most common nonmidline type was lumbar hernia (34%). Hematomas (17%) predominated in the inguinal types, and pain predominated in the lumbar types. Two early recurrences were diagnosed for poor mesh placement: one subcostal and one lumbar.
  
  
  CONCLUSIONS
  Laparoscopic incisional hernioplasty can be applied to nonmidline defects with the same rates of morbidity and recurrence as for patients with midline defects. The four types of nonmidline defects seem to have their own evolutionary characteristics.
authors: Abdominal Wall Unit, Department of Surgery, J. M. Morales Meseguer Hospital, Avda. Primo de Rivera 7, 5D (Edf. Berlín), 30008, Murcia, Spain. moreno-egea@ono.com
authors: A
authors: A
authors: Moreno-Egea
authors: A
authors: A
authors: Carrillo
authors: J L
authors: JL
authors: Aguayo
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007264:Inguinal Canal; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D010147:Pain Measurement; D010149:Postoperative Pain / Q000503:physiopathology*; D011183:Postoperative Complications / Q000503:physiopathology; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D013526:Surgical Mesh; D016896:Treatment Outcome
references: Ann Plast Surg. 2005 Jul;55(1):36-41; discussion 41-2
references: 15985789
references: Br J Surg. 2002 May;89(5):534-45
references: 11972542
references: Surg Laparosc Endosc Percutan Tech. 2001 Apr;11(2):103-6
references: 11330373
references: Hernia. 2005 Dec;9(4):310-5
references: 16044202
references: Curr Probl Surg. 2006 May;43(5):326-75
references: 16679124
references: Am Surg. 1999 Sep;65(9):827-31; discussion 831-2
references: 10484084
references: Br J Surg. 1998 Oct;85(10):1415-8
references: 9782028
references: Arch Surg. 2002 Oct;137(10):1161-5
references: 12361426
references: Surg Laparosc Endosc Percutan Tech. 2002 Jun;12(3):171-4
references: 12080257
references: J Am Coll Surg. 2005 Jul;201(1):132-40
references: 15978454
references: World J Surg. 2005 Aug;29(8):1073-9
references: 15983711
references: Hernia. 2005 Dec;9(4):316-21
references: 16172802
references: Surg Endosc. 1999 Mar;13(3):250-2
references: 10064757
references: Ann Surg. 2003 Sep;238(3):391-9; discussion 399-400
references: 14501505
references: J R Coll Surg Edinb. 2001 Feb;46(1):39-43
references: 11242742
references: Hernia. 2006 Apr;10(2):110-9
references: 16453075
references: Surgery. 1998 Oct;124(4):816-21; discussion 821-2
references: 9781006
references: Am J Surg. 2003 Jan;185(1):61-5
references: 12531448
references: Eur J Surg. 1999 Dec;165(12):1187-8
references: 10636555
references: J R Coll Surg Edinb. 1998 Feb;43(1):29-30
references: 9560503
references: World J Surg. 2005 Aug;29(8):1080-5
references: 15983710