title: Laparoscopic management of incisional hernias > or = 15 cm in diameter.
abstract: BACKGROUND
  Despite good results in terms of safety and minimal recurrence ensured by laparoscopy in the management of incisional hernias, the use of minimally invasive techniques for large incisional wall defects is still controversial.
  
  
  METHODS
  Between 2002 and 2008 as many as 36 patients with abdominal wall defects > or = 15 cm were managed laparoscopically in our institution. The wall defects were > or = 20 cm in eight cases. The diameter of parietal defects was measured from within the peritoneal cavity. None had loss of domain. Body mass index (BMI) for 18 patients was > or = 30 kg/m(2).
  
  
  RESULTS
  The mean duration of operations was 195 +/- 28 min (range 75-540). One patient needed conversion for ileal injury and massive adhesions. Post-operative complications occurred in nine patients; there were six surgical complications. Morbidity in obese and non-obese patients was not statistically different (p > 0.05). There was no postoperative death. Mean hospital stay was 4.97 +/- 3.4 days (range 2-18). Mean follow up was 28 months (range 2-68) and only one hernia recurrence was observed.
  
  
  CONCLUSIONS
  Minimum-access procedures can provide good results in the repair of giant incisional hernia. Obesity is not a contraindication to laparoscopic repair. Further studies are expected to confirm our promising results.
authors.affiliation: Surgery and Videolaparoscopy Department, Niguarda Hospital, Milan, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
authors.forename: G C
authors.initials: GC
authors.lastname: Ferrari
authors.forename: A
authors.initials: A
authors.lastname: Miranda
authors.forename: F
authors.initials: F
authors.lastname: Sansonna
authors.forename: C
authors.initials: C
authors.lastname: Magistro
authors.forename: S
authors.initials: S
authors.lastname: Di Lernia
authors.forename: D
authors.initials: D
authors.lastname: Maggioni
authors.forename: M
authors.initials: M
authors.lastname: Franzetti
authors.forename: R
authors.initials: R
authors.lastname: Pugliese
mesh_terms: D000328:Adult; D005260:Female; D006555:Hernia, Ventral / Q000473:pathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D011183:Postoperative Complications; D012008:Recurrence; D016896:Treatment Outcome