Recurrences after laparoscopic repair of ventral and incisional hernia: lessons learned from 505 repairs.
BACKGROUND
All hernia recurrences in a series of 505 patients who underwent laparoscopic repair of a ventral hernia (n=291) or incisional hernia (n=214) were analyzed to identify factors responsible for the recurrence.


METHODS
In all laparoscopic repairs, an expanded polytetrafluoroethylene prosthesis overlapping the hernia margins by >or=3 cm was fixed with a double ring of tacks alone (n=206) or with tacks as well as sutures (n=299). During the mean follow-up time of 31.3 +/- 18.4 months, nine patients (1.8%) had a recurrence, eight of which were repaired laparoscopically. Operative reports and videotapes of all initial repairs and repairs of recurrences were analyzed.


RESULTS
All recurrences followed an incisional hernia repair (p<0.001). Five recurrences developed after mesh fixation with both tacks and sutures and four after mesh fixation with tacks alone (p=1.0). All recurrences were at the site of the apparently sufficient original incision scar: in eight patients, the recurrent hernia was attached to the mesh; in one, it developed in another part of the scar. All initial repairs had been performed without technical errors. Upon repair of the recurrences, a new, larger mesh was placed over the entire incision, not just the hernia. There were no re-recurrences during follow-up (mean 19.8+/-10.3 months).


CONCLUSIONS
Recurrence after incisional hernia repair appears to be due primarily to disregard for the principle that the whole incision--not just the hernia--must be repaired. Our experience supports the idea that the entire incision has a potential for hernia development. Insufficient coverage of the incision scar is a risk factor for recurrence after laparoscopic repair of ventral and incisional hernia.
Wassenaar
Eelco B
EB
Department of Surgery, Twenteborg Hospital, Postbox 7600, 7600 SZ Almelo, The Netherlands. ebwassenaar@tiscali.nl
Schoenmaeckers
Ernst J P
EJ
Raymakers
Johan T F J
JT
Rakic
Srdjan
S
D005260:Female; D006555:Hernia, Ventral / Q000453:epidemiology* / Q000601:surgery; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011475:Prosthesis Failure; D019651:Plastic Surgery Procedures / Q000379:methods*; D012008:Recurrence; D013526:Surgical Mesh
D011138:Polytetrafluoroethylene