Laparoscopic incisional hernia repair: evaluation of effectiveness and experiences.
BACKGROUND
Incisional hernia is the most frequent postoperative complication following abdominal surgery and is a common and costly source of morbidity. Conventional mesh repair is the standard treatment today, but the use of laparoscopic incisional hernia repair (LIHR) seems to be a good alternative. We performed a retrospective analysis comparing open incisional hernia repair with the laparoscopic approach.


METHODS
Between June 2004 and June 2006, 123 patients with incisional hernia were included. Open repair (37 men and 45 women; mean age 62.6 years) was performed in 82 cases, whereas 41 patients underwent laparoscopic repair (29 men and 12 women; mean age 64.3 years). Patient- and procedure-associated characteristics, clinical outcome, and recurrence rate were determined after a median follow-up period of 23 months for the laparoscopic group and 24 months for the open group.


RESULTS
Hernia sizes were comparable between the groups. Conversion to open repair was required in two cases. Postoperative pain scores did not differ significantly. In the long-term follow-up, however, the pain score was less (P = 0.001) and the satisfaction rate was higher (P = 0.003) in the laparoscopic group. Complications occurred in 23% of patients in the open group and 20% in the LIHR group. The recurrence rate was lower in the laparoscopic group, with 9% (3/35) compared to 23% (18/77) in the open group (P = 0.089).


CONCLUSIONS
Our results show the tendency that LIHR is associated with less postoperative pain and comparable postoperative complications. The low recurrence rate proves the safety and the good long-term results of this procedure. Laparoscopic hernia repair is an alternative to open procedures in cases of feasibility. Further studies, especially randomized controlled trials, are required to confirm these findings and provide the basis for future treatment guidelines.
Department of Visceral, Vascular and Transplant Surgery, Clinical Center Cologne-Merheim, University of Witten/Herdecke, Ostmerheimer Street 200, Cologne 51109, Germany. woltera@kliniken-koeln.de
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Wolter
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Rudroff
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Sauerland
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Heiss
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013526:Surgical Mesh; D016896:Treatment Outcome