Long-term results of laparoscopic repair of incisional hernias using an intraperitoneal composite mesh.
BACKGROUND
This study was designed to evaluate the long-term complications and recurrences of laparoscopic repair of incisional hernias. Very few studies evaluate objectively the long-term results of laparoscopic incisional hernia repair.


METHODS
Data for 200 consecutive patients who underwent laparoscopic incisional hernia repair (LIHR) in a university teaching hospital using a standardized procedure between January 1994 and December 2006 were collected prospectively. The median follow-up was 6 (range, 1-12) years.


RESULTS
The conversion rate from laparoscopic to open approach was 2.5% (205 initial patients). Mean operative time was 51 minutes; 63% of these patients were discharged the day of surgery. Mean hospital stay was 2.6 days. There was an overall postoperative complication rate of 15%. We had four small bowel injuries repaired laparoscopically, and one patient died as a result of a sepsis. Postoperative pain was limited, with a mean analgesics requirement of 6.8 (range, 0-30) days. During a mean follow-up of 60 (range, 12-144) months, the recurrence rate was 6.2%, which developed within 1 year of the operation and associated with body mass index >37, defect size >10 cm, and multiple Swiss-cheese defects (p < 0.01).


CONCLUSIONS
1) Intra-abdominal composite mesh is good tolerance. 2) The recurrence rate is low and within 1 year of the operation. 3) The long-term morbidity with LIHR is moderate. 4) The risk of intestinal injury is not predictable. 5) Reoperations can be performed with sufficient guarantee using laparoscopy.
Moreno-Egea
Alfredo
A
Abdominal Wall Unit, Department of Surgery, Morales Meseguer University Hospital, Murcia, Spain. moreno-egea@ono.com
Bustos
José Antonio Castillo
JA
Girela
Enrique
E
Aguayo-Albasini
José Luis
JL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D046449:Hernia, Abdominal / Q000601:surgery*; D006801:Humans; D007421:Intestine, Small / Q000293:injuries; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000379:methods*; D012008:Recurrence; D018805:Sepsis / Q000453:epidemiology / Q000209:etiology; D013526:Surgical Mesh; D013529:Surgical Wound Dehiscence / Q000601:surgery*