title: Laparoscopic ventral/incisional hernia repair: a single centre experience of 1,242 patients over a period of 13 years.
abstract: OBJECTIVE
  Laparoscopic technique is now well established for ventral/incisional hernia repair. However several issues such as optimal fixation technique, occult hernias, management of inadvertent enterotomies, postoperative seromas and recurrence require appraisal.
  
  
  METHODS
  A single centre retrospective review of 1,242 patients between January 1992 and June 2005 is described. All patients had laparoscopic ventral/incisional hernia repair (LVIHR) following a standardised protocol by five consultants and fellows in a dedicated minimal access surgery unit of a tertiary care hospital.
  
  
  RESULTS
  LVIHR was completed in 1,223 patients (98.5%). The average BMI was 32, mean defect size was 26.2 cm(2), mean operating time was 81 min and mean hospital stay was 1.9 days. The mean mesh to hernia ratio was 37.5. Occult hernias were observed in 203 (16.3%) patients and inadvertent enterotomies occurred in 21 (1.7%) patients. Mortality occurred in two patients, pulmonary embolism and cardiac dysrhythmia being the respective reasons. The most common sequel was early seroma formation (25%). Chronic pain occurred in 14.7% patients. Recurrence rate was 4.4%, which was associated with a higher BMI, use of staplers as fixation device, multiple defects and recurrent hernias. The mean follow up was 5.4 years; (range 2.4-10 years). The follow up rate was 78%.
  
  
  CONCLUSIONS
  LVIHR leads to low recurrence rates and low rates of wound and mesh infection. Occult hernias are diagnosed and optimally treated laparoscopically. However, chronic pain remains an unresolved issue.
authors.affiliation: Max Institute of Minimal Access, Metabolic and Bariatric Surgery, A unit of Devki Devi Foundation, Max Super Speciality Hospital, East Block, 2, Press Enclave Road, Saket, New Delhi, 110 017, India. a_sharma1@vsnl.com
authors.forename: A
authors.initials: A
authors.lastname: Sharma
authors.forename: M
authors.initials: M
authors.lastname: Mehrotra
authors.forename: R
authors.initials: R
authors.lastname: Khullar
authors.forename: V
authors.initials: V
authors.lastname: Soni
authors.forename: M
authors.initials: M
authors.lastname: Baijal
authors.forename: P K
authors.initials: PK
authors.lastname: Chowbey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001672:Biocompatible Materials / Q000627:therapeutic use; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D013526:Surgical Mesh; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001672:Biocompatible Materials