title: Management of non-midline incisional hernia by the laparoscopic approach: results of a long-term follow-up prospective study.
abstract: BACKGROUND
  The role of the laparoscopic approach in the repair of non-midline incisional hernias is controversial due to the absence of adequate scientific studies. This study aimed to determine the safety and efficacy of laparoscopic repair for non-midline incisional hernias.
  
  
  METHODS
  This prospective clinical study was conducted in an abdominal wall unit of a teaching hospital. Patients underwent surgery for non-midline incisional hernias using the laparoscopic approach (n = 73) and were classified into three groups: subcostal, iliac, and lumbar. The primary end point was recurrence. The secondary end points were intraoperative parameters, comorbidity, and patient outcomes. The median follow-up period was 62 months (range, 36-170 months).
  
  
  RESULTS
  No hospital stay was needed for 34% of the patients. The remaining patients needed an average hospital stay of 2.7 days. The most frequent morbidity was hematoma. The overall recurrence rate was 8.2% and was higher for the subcostal hernias (25%). The three groups differed in size, local morbidity, and recurrence (P < 0.05). The independent risk factors for recurrence were size (hazard ratio [HR], 2.16; 95% confidence interval [CI], 1.08-4.33) and local morbidity (HR 30.62; 95% CI 1.22-768-82). The best predictor of recurrence was a hernia diameter greater than 15 cm. The only predictive factor of local morbidity was obesity (P < 0.007).
  
  
  CONCLUSIONS
  The laparoscopic approach is a safe and effective treatment for non-midline incisional hernias. Caution should be taken with subcostal hernias, obese patients, and a defect size greater than 15 cm. An algorithm is suggested to guide the "rational" treatment of non-midline incisional hernias.
authors: Abdominal Wall Unit, Department of Surgery, J. M. Morales Meseguer Hospital, Avenida Primo de Rivera 7, 5º D, Edif, 30008, Murcia, Berlin, Spain. moreno-egea@ono.com
authors: Alfredo
authors: A
authors: Moreno-Egea
authors: Andres
authors: A
authors: Carrillo-Alcaraz
mesh_terms: D000368:Aged; D005260:Female; D046449:Hernia, Abdominal / Q000150:complications / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012372:ROC Curve; D012008:Recurrence; D012307:Risk Factors; D013526:Surgical Mesh; D014057:Tomography, X-Ray Computed