title: Short- and mid-term outcome after laparoscopic repair of large incisional hernia.
abstract: OBJECTIVE
  To compare the outcome after laparoscopic incisional and ventral herniorrhaphy (LIVH) for fascial defect larger or equal than 15 cm in width with the outcome after LIVH in patients with hernia defect smaller than 15 cm.
  
  
  METHODS
  From 2003 through 2010, 350 patients were submitted to LIVH. In 70 cases, hernia defect was ≥15 cm in width and in 280 was <15 cm. Incisional hernias were often recurrent, double or multiorificial. In the group of larger hernias, the rate of obesity, recurrent hernia and multiorificial hernia was 27.1, 24.2 and 12.8 %, respectively, and in the group of smaller hernias 27.3, 16.1 and 2.8 %, respectively. Patients were interviewed using McGill pain score test to measure postoperative quality of life (QoL) in the mid-term.
  
  
  RESULTS
  LIVH for hernia ≥15 cm required longer surgical time (p = 0.034) and postoperative hospital stay (p = 0.0001). Besides, there were higher rate of postoperative prolonged ileus (p = 0.035) and polmonitis (p = 0.001). Overall recurrence rate was 2.6, 8.6 % for larger and 1.1 % for smaller incisional hernias, p = 0.045. Mc Gill pain test revealed no significant difference in the two groups of patients in postoperative QoL within 36 months.
  
  
  CONCLUSIONS
  Laparoscopic approach seems safe and effective even to repair large incisional hernia, the rate of recurrence was higher, but acceptable, if compared to smaller hernias. To the best of our knowledge, this is the largest reported series of incisional hernias ≥15 cm managed by laparoscopy.
authors.affiliation: Division of Gastrointestinal and Pancreatic Surgery, Department of General Surgery, Scientific Institute San Raffaele University Hospital, Via Olgettina 60, 20132, Milan, Italy, paolo.baccari@hsr.it.
authors.forename: P
authors.initials: P
authors.lastname: Baccari
authors.forename: J
authors.initials: J
authors.lastname: Nifosi
authors.forename: L
authors.initials: L
authors.lastname: Ghirardelli
authors.forename: C
authors.initials: C
authors.lastname: Staudacher
mesh_terms: D057186:Comparative Effectiveness Research; D005260:Female; D006555:Hernia, Ventral / Q000503:physiopathology / Q000523:psychology / Q000601:surgery; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000145:classification / Q000209:etiology; D011788:Quality of Life; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013526:Surgical Mesh; D016896:Treatment Outcome