title: Laparoscopic repair for recurrent incisional hernias: a single institute experience of 10 years.
abstract: OBJECTIVE
  The treatment of recurrent incisional hernias (RIH) has been associated with unsatisfactory postoperative (PO) morbidity and high failure rates. The aim of this study is to retrospectively investigate our single-center experience of laparoscopic repair (LR) for RIH.
  
  
  METHODS
  The case records of 69 patients with RIH who underwent LR in our institution between January 2002 and November 2011 were reviewed. The operative technique has been standardized and provides onlay placement of an ePTFE mesh fixed with titanium tacks. Patients' demographic data and comorbidities, intraoperative course, PO complications and recurrences at follow-up were systematically collected and analyzed. The influence of defect's size and obesity variables on clinical outcomes was also investigated.
  
  
  RESULTS
  The mean operative time was 147.6 ± 71.2 min and mean hospital stay was 5.8 ± 1.8 days. No conversion occurred while five intraoperative complications (7.2 %) were recorded: three bowel injuries treated by laparoscopic sutures, one omentum bleeding and one epigastric vessel lesion. PO mortality was null, while overall morbidity was 13 % (9 patients) with a prevalence of seroma lasting over 8 weeks in six patients (8.7 %). Along a mean follow-up of 41 months (range 6-119), recurrence rate was 5.7 % (4 patients). Univariate analysis for width of defects and BMI showed no significant influence on patients' outcomes.
  
  
  CONCLUSIONS
  Surgical treatment for RIH remains controversial because of lack in literature of specific studies on this topic. Morbid obesity and large defects have been often associated with technical difficulties and worse results. Our 10 years' experience with LR provided satisfactory results in terms of PO morbidity and recurrence rate, despite any kind of patient selection.
authors: Oncologic and Mini-invasive Surgery Department, Niguarda Cà Granda Hospital, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
authors: G
authors: G
authors: Ferrari
authors: C
authors: C
authors: Bertoglio
authors: C
authors: C
authors: Magistro
authors: V
authors: V
authors: Girardi
authors: M
authors: M
authors: Mazzola
authors: S
authors: S
authors: Di Lernia
authors: R
authors: R
authors: Pugliese
mesh_terms: D000368:Aged; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D007431:Intraoperative Complications / Q000145:classification / Q000453:epidemiology / Q000209:etiology; D007558:Italy / Q000453:epidemiology; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008501:Medical Records, Problem-Oriented; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology / Q000209:etiology; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
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