Totally laparoscopic abdominal wall reconstruction: lessons learned and results of a short-term follow-up.
OBJECTIVE
Totally Laparoscopic Abdominal Wall Reconstruction (TLAWR) combines the laparoscopic component separation and the laparoscopic ventral hernia repair, with the purpose of further increasing the benefits of a minimally invasive procedure. However, neither the patient selection criteria nor the long-term results of this technique have been reported. Our objective is to discuss our experience with five patients who received a TLAWR.


METHODS
All patients with a midline incisional hernia who underwent a TLAWR from September 2008 to October 2009 were retrospectively reviewed for early and late postoperative complications.


RESULTS
A total of five patients underwent the procedure, with a mean age of 48.6 ± 7.9 years. The mean length of stay was 9.2 ± 5.4 days, and follow-up was 12.3 ± 6.8 months. The mean defect size was 175.8 ± 56.2 cm(2). There were no early or late wound complications. Two patients had an early respiratory complication, and one patient developed a port site hernia and small bowel obstruction early after procedure, which required a re-operation. Three patients (60 %) experienced a recurrence. Possible risk factors for recurrence include previous failed hernia repair, loss of domain, large hernias and close proximity to bony structures.


CONCLUSIONS
Although TLAWR is feasible and improves wound complications, it may be associated with higher recurrence. Appropriate patient selection is imperative in order for the patient to benefit from this technique.
Harbor-UCLA Medical Center, Torrance, CA, USA, amoazzez@dhs.lacounty.gov.
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Moazzez
R J
RJ
Mason
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Darehzereshki
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Katkhouda
D034861:Abdominal Wall / Q000503:physiopathology / Q000601:surgery; D000328:Adult; D005260:Female; D006555:Hernia, Ventral / Q000145:classification / Q000503:physiopathology / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D010535:Laparoscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000145:classification / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D055502:Secondary Prevention; D013526:Surgical Mesh; D016896:Treatment Outcome