title: Laparoscopic Treatment of Giant Ventral Hernia: Experience of 35 Patients.
abstract: BACKGROUND
  Minimal access surgery for incisional hernia repair is still debated, especially for giant wall defects. Laparoscopic repair may reduce pain and hospital stay. This study was designed to evaluate the feasibility of the laparoscopic technique in giant hernia.
  
  
  METHODS
  From 2007 to 2013, 35 consecutive patients with giant ventral hernia, according to the Chevrel classification, underwent laparoscopic repair. Fourteen patients were obese, with a body mass index (BMI) > 30 and in 21 patients the mean BMI was 24 (range 22-28). In all patients, the wall defect was larger than 20 cm.
  
  
  RESULTS
  Mean operative time was 159±30 minutes, and, for defects larger than 25 cm, it was 210±20 minutes. Patient conversion did not occur. In 29 patients, the mean wall defect was 20x25 cm, and in six patients the mean wall defect was 26x31 cm, and, as measured from within the peritoneal cavity, the mean overlap was 5 cm (range 3-6). Short-term antibiotic prophylaxis consisted of Cefazolin 2 g IV (intravenous) the day of surgery. All patients were discharged within 72-96 hrs. The mean follow-up was 24 months. No infection occurred and no chronic pain was recorded. However, three seroma were observed (outpatient treatment) and two xiphoid recurrences were observed.
  
  
  CONCLUSIONS
  Laparoscopic hernia repair is technically feasible and is safe in patients with giant fascial defects as well as obese patients. This operation decreases postoperative pain, hastens the recovery period, and reduces postoperative morbidity and recurrence. This approach should be reserved for patients with no history of previous hernia repair. Further studies are expected to confirm these promising results.
authors.affiliation: Department of Surgery, University Hospital of Tor Vergata, Rome, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Grande
authors.affiliation: Department of Surgery, University Hospital of Borgo Roma, Verona, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Lisi
authors.affiliation: Department of Surgery, University Hospital of Modena, Modena, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Campanelli
authors.affiliation: Department of Surgery, University Hospital of Messina, Messina, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Grande
authors.affiliation: Department of Surgery, University Hospital of Tor Vergata, Rome, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Venditti
authors.affiliation: Department of Surgery, University Hospital of Tor Vergata, Rome, Italy.
authors.forename: Casimiro
authors.initials: C
authors.lastname: Nigro
authors.affiliation: Department of Surgery, University Hospital of Modena, Modena, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Cabry
authors.affiliation: Department of Surgery, University Hospital of Tor Vergata, Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Villa