Laparoscopic repair of ventral hernia

ABSTRACT

Laparoscopic repair of ventral hernia is rapidly becoming more commonplace in the armamentarium of general surgeons. Its utility and low recurrence rates make it a very attractive option. The technique of the laparoscopic repair is based on the principle described by Stoppa, however the hernial sac is not dissected and is left behind. This minimizes difficult dissection, blood loss and large incisions. The laparoscopic technique also ensures that all defects are seen and repaired. The aim of the study is to evaluate this technique in comparison to open onlay mesh repair of ventral hernia. From November 2004 to October 2006, 60 patients with ventral hernias were equally randomized into two groups; in group I, laparoscopic repair was practiced using a composite mesh [Parietex [registered sign]], fixed intraperitoneally by sutures and tackers, while in group II, open mesh repair was employed after dissection, herniotomy and peritoneal closure, a prolene mesh used to close the defect, fixed by continuous prolene 0 suture. The two groups were compared in regard to operative time, postoperative complications, hospital stay, recurrence and the cost. The patients in the two groups were comparable at baseline in terms of sex, age, presenting complaints, and comorbid conditions. The mean surgery durations were 90.6 minutes for the laparoscopic repair and 99.3 minutes for the open repair with no significant difference. The mean postoperative stay was shorter for laparoscopic group than for open hernia group [1.8 Vs 3.7 days with significant difference]. There were fewer complications [20% and no recurrences] among the patients who underwent laparoscopic repair than among those who had open repair [40% and no recurrence]. The cost of composite mesh and tacker were significantly higher than the cost of prolene mesh. Laparoscopic ventral hernia repair is safe and resulted in shorter hospital stays, fewer complications and so far no recurrence during the period of follow-up