Laparoscopic intraperitonealmesh repair of ventral hernia :prospective comparison toconventional mesh repair

ABSTRACT

The recurrence rate after standard repair of ventral hernias may behigh and the wide surgical dissection required often results in wound complications. Use of laparoscopic approach may decrease rates of complications and recurrence after ventral hernia repair. The laparoscopic repair of ventral hernias is still a controversial therapeutic op-tion. To evaluate the efficacy and safety of laparoscopic repair we compared the results of open and laparoscopic repair of ventral her-nias. Fifty three patients were randomized prospectively to undergo laparoscopic or open repair of ventral hernias. Thirty-eight patients presented with incisional hernias [12 upper midline, 15 lower midline, and 10 transverse abdominal], 8 had epigastric hernias, 8 had periumbilical hernias. All defects were estimated to be larger than 5 cm in diameter. Twenty six patients underwent attempted laparoscopic ventral hernia repair [LVHR] with mesh and twenty seven patients underwent open ventral hernia repair [OVHR] with mesh. Two of the 26 attempts of LVHR were converted to OVHR for a conversion rate of 7.6 percent The mean duration of surgery was significantly longer in the open group. The analgesic requirement was lower in the laparoscopic group. Time to oral solid food intake was longer in the open group. Post-operative stay was shorter in the laparoscopic group. Also, we noticed that there were significant early pain free return to activity and work in LVHR. In LVHR, postoperative complications occurred in 8 patients inthe form of seroma, and ileus in one patient. Whereas, in OVHR, 10 patients had postoperative complications that included wound seroma in 4patients, wound infection in 4 patients [one required removal of mesh],postoperative ileus in one patient, and wound dehiscence in one patient. There was a significant less recurrence rate in LVHR in comparison with OVHR [0 vs. 3 patients]. In conclusion, laparoscopic incisional hernia re-pair, is a safe, feasible alternative to open techniques. However, largerstudies and long-term follow-up are required to further evaluate the true effectiveness of this operation