Safety, pitfalls and early complications of laparoscopic ventral hernia repair

ABSTRACT

Ventral hernia repair, particularly with large defects are plagued by high recurrence and frequent wound complications. Laparoscopic ventral hernia repair [LVHR] potentially offers a tension-free technique with less morbidity and fewer recurrences. This study addresses safety, pitfalls and early complications associated with LVHR. Patients underwent LVHR in the period between January 2002 and May 2003 Preoperative, Intraoperative and postoperative as well as follow up data is presented. Thirty-six patients [41 hernias] had attempted LVHR. Hernias were 27 incisional, 7 recurrent incisional, 6 primary and 1 iatrogenic. Mean operative time was 2 hours [range 1-4]. Mean hospital stay was 2.4 days [range 1-10]. Two cases underwent concomitant additional procedures. Two cases [5.5%] were converted to open procedure; 2 others needed open re-exploration. Complications included 3 cases [8.3%] of inadvertent bowel injury. Twenty-two cases [68.7%] had wound complications; none needed operative intervention. Pain was the most common reason delaying patient discharge. Mean follow-up was 22 months [range /2-28 months] with 2 [7.14%] recurrences. LVHR is safe however, it may be associated with significant morbidity, in part preventable by proper patient selection, meticulous technique and liberal conversion to open technique. Benefits for LVHR include proper repair of all defects, without long incision or extensive abdominal wall dissection. Although wound morbidity seems common, most are minor and resolve spontaneously