All complications, except one recurrence due to failure of the material, were surgical mistakes and cannot be attributed to the laparoscopic procedure. Consequently, after taking into account the surgical mistakes and possible technical errors, the low recurrence rate justifies further application of laparoscopic ventral hernia repair.

The laparoscopic repair of parastomal hernias is a surgically challenging procedure with promising results when using the two-mesh technique. Therefore, two meshes should be used in all cases of parastomal hernias. Polyvinylidene fluoride was revealed to be the most suitable material for the sandwich repair in terms of possible ingrowth and infection resistance.

The laparoscopic repair of incisional and parastomal hernias with meshes made of PVDF (Dynamesh IPOM) revealed low recurrence and, overall, low complication rates. Especially in cases of infection, the material proved to be resistant without clinical signs of persistent bacterial contamination. Mesh-related complications did not occur during the follow-up.

The rationale for laparoscopic repair of incisional hernias lies in the fact that any kind of incisional hernia is caused by an intrinsic defect of wound healing. This means that the abdominal wall needs to be reinforced with foreign nonresorbable material. During laparoscopic repair a nonresorbable mesh with the characteristic feature that its two surfaces are quite different is used to completely cover the original incision. One surface is designed to ensure stable incorporation into the abdominal wall and the other, to keep adhesions between the mesh and the bowel to a minimum. Experience reported since its first description in 1993 has clearly shown that the main advantage of the laparoscopic technique over conventional methods is that it involves an extremely low risk of mesh infection. The reported recurrence rates of 1-11% are mainly attributable to technical error and demonstrate that in this way too, the laparoscopic technique is at least as good as the open techniques. Up to now, no mesh-related complications in the form of fistula or mesh migration have been described. In conclusion, then, laparoscopic repair of ventral hernia is an important addition to the surgical armamentarium, which at least in our hands has almost completely replaced conventional techniques.

Zusammenfassung. Grundlagen: Die laparoskopische Reparation von Narbenhernien, die auf der so genannten intraperitonealen Onlay Mesh-Technik beruht, findet zunehmend Eingang in den klinischen Alltag. Ursache hierfür ist das reduzierte Bauchdeckentrauma im Vergleich mit den offenen Verfahren.Methodik: Literaturübersicht zur laparoskopischen Behandlung von Narbenhernien.Ergebnisse: Die aktuelle Literatur zeigt niedrige Rezidiv-und Konversionsraten bei akzeptabler Morbidität im Sinne von unerkannten Darmläsionen. Der entscheidende Vorteil der laparoskopischen gegenüber den offenen Techniken ist die reduzierte Rate an Wundkomplikationen. Die Frage nach dem intraperitoneal zu applizierendem Material, die Gegner der laparoskopischen Reparation gerne anführen, ist heute geklärt. Verschiedene Netzstrukturen verhindern auf der einen Seite die Ausbildung von Adhäsionen und erlauben eine echte Inkorporation auf der anderen Seite. Eine aktuelle Entwicklung (Polyvinyliden Fluorid) scheint besonders attraktiv, da sie eine Überlappung und damit die Anwendung von mehreren Netzen erlaubt und außerdem eine der originären Bauchwand vergleichbare Elastizität aufweist.Schlussfolgerungen: Fast alle Narbenhernien können zwar laparoskopisch versorgt werden. Trotzdem ist eine genaue Kenntnis der Hernienkrankheit selbst sowie der verschiedenen Behandlungsoptionen notwendig, um für den individuellen Patienten die jeweils beste Therapie zu finden.Schlüsselwörter: Bauchwandhernie, Netzimplantation, laparoskopische Technik.Summary. Background: Laparoscopic repair of incisional hernias, which basically means an intraperitoneal onlay mesh technique, is becoming increasingly popular as it reduces trauma to the abdominal wall compared with open techniques.Methods: Review of the literature on laparoscopic repair of incisional hernias.Results: The recent literature reveals low recurrence and conversion rates with acceptable morbidity in terms of unrecognized enterotomies. The main advantage of the laparoscopic repair over conventional techniques is the reduced rate of wound complications. The question of material often posed by opponents of laparoscopic repair can be answered today. Several materials are available that provide incorporation into the abdominal wall and prevent formation of adhesions to the intestine. A very recent development (polyvinylidene fluoride) seems to be most attractive because of (i) the primary pore size so that 2 meshes can be overlapped, and (ii) elasticity similar to the human abdominal wall.Conclusions: Although most incisional hernias can be repaired laparoscopically, profound knowledge of the hernia disease itself and different treatment approaches are necessary to provide the best procedure for the individual patient in the sense of tailored surgery.