Current status of laparoscopic ventral hernia repair

Abstract

Ventral abdominal wall hernias are a common problem for the general surgeon. Historically, the best results have been obtained with the open Rives-Stoppa approach. This is done by fixing a large piece of prosthetic mesh behind the rectus muscle. Extensive dissection is required and can lead to postoperative pain and wound complications. A laparoscopic approach allows similar mesh placement with minimal dissection. Several small comparative studies have found laparoscopic ventral hernia repair to have fewer complications, a shorter length of stay, and possibly a lower recurrence rate when compared to open mesh repair. Large prospective studies have now confirmed these findings, with recurrence rates below 4%. This is significantly lower than the best reported rates of open mesh repair. Additionally, the morbidity appears to be significantly less. This technique is easily mastered by anyone with basic laparoscopic skills and is briefly presented.

Complications of laparoscopic incisional?ventral hernia repair: the experience of a single institution

“…Our recurrence rate of 2% is consistent with previously reported rates of 2.5% to 11% [17]. Both recurrences were in the epigastrium.…”

“…An evaluation annually would be ideal for obtaining long-term recurrence rates. A recent multivariate analysis of the data available to date by Thoman and Phillips [17] confirmed the observation that the laparoscopic technique has a decreased length of stay, fewer complications, and lower recurrence rates than open repairs. These authors recommend further evaluation including longer follow-up periods [8,18].…”

Incisional hernia repair

“…Almost half of these recurrences happened during the time when the technique was not well standardized. More recent works and reviews seem to confirm good results [1,2,5,25].…”

“…The laparoscopic technique has been well standardized and described by others [16,17,25]. Briefly, we routinely used the open technique (Hasson's trocar) to establish the pneumoperitoneum, beginning in the left hypocondrium far from the defect.…”

Robot-assisted laparoscopic repair of ventral hernia with intracorporeal suturing

“…The current da Vinci instruments have a 34-cm reach. Considerations for port placement must be made to accommodate the 3-5-cm overlap of mesh and fascia so as to allow for increased distribution of pressure over a wider area, according to the Pascal principle for low recurrence rates [2,6,7,9,12,20].…”