Laparoscopic Management of Non-Midline Ventral Hernia

Romesh Lal, Deborshi Sharma, Priya Hazrah, Pawan Kumar, Saurabh Borgharia

Department of Surgery, Lady Hardinge Medical College, New Delhi 110001 India

Introduction: Ventral hernias are routinely managed laparoscopicaly. These hernias are generally central in location over the abdomen and techniques are particularly specified and described for them. Non-midline ventral hernia are rarer and may not have the requisite space in its lateral extent leading to problems with mesh fixation and the hernia’s proximity to major organs makes it even more challenging at times. We carried out this study to determine the pattern of presentation, Intra-operative problems and post-operative outcomes after repair of non midline ventral hernia.

Methods: We retrospectively analyzed all the cases operated in last 5yrs for ventral hernias in our surgical unit. Among 183 laparoscopic ventral hernia operated 25 fulfilled the criteria of non-midline ventral hernia. These 25 cases either were totally away from the midline (E.g: Lumbar hernia) or had an extension beyond the limits of the rectus muscle (E.g: Sub-costal hernia & Supra pubic extension). Among 25 cases we had the following profile.
1. Lumbar area (n=5)
a. Primary lumbar hernia: 1
b. Incisional hernia: 4
2. Suprapubic area (n=7)
a. Extension of midline incision: 7
3. Iliac area (n=10)
a. Post Appendicectomy incisional hernia: 4
b. Spigellion: 1
c. Post pffanensteil incision: 5
4. Sub-costal area (n=3)
a. Post Cholecystectomy: 3
Univariate and multivariate analysis using SPSS 19 software was done. All the groups were compared for pre-operative, intra-operative and post-operative characteristics using appropriate tests . Continuous data was analyzed using Mann Whitney U test/t test as applicable and categorical data using Chi-square test. A p value of ≤ 0.05 was considered significant

Results: Mean age was lowest in the Iliac group 29.7±5.96 and highest in Lumbar group 51.60±8.70. BMI was highest in the sub-costal group 30.133±1.30 and least in iliac group 28.65±1.35. Diameter of hernia ranged from 5.40±1.59 in lumbar group to 7.20±1.43 cm in iliac group. Least mean time for surgery was taken in Lumbar 90.0±11.18 minutes while in suprapubic extension group mean operative time was 113.15±6.90. None of the above parameters had any statistically significant difference between all the groups.
One case had Intestinal injury in iliac group (p=0.668). Intra-operatively major organs were injured once in both Lumbar (spleen) and sub costal (Liver) (p=0.167) groups. In post-operative period, Iliac group had one hematoma (p=0.668) while seroma was seen in one lumbar group and two iliac group patients (p=0.518). Persistant cough impulse was seen in one case each in iliac and lumbar group (p=0.593). One case in the iliac group recurred after primary surgery (p=0.668).

Conclusion: Though we had analyzed only 25 case of non-midline ventral hernia, it was definitely seen that almost all the intra and post operative problems of laparoscopic ventral hernia repair were encountered in these cases. Laparoscopic repair of non-midline hernia is feasible but incidence of complication might be more than that of mid-line ventral hernias.

Session: Poster Presentation

Program Number: P296

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