The Incidence of Occult Fascial Defects Discovered in Laparoscopic Ventral Hernia Repairs in 374 Patients

Objective: One aspect unique to the laparoscopic ventral hernia repair (LVHR) is the visualization and repair of occult fascial defects not recognized during open repairs. This recognition of occult fascial defects leads to wider mesh coverage of the areas that would likely go undetected (and un-repaired) at the time of open surgery. This study reviews the incidence of such occult fascial defects. This study analyzes a single surgeons experience at a single institution and decreases variability of operative technique and postoperative management inherent in other multi-surgeon studies.

Methods and Procedures: The short term outcomes of LVHR were analyzed by retrospectively reviewing the records of all patients who underwent this procedure by a single surgeon in a single institution from January 2000 to August 2007. The data from 374 patients was reviewed including patient demographics, history of ventral hernia repairs, the number of occult fascial defects, operative details, and postoperative outcomes.

Results: The study was comprised of 374 patients (179 men and 195 women: mean age 51 years) who underwent LVHR with mesh over a 7-year period. 7 patients were converted to an open procedure. Average ASA class was 1.8. 26.5% of patients had a previous ventral hernia repair. The average fascial defect size was 46.75 cm2. Occult fascial defects were found in 57% of the patients. Average operative time was 54 minutes and the patients average length of stay was 1.45 days. There was a 7% complication rate including 2 enterotomies, 1 postoperative bowel obstruction, 5 post op ileus, 1 fistula and 15 patients with seromas. 92% were seen in follow-up at median 11 days postoperatively. Patients reported narcotic use on average of 4.3 days. 91% pf patients reported marked pain improvement and 92% were back to full activity at follow-up. There were no deaths in this series.

Conclusions: There was a 57% incidence of occult fascial defects detected and repaired in 374 LVHR. This single surgeon experience showed less operative time, shorter length of stay, and fewer complications than reported in previous multi-surgeon, single institution studies. LVHR offers the advantage of recognizing and repairing occult fascial defects not detected in open repairs with minimal complications. In addition, the laparoscopic repair allows for the well-known advantages of wider mesh coverage, less tissue destruction, earlier recovery, fewer postoperative complications and decreased recurrence rates.

Session: Podium Presentation

Program Number: S042

« Return to SAGES 2008 abstract archive