Combined Laparoscopic and Open Technique for the Repair of large Complicated Incisional Hernias

Yun Ji, MD, Xiaoli Zhan, MD, Yuedong Wang, MD, PhD, Jinhui Zhu, MD

Department of General Surgery, Second Affiliated Hospital Zhejiang University College of Medicine

Background During laparoscopic incisional hernia repair, conversion to open surgery is sometimes needed, especially in large complicated incisional hernias. There are no guidelines for determining when conversions should be considered. The purpose of this study is to investigate the safety of the combined technique as an alternative to conversion in laparoscopic repair of large complicated incisional hernias and to evaluate the impact of early conversion to the combined technique on patient outcome.

Methods Beginning in November 2008, early conversion was initiated for patients with large complicated incisional hernia when there were dense extensive intra-abdominal adhesions. Two cohorts of patients with large complicated incisional hernia were retrospectively analyzed: 21 patients before the initiation of early conversion (group 2) and 21 patients after its inception (group 1). Data analyzed included patient demographics, operative parameters, complications, and recurrence.

Results No significant differences were found between the two groups with respect to age, gender, body mass index, coexisting conditions, number of previous laparotomies, number of previous repairs and features of the hernia. There were significant differences between groups 1 and 2 in terms of mean operative time (110.7 vs. 138.8 min), enterotomy rate (0% vs. 29%) and postoperative hospital stay (4.7 vs. 6.1 days). In group 1, early conversion to the combined technique was necessary in 16 (76%) patients, and there was no delayed conversion. In group 2, delayed conversion to the combined technique was necessary in 11 (52%) patients, and there was no early conversion. During the follow-up period, neither wound/mesh infection nor trocar-site hernia occurred.

Conclusion The combined technique was a safe and minimally invasive alternative to conversion in laparoscopic repair of large complicated incisional hernias. Early conversion to the combined technique was associated with less technical difficulty, deceased operative time, lowered enterotomy rate and reduced postoperative hospital stay.

Keywords Adhesiolysis, Conversion, Enterotomy, Laparoscopy, Recurrent incisional hernia


Session: Poster Presentation

Program Number: P277

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