Laparoscopic Ventral/incisional Hernia Repair with Tissue Augmentation and Transfascial Fixation, 17 Years Follow Up

BACKGROUND:
Incisional hernias develop in 2%-20% of laparotomy incisions, necessitating approximately 90000 ventral hernia repairs per year. Although a common general surgical problem, a “best” method for repair has yet to be identified, as evidenced by documented recurrence rates of 25%-52% with primary open repair, there is controversy regarding the closure of the defect and the transfascial fixation of the mesh.. The aim of this study was to evaluate the efficacy and safety of laparoscopic ventral and incisional herniorrhaphy, and the long term follow up with fascial closure and transfascial fixation of the mesh.
METHODS:
From February 1991 through December 2008, a total of 955 patients were treated by laparoscopic technique for primary and recurrent umbilical hernias, ventral and incisional hernia. The technique was essentially the same for each procedure and involved lysis of adhesions, reduction of hernia contents, closure of the defect, and 5 cm circumferential mesh coverage of all hernias.
RESULTS:
Of the 955 patients in our study group, 49% were females and 5 1% were male. The mean age was 58.3 years (range 27-100 years). The mean operating time was 68 min (range 14-405 min), and the mean estimated blood loss was 25 mL (range 10-200 mL). Conversion rate was 1.46% (14 patients). The mean postoperative hospital stay was 2.9 days and ranged from same-day discharge to 36 days. The overall postoperative complication rate was 10.1%. There have been 20 recurrences (2.09%) during a mean follow-up time of 74.1 months (range 6-171 months).
CONCLUSION:
Laparoscopic ventral and incisional hernia repair, based on the Rives-Stoppa technique, is a safe, feasible, and effective alternative to open techniques. More long-term follow-up is still required to further evaluate the true effectiveness of this operation.


Session: Podium Presentation

Program Number: S019

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