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Laparoscopic Repair of Ventral Hernia an Early Experience at Khyber Teaching Hospital

In our series complication rate was low. There was no copically. Other series also have reported fewer complications,
mortality or major complication. 3 patients had port site bleeding commonly a seroma in 2-4.4%, pain in 2.5% and sepsis in only
which was controlled by taking a simple suture. 9 (16.66%) 0.25% patients. 9, 10, 13 We had seroma in only 2 (3.7%) patients
patients had omental bleeding, which was controlled with and they were treated conservatively.
diathermy. Severe pain was complained postoperatively by only The suture site pain was common and severe pain was
11 (20.37%) patients requiring multiple analgesic injections while complained by 11 (20.31%), and moderate pain by 22 (40.74%)
in the rest mild to moderate pain was relieved after a single patients. Suture site pain may have originated from tissue or
analgesic injection. 2 (3.7%) patients developed a seroma that nerve entrapment during placement of sutures through full
subsided with conservative treatment in 2 weeks while another thickness of anterior abdominal wall. It could also result from
3 (5.55%) had superficial port site infection. This responded to traction of transabdominal sutures fixing the mesh to the anterior
daily dressing and cleaning with antibiotic treatment. During abdominal wall. However fixing is vital to the long-term durability
follow-up period, there was a single recurrence at 4 months, of mesh repair and do not advocate any change in technique.
giving a rate of 1.85%. The overall outcome with patient and Suture site pain was managed by analgesics and improved with
surgeon satisfaction was excellent. time. The other major complications following LVHR, like
enterotomy, mesh infection, skin breakdown, intra-abdominal
DISCUSSION
abscess have been documented, but we did not encounter such
Ventral abdominal hernias represent a frequent and often complications. There was only 1 (1.85%) recurrence at 4 months
formidable clinical problem, and a lasting surgical correction in our series, however other have reported a recurrence rate of
remains a challenge. Laparoscopic ventral hernia repair (LVHR) 4% and 2.5% between 1-3 months of surgery. 4, 9 Cobb WS et al
is becoming a popular technique with good results and a fast reported recurrence as 4.7% after a mean follow up period of 21
postoperative recovery. The mesh is placed directly under the months. 14
peritoneum and anchored with transabdominal sutures and Mobilization, hospital discharge and return to activities were
tacks. 7 prompt, with an average hospital stay of 2 days in our patients,
The LVHR utilizes the principles of the open technique, and majority of them returned to work after 2 weeks. Mean
including using a large mesh prosthesis, adequate overlap of hospital stay in LVHR has been reported as 2.4 and 3 days. 10, 14
the hernia defect and eliminating tension. The mesh is placed Navitsky YW, et al has described LVHR as an approach of
intraperitoneally and extensive soft tissue dissection is elimi- choice in obese patients with no perioperative mortality, mean
8
nated. Various comparative studies have shown that with hospital stay of 2.6 days and a recurrence rate of 5.5% at 25
LVHR, wound complication rate, patient discomfort, length of months follow-up. LVHR can be extended to any patient who
15
hospital stay, time to return to normal activities and recurrence is a candidate for open repair and with an acceptable risk for
8
rates are all reduced. 2,9,10 general anesthesia. As experience increases LVHR can safely
Our study group included 54 patients with ages ranging be done in patients with multiple prior abdominal procedures
between 25-62 years whereas other studies have reported mean and in atypically located hernias. The limitations in our study
ages of 55.25 years and 56 years. 2,9 Incisional hernias were the are the relatively small study group and the short mean follow
commonest ventral hernias followed by paraumbilical hernias up period. This paper serves to show our experience for better
in our patients. Other studies also show postoperative ventral awareness and acceptability of the procedure.
hernias as a common occurrence and a significant cause of
morbidity and a common indication for laparoscopic CONCLUSION
repair. 1, 9, 11
In our series, the patient as a group had a good outcome. Although LVHR may be challenging, it has the potential to be
Despite an early experience with this technique there were no considered a primary approach for most ventral and incisional
conversion to open surgery. The operating time ranged between hernias, regardless of patient status or hernia complexity. LVHR
35 minutes to 2 hours in difficult cases due to adhesions and in our experience was safe and resulted in shorter operative
obesity. Others have reported mean operating time as 90.6 time, fewer complications, shorter hospital stays, and less
minutes and 117 minutes, whereas in one series average time recurrence. It should be considered as the procedure of choice
taken was 65.6 minutes (range 28-130 minutes). 2, 8, 9 Open mesh for ventral hernia repair.
repair also required longer operating time and associated with
greater blood loss than simple repair. 12 REFERENCES
There were no major intraoperative accidents and also no 1. Salameh JR. Primary and unusual abdominal wall hernia. Surg
mortality or major complication in our series. Omental bleeding Clin N Am, 2008;88(1): 45-60. © WB Saunders Company.
occurred in 9 (16.66%) and port site bleeding occurred in 2. Adotey JM. Incisional hernia: a review. Niger J Med. 2006;15(1):
3 (5.55%) patients, it was controlled with diathermy laparos- 34-43.
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