Page 29 - WALS Journal

World Journal of Laparoscopic Surgery, May-August 2008;1(2):32-35
M Dhanesh Kumar
Long-term Outcomes in Laparoscopic vs

Open Ventral Hernia Repair

M Dhanesh Kumar
Dhanesh Hospital, Vellore

Abstract open or laparoscopic repair shouldbe performed it depends on

Objective: To ruleout whether there was a difference in, recurrence general surgeons interest. Data are still inconclusive on

rate, morbidity, and duration of hospital stay between patients morbidity and recurrence rates.The main purpose of this study

undergoing open or laparoscopic ventral hernia surgery.
is to compare the outcome of the patientsundergoing open and

Materials and methods: Cohort study in single-institution was laparoscopic intraperitoneal onlay mesh repairs in a single
compared prospectively collected from patient cohorts undergoing institution for a period of 10 years.
laparoscopic or open intraperitoneal onlay mesh repair. Literature
search was performed using search engine Google and our online facility DATA
of Springer Link. The following search terms were used. Laparoscopic
versus ventral hernia repair, ‘laparoscopic repair of ventral hernia, Data from all 651 patients who underwent ventral incisional
controversies in laparoscopic ventral hernia repair, comparison of hernia repair between October 1995 to December 2005 at a single
laparoscopic and open (Ventral Hernia) repair, Laparoscopic Repair institution were collected prospectively. Patients who had

of Ventral Hernia during obesity. About 143 citations found in total. undergone an intraperitoneal onlay mesh repair, either openor

Data collected from 360 consecutive patients who had undergone
laparoscopic or open intraperitoneal onlay mesh repair of a ventral laparoscopic, are only considered. The techniques of both

hernia were prospectivelycollected from October 1995 and December repairs have been described here.
2005 are recorded .
Open Mesh Techniques

Main outcome of the study: Hernia recurrence andduration of hospital

stay and morbidity. Postoperative complications of Claviengrade 2 or Rives, Stoppa and Wantz popularized Open surgical technique
more than grade 2 were considered as major complications. After taking patients to operative theater and under general

Results: Intraperitoneal onlay mesh surgery was performed in 233 anesthesia, endotracheal intubation and with close
patients by open approach and in 127 patients by laparoscopic monitoring operation was started. After painting and draping

approach. Groups were similar for sex and body mass index and it is of abdomen the incision was made according to the site and

calculated by weight in kilograms divided by the height in meters size of the hernia subcutaneous flap was raised up to 4 to 5 cm

squared and the mean age for the laparoscopic group was 3 years around the hernia and the hernial sac was found, contents was

younger; and the mesh was selected larger for the laparoscopicgroup. reduced sac was excised. The mesh is placed in the

Mean follow-up for both laparoscopic and open groups was 30 and 36 intraperitoneally and fixation of the mesh done withinterrupted

months; and the conversion rates are 4%. Majormorbidities were 15%

in the open group and 7% in the laparoscopicgroup. Recurrence rates sutures at minimum of two centimeters from the fascial edge.

were 9% in the open group and 12% in the laparoscopic group. Anterior rectus sheath closed over the mesh with a loop of

Postoperative inpatient admission was more frequent after the open polypropylene without tension, and then skin closed over the
procedure than after the laparoscopic procedure (28% and 16%, drain depending upon size and extension of the wound.
respectively).
Conclusions: Outcomes of the study shows not much difference with Laparoscopic Repair of Ventral Hernia

respect to recurrence rates after long-term follow-up; however, lower Almost all types of Ventral Hernia can be operated by minimal

rate ofmajor morbidity and increased outpatient-based procedure rates access surgical techniques except if the size more than 10 cm
favor laparoscopic repair in this study.
and it should be explained clearly to the patient that the
INTRODUCTION laparoscopic repair will not help cosmetically if the skin is very
lax and hanging loosely in the large hernia. In Laparoscopic
More than 2 million abdominal surgery’s take place yearly in Ventral Hernia Repair evacuation of urinary bladder in lower

USA; with an estimated 3 to 20% of those patients develop abdominal surgery and Nasogastric tube in upper abdominal

ventral incisional hernia. With 90 000ventral incisional hernia surgery is necessary, because in most of the cases the access

repairs are performed every year, the question of whether an is through the palmar’s point which is about 2 to 3 cm below the
32