Page 71 - World Journal of Laparoscopic Surgery

ORIGINAL RESEARCH
Laparoscopic Ventral Hernia Repair: Our Experience

and Review of Literature

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Tajamul Rashid , Mohammad Mohsin , Musharraf Husain , Manzoor Ahmad 4
AbstrAct
Background: The incidence of primary ventral hernias has been relatively static, while the incidence of incisional hernias has increased over
time with the increase in the number of abdominal surgeries performed. The repair of ventral wall hernias continues to be a surgical challenge.
Laparoscopic ventral hernia repair is nowadays being performed in every laparoscopic center and has become a preferred treatment methodology
of ventral hernias. This approach is a feasible option for almost all ventral hernias.
Materials and methods: This was a prospective observational study, conducted in the Department of Surgery, Hamdard Institute of Medical
Sciences and Research, New Delhi over a period of 2 years from December 2016 to December 2018. A total of 40 patients who met the inclusion
criteria were included in the study. The procedure was done by a single surgical team. The average follow-up ranged from 6 to 12 months.
Results: Out of 40 patients in the age-group of 30–79 years, 24 were females and 16 were males. Fifty-five percent of the patients had incisional
hernias with the average defect size ranging from 2 to 4 cm. The average operative time was 71–90 minutes. The hospital stay ranged from 2 to 4 days.
There was no major intraoperative complication in our study. There was no conversion to open. Early postoperative pain was noted in 10
patients. Port site infection was noted in one patient and two patients developed postoperative seroma. Chronic pain was noted in one patient
at 6 months follow-up. Port site herniation was noted in none. The recurrence of hernia was noted on one patient at the end of the follow-up.
Conclusion: Laparoscopic ventral hernia repair, although sometimes technically challenging is an extremely safe and effective option in the
management of ventral hernias. This approach offers a good cosmetic outcome to the patient without compromising on the results of hernia repair.
Keywords: Incisional hernia, Laparoscopic repair, Ventral hernia.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1499

IntroductIon 1–4 Department of General Surgery, Hamdard Institute of Medical
The word hernia in Greek means “Bud” and in Latin means Sciences and Research, New Delhi, India
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“Rupture”. A hernia is defined as an abnormal protrusion of a Corresponding Author: Tajamul Rashid, Department of General
viscera or tissue through a defect in its surrounding wall. A ventral Surgery, Hamdard Institute of Medical Sciences and Research, New
hernia usually arises in the abdominal wall where a previous surgical Delhi, India, Phone: +91 7006473796, e-mail: doc.tajamul@gmail.com
incision was made, hence the name incisional hernia. Hernias in How to cite this article: Rashid T, Mohsin M, Husain M, et al.
the ventral wall of the abdomen may be primary or acquired later Laparoscopic Ventral Hernia Repair: Our Experience and Review of
in life. The incidence of primary ventral hernias has been relatively Literature. World J Lap Surg 2022;15(1):69–73.
static, while the incidence of incisional hernias has increased over Source of support: Nil
time with the increase in the number of abdominal surgeries
performed. In the United States alone, it is estimated that 3–5% of Conflict of interest: None
patients who undergo laparotomy will develop ventral wall hernia
(incisional hernia). 2,3
The repair of ventral wall hernias continues to be a surgical posterior to the fascia in the intraperitoneal anatomic space. This
challenge. Historically, ventral wall hernias were repaired by open approach is a feasible option for almost all ventral hernias. This
techniques prior to 1993, but at the cost of very high recurrence is particularly beneficial for hernias with multiple defects (Swiss
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rates varying from 8 to 63%. Minimally invasive surgery has been cheese hernias) as a single mesh can cover all the defects. It has
a breakthrough in the surgical sciences. Erich Mühe performed the benefits of shorter hospital stay, less pain, and better cosmetic
first laparoscopic cholecystectomy in 1985. Thereafter, there was an results, although it continues to remain a challenging procedure,
explosion of laparoscopic procedures. The first laparoscopic ventral more so in the reoperative abdomen and in patients with serious
hernia repair was done by LeBlanc and Booth. 5 comorbidities. The contraindications for laparoscopic ventral hernia
Laparoscopic ventral hernia repair is nowadays being repair are the same as those for any major laparoscopic operation. In
performed in every laparoscopic center and probably has become addition, it is relatively contraindicated in patients who are morbidly
a method of choice for the treatment of ventral hernias. About obese. Such patients should be counselled for weight loss surgery
20–27% of repairs are performed laparoscopically in the United prior to hernia repair.
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States. With the advent of meshes, the recurrence rates have been
brought down to as low as 1–14% as reported in some series. Inclusion and Exclusion Criteria
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The laparoscopic approach involves safe entry into the abdomen, Patients in all age-groups and of both sexes with diagnosed
adhesiolysis, reduction of contents and the sac, with reinforcement (clinical and radiological), primary or acquired ventral hernias of
or bridging of the fascial defect, with appropriate sized mesh placed any size were included in the study. Patients with multiple previous
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