Page 74 - World Journal of Laparoscopic Surgery

Laparoscopic Ventral Hernia Repair: Our Experience and Review of Literature
• Chronic pain: Chronic pain was noted in three patients at Another concern of laparoscopic ventral hernia repair is seroma
1 month, in two patients at 6 months and none at the follow-up formation and port site/wound infection. Several studies have
of 12 months. reported that laparoscopic ventral hernia repair reduces the risk
• Port site herniation: Port site herniation was noted in none of of wound infection. 13,14 The results of our study with regards to
our patients. seroma formation and wound infection did not differ much from
• Recurrence: Recurrence of hernia was noted in one patient at those studies that have been already published in the literature.
the follow-up of 12 months. It has been reported in previous studies that the risk of port site
herniation especially from the site of 10- to 12-mm ports ranges
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from 1 to 5%. We did not report any port site hernia formation
dIscussIon And revIew of lIterAture in our study.
The treatment of various surgical problems including ventral In this study, we encountered one hernia recurrence (2.5%) at
hernias has tremendously evolved since the early 1990s. The the end of 6 months of follow-up. Many studies have not reported
advent of laparoscopy is one of them. Laparoscopy has gained any significant differences in recurrence rates for laparoscopic and
universal acceptance by demonstrating improved outcomes. open incisional hernia repair. 9,16 Eker et al. in their study, reported a
Consequently, various techniques have been introduced higher rate of recurrence in the laparoscopic ventral hernia repair
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ranging from intraperitoneal onlay mesh (IPOM) (a technique group. The relatively lower recurrence rate in our study could be
employed in our study) to IPOM-PLUS and extended totally attributed to the fact of a small cohort of patients with a short
extraperitoneal repair (E-TEP) among various others. The goals of term follow-up.
laparoscopic ventral hernia repair include minimizing intraoperative
and postoperative complications, achieving effective repair, Limitations of the Study
lowest possible recurrence, and early return to normal life, The major limitations of our study were the absence of any
cost–effectiveness, and better cosmetic results. comparative cohort, a smaller number of study patients, and a
The operative time is one of the important factors which relatively shorter duration of the follow-up.
determines the feasibility of any procedure. The average operative
time in our study was 71–90 minutes. This was comparable to conclusIon
other studies reported in the literature. Eker et al. in their study, Laparoscopic ventral hernia repair, although sometimes technically
reported a mean operative time of 100 minutes in the laparoscopic challenging is an extremely safe and effective option in the
group which was significantly longer than in the open group management of ventral hernias. This approach offers a good
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(76 vs 100 minutes; p = 0.001). Longer operative time maybe cosmetic outcome to the patient without compromising much on
because of difficult dissection, complicated hernias, inability to the results of hernia repair. Patients are found to return to normal
achieve a good working space because of misplaced port sites, activity at a much faster rate with minimal loss of occupational
inability to roll and fix the mesh besides less experience of the income. This technique is easy to reproduce, however, right patient
surgeon. Nevertheless, many studies published have reported selection needs to be ensured preoperatively.
shorter operative times for laparoscopic ventral hernia repair. 9
No major intraoperative complications were reported in
our series. Eker et al. reported a higher overall intraoperative references
complication rate (enterotomy, serosal bowel injury, and bladder 1. Wantz GE. Abdominal wall hernias. In: Schwartz SI, editor. Principles
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perforation) for laparoscopic repair (10%) than open repair (2%). of surgery. 7th ed. New York, NY: Mc Graw Hill; 1999. p. 1585–1611.
We had one serosal bowel injury (2.5%). The lower incidence of 2. Sajid MS, Bokhari SA, Mallick AS, et al. Laparoscopic versus open repair
intraoperative complications in our series may be explained by of incisional/ventral hernia: a meta-analysis. Am J Surg 2009;197(1):
64–72. DOI: 10.1016/j.amjsurg.2007.12.051.
the fact of proper preoperative patient selection and exclusion of 3. Moreau PE, Helmy N, Vons C. Laparoscopic treatment of incisional
patients with recurrent or complicated ventral hernias; as difficult hernia. State of the art in 2012. J Visc Surg 2012;149:e40–e48. DOI:
and more prolonged dissections in such patients are risk factors 10.1016/j.jviscsurg.2012.09.001.
for increased rate of intraoperative complications. 4. Nguyen MT, Berger RL, Hicks SC, et al. Comparison of outcomes
Pain is a subjective phenomenon and perception of postoperative of synthetic mesh vs. suture repair of elective primary ventral
pain varies among patients accordingly. Early postoperative pain is herniorrhaphy: a systematic review and meta-analysis. JAMA Surg
a usually expected phenomenon, however chronic postoperative 2014;149(5):415–421. DOI: 10.1001/jamasurg.2013.5014.
pain (lasting for >3 months) is largely because of mesh and its 5. LeBlanc KA, Booth WV. Laparoscopic repair of incisional abdominal
fixation with tacks or transfacial sutures rather than the hernia or hernias using expanded polytetrafluoroethylene: preliminary
findings. Surg Laparosc Endosc 1993;3(1):39–41. PMID: 8258069.
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wound itself. Our study was no exception to this, although we 6. Funk LM, Perry KA, Narula VK, et al. Current national practice patterns
noticed chronic pain only in two patients, however, we conclude for inpatient management of ventral abdominal wall hernia in the
that the incidence of long-lasting pain could be brought down by United States. Surg Endosc 2013;27(11):4104–4112. DOI: 10.1007/
the better availability of a near-ideal mesh and better methods of s00464-013-3075-4.
mesh fixation techniques. Various studies have reported less need 7. Muysoms FE, Miserez M, Berrevoet F, et al. Classification of primary
for postoperative analgesia in laparoscopic ventral hernia repair. 11 and incisional abdominal wall hernias. Hernia 2009;13(4):407–414.
Patients are expected to recover and start their normal daily DOI: 10.1007/s10029-009-0518-x.
activities faster after any laparoscopic surgery. After laparoscopic 8. Eker HH, Hansson BM, Buunen M, et al. Laparoscopic vs. open
incisional hernia repair: a randomized clinical trial. JAMA Surg
incisional hernia repair, many studies have shown a shorter hospital 2013;148(3):259–263. DOI: 10.1001/jamasurg.2013.1466.
stay compared to open repair. 9,12 Our study reported an average 9. Olmi S, Scaini A, Cesana GC, et al. Laparoscopic versus open incisional
hospital stay of 2.5 days, which is comparable with other studies hernia repair: an open randomized controlled study. Surg Endosc
reported in the literature. 2007;21(4):555–559. DOI: 10.1007/s00464-007-9229-5.

72 World Journal of Laparoscopic Surgery, Volume 15 Issue 1 (January–April 2022)