Page 36 - Journal of Laparoscopic Surgery

Jitendra Kumar, Rajni Raina
articles but, even textbooks are also missing any chapter tive time reported by another series. 14,15 It may be due to
or topics on this subject. the complexity of a non-midline hernia and individual
Therefore because of very little availability of report in surgeon experience. Different postoperative complica-
respect of a non-midline hernia we tried to compare our tions in our series seem to be of the little higher side it
results and other outcomes with studies reported in term may be due to small sample size and complexity of non-
of laparoscopic ventral hernia in general also. However, midline hernia. 13,15,16.
all the available reports unanimously considered non- One patient was required for removal of his mesh
midline or lateral hernias as a more complex variety of due to infection and not responding to other conserva-
abdominal wall hernia in term of its repair as well as tive management. Same and only patient in our series
unpredictable surgical outcome. 11 reported recurrence which overall percentage would
In our series, we have got a common epidemiological be 07.69%. In most of the series recurrence rate reported
trend of the patient’s parameter as compared to other are between about four to seven percent which is quite
reported series of cases of laparoscopic ventral hernia comparable to our result. 14-17.
repair. 11,12 Most of the patients were overweight which Most of the reported studies found a reduction in the
supports the literature explaining its relation with a duration of operating time and surgical complications
spontaneous ventral hernia. Comparatively this cohort with an increase in the experience of a surgeon. The same
has got larger share of patients with the comorbid thing is true here with author’s finding, as apart from a
condition which again corroborating with past studies reduction of the time duration of surgery with experience,
reported comorbid condition as a frequent association one patient with a spontaneous right subcostal hernia
with abdominal wall hernia. 12. which has got recurrence was a first patient of this series
In our series, we got more percentage of painful or of non-midline ventral hernia. 17
tender swelling as a clinical presentation in comparison
to a series of another laparoscopically repaired midline CONCLUSION
ventral hernia repair. Average hospital stay for all
patients of this series was also comparatively longer Even though non-midline abdominal wall hernias are
and was maximum for the patient who reported recur- comparatively uncommon and surgically challenging,
rence. Moreno-Egea et al. reported in their study titled overall their epidemiological profile, presentation, com-
Midline versus non-midline laparoscopic incisional plications, and recurrences are not much different than
hernioplasty: a comparative study, published in journal those of midline ventral hernias.
Surg Endosc. In March 2008 that non-midline hernias are
associated with more preoperative pain, require more CLINICAL SIGNIFICANCE
analgesics and required a more extended hospital stay Non-midline abdominal wall hernia even at its early stage
13
than the midline incisional hernias. The only explana- presents in more symptomatic manner, and because of
tion to this is comparatively narrow neck and sideway its rarity and complexity an experienced surgeon must
protrusion of sac with the more applicable constricting supervise the beginners.
force of lateral abdominal wall musculature. Although
it needs to be verified with further studies. ACKNOWLEDGMENTS
In our studies, anatomical location of a hernia was
equally on upper and lower half while whatever little Authors would like to convey their heartiest thankful-
available studies found a location of non-midline hernias ness and gratitude to Mrs Bobby and MRO Mr. Yogesh
3
are little more common in the lower half of the abdomen. of LHMC for their huge support and cooperation in col-
However, in our series average size of the lower abdomi- lecting the data of the patients.
nal wall located hernia were much larger and at the lateral
edge of the rectus muscle. Although, right now it will be REFFERENCES
too early to comment on that. 1. McGlannan A. Lateral Ventral Hernia. Ann Surg. 1927
Another important finding was the presence of another Feb;85(2):284-7. PubMed PMID: 17865625; PubMed Central
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many studies which has supported the laparoscopic repair 1922 Jun;75(6):677-85. PubMed PMID: 17864645; PubMed
of ventral hernia repair, that can cover these sort of unsus- Central PMCID: PMC1400017.
pected defect also and prevent recurrence. 5,10 3. Moreno-Egea A, Guzman P, Morales G, Carrillo A, Aguayo
JL. Treatment of non-midline ventral hernia: experience in an
Average time taken for surgery in our series were abdominal wall unit and literature review. Cirugia espanola.
78.4 minutes which was little more than average opera- 2007 Jun;81(6):330-334.
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