Experience of laparoscopic incisional and ventral hernia repair

(2005 – 2012)

UO di Chirurgia Dott. Paolo A. Riccio

Patient Characteristics (222)Male/Female 84/138

Age (y) 61.7 (15-88)

Body mass index 28.8 (18-45)

ASA classification 2.1 (1-3)

Previous open hernia repair

24 (10.8%)

Max diameter size (cm) 8.4 (2-28)

Operating time (min) 97.5 (25-240)

Postoperative hospital stay (d)

4.8 (1-27)

Associated procedures 15 10 cholecistectomy

5 inguinal hernia

Type of defect (1)Laparoscopic Incisional Hernia Repair - LIHR (172)

Median laparotomies 145

Lateral: 24

Left side 5

Mc Burney 5

Subcostal 10

Lumbar hernia 4

Parastomal 3

Laparoscopic Ventral Hernia Repair - LVHR (50)

Umbilical hernia 29

Epigastric hernia 21

Type of defect (3)Chevrel classification

Small (<= 5 cm) 45 (20.2%)

Medium (6-9 cm) 69 (31.0%)

Large (=> 10 cm) 71 (32.1%)

Type of defect (2)ABDOMINAL BORDER (42)

Subxiphoidal 8

Suprapubic 24

Subcostal 10

Type of defect (4)Swess-Cheese 37 (16.7%)

Type of ProsthesisSEPRAMESH

VENTRALIGHT

40 (18.0%)

20 (9.0%)

DYNA-MESH 12 (5.4%)

PARIETEX 5 (2.2%)

COMPOSIX 33 (14.8%)

PROCEED 110 (49.5%)

PHISIOMESH 2 (0.9%)

Type of fixation (1)ABSORBABLE TACK 52 (23.5%)

NON ABSORBABLE TACK 170 (76.5%)

Type of fixation (2) Use of Tissucol

OUTCOMES

Complications 32 (14.4%)

Recurrence 12 (5.4%)

Conversion to open technique 8 (3.6%)

COMPLICATIONS (32)Prolonged seroma (> 8 wk) 12 (5.6%)

Prolonged ileus 10 (4.7%)

Prolonged pain (> 6 months) 5 (2.3%)

Pulmunary Embolism 1 (0.6%)

Myocardial Infarction 1 (0.6%)

Pneumonia + wound infection 1 (0.6%)

Wound infection 2 (0.9%)

RE-OPERATION (7)Intestinal injury 4 (1.8%)

Postoperative bleeding 2 (0.9%)

Trocar site erniation 1 (0.6%)

RECURRENCE 12 (5.4%)Time to recurrence (days): 537 (31-1517)

Treatment of recurrence:

Laparoscopic repair 2

Open repair 5

No repair 5

CONVERSION TO OPEN TECHNIQUE 8 (3.6%)

Severity of adhesions 5 (2.2%)

Severity of adhesions and obesity 1 (0.5%)

Complete prosthesis detachment 1 (0.5%)

Intestinal injury 1 (0.5%)