Laparoscopic incisional/ventral herniorrhaphy: A five year experience

Conventional repairs of incisional hernia are plagued with frequent complications and recurrences. Laparoscopic incision/ventral herniorrhaphy (LIVH) has been reported to be a safe and feasible technique with low morbidity and low early rates of recurrence. In this study, we review our experience with LIVH. All cases of LIVH performed consecutively at St. Joseph's Hospital, Hamilton, Ontario and University of Kentucky Medical Center between November 93 and January 1999 being followed prospectively were reviewed. Seventy-five hernias were repaired in 73 patients (38F, 35M) ranging from 25 to 84 years (mean 57) with a mean American Society of Anesthesiologists (ASA) score of 2.1. Postoperative complications occurred in 14 patients (19%) including seroma (3), wound infection (1), patch infection (2), bowel injury (2), ileus (3), pain (1), atelectasis (1), and congestive heart failure (1). One case was converted to an open procedure and in one case a prosthesis was not placed due to an enterotomy repaired laparoscopically. Postoperative recurrences occurred in 7 (9%) of patients, within two to twelve months. Three of these were repaired laparoscopically. Over the five-year experience, the number of recurrent hernias repaired has increased, operative times have increased, and hospital length of stay has decreased. During that same interval the incidence of recurrence and complications has not changed. In conclusion, LIVH is a safe and feasible technique, applicable to all patient populations including the obese and multi-operated abdomen. Recurrence is low, and may be repaired laparoscopically.