Laparoscopic incisional and ventral herniorraphy: our initial 100 patients.

A review of our initial 100 patients upon whom we attempted a laparoscopic repair of either a ventral and incisional hernia is presented. The average follow-up period of these individuals was 51 months. The operation was completed with the laparoscopic technique in 96 cases. The average defect size was 155 cm2 and the average prosthetic biomaterial size to repair these defects was 214.8 cm2. The major complication rate was 4.1%. The incidence of recurrence in these patients was 9.3%. In all of these cases of recurrence, the method of attachment was that of staples or spiral tacks alone. In 5 patients, it appeared that the prosthesis was too small to cover the defect adequately. We believe that this is an effective operation but one that has two technical mandates. The prosthetic biomaterial (DualMesh) must cover the fascial edges by a minimum of a three-centimeter overlap. Additionally, the attachment of the patch by staples or tacks alone is inadequate; consequently, the herniorraphy must include the use of through and through sutures to assure adequate fixation of the prosthesis.

Laparoscopic incisional and ventral herniorrhaphy in 100 patients.

BACKGROUND: Laparoscopic incisional and ventral herniorrhaphy, a procedure first described 7 years ago, continues to gain acceptance. A series of about 100 patients who underwent the operation is described. Follow-up in this series was longer (mean 51 months) than that in previously reported series. METHODS: A retrospective review was conducted of operative and follow-up records of a series of patients scheduled to undergo laparoscopic incisional or ventral herniorrhaphy between 1992 and 1997. RESULTS: Laparoscopic repair was completed in 96 of 100 patients. The complication rate was 14%, with seromas accounting for half of the postoperative problems. Mean hospital stay was 1 day. The late recurrence rate was 9%, with 4 of the 9 recurrences developing >2 years postoperatively. CONCLUSIONS: Laparoscopic incisional and ventral herniorrhaphy is safe and effective. Most patients require hospitalization for /=3 years.

In vivo study of meshes implanted over the inguinal ring and external iliac vessels in uncastrated pigs.

BACKGROUND: The effects of placing a prosthesis directly on the internal inguinal ring and external iliac vessels in inguinal hernia repair are unknown. We compared tissue responses to five prostheses implanted in this position in uncastrated male pigs. METHODS: Three types of polypropylene and two types of expanded polytetrafluoroethylene (ePTFE) mesh were implanted in 20 pigs (n = 8 for each prosthesis type). Specimens of the implants and surrounding tissue were obtained 30 and 90 days after implantation and assessed histologically. RESULTS: The polypropylene implants had more adhesions, more surface area covered by adhesions, and more tenacious adhesions than did the ePTFE implants. Perivascular cuffing was observed in eight polypropylene and one ePTFE specimen; ossification, necrosis, and testicular venous congestion were seen in polypropylene specimens. CONCLUSIONS: Abnormal healing processes after implantation of polypropylene mesh may increase complications of the transabdominal preperitoneal and total extraperitoneal approaches in laparoscopic inguinal hernia repair, whereas the minimal response to ePTFE meshes may make them safer for use in the preperitoneal space.

Avoiding complications with laparoscopic herniorrhaphy.

Before laparoscopic inguinal hernia repair can be widely adopted, general surgeons must become familiar with the laparoscopic presentation of the inguinal anatomy and must obtain practice with an effective technique that follows the surgical tenets of a good repair. This paper discusses some of the possible pitfalls of performing laparoscopic hernia repair and presents recommendations for success, including a brief description of a technique that has been used successfully in > 60 cases.

Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: preliminary findings.

Laparoscopic techniques were used in five cases to repair incisional abdominal hernias ranging in size from 1.5 to 6 cm2. Four to five trocars were used in each case, one in the upper midline and three or four placed laterally. All repairs were made using 1-mm-thick expanded polytetrafluoroethylene patches inserted intraperitoneally and stapled to the anterior abdominal wall over the defects, making use of intra-abdominal pressure to secure the repair. The surgical technique is an extension of our current laparoscopic techniques for repairing inguinal hernias and potentially offers a significant decrease in morbidity.