Long-term results of laparoscopic repair of incisional hernias using an intraperitoneal composite mesh.

BACKGROUND: This study was designed to evaluate the long-term complications and recurrences of laparoscopic repair of incisional hernias. Very few studies evaluate objectively the long-term results of laparoscopic incisional hernia repair. METHODS: Data for 200 consecutive patients who underwent laparoscopic incisional hernia repair (LIHR) in a university teaching hospital using a standardized procedure between January 1994 and December 2006 were collected prospectively. The median follow-up was 6 (range, 1-12) years. RESULTS: The conversion rate from laparoscopic to open approach was 2.5% (205 initial patients). Mean operative time was 51 minutes; 63% of these patients were discharged the day of surgery. Mean hospital stay was 2.6 days. There was an overall postoperative complication rate of 15%. We had four small bowel injuries repaired laparoscopically, and one patient died as a result of a sepsis. Postoperative pain was limited, with a mean analgesics requirement of 6.8 (range, 0-30) days. During a mean follow-up of 60 (range, 12-144) months, the recurrence rate was 6.2%, which developed within 1 year of the operation and associated with body mass index >37, defect size >10 cm, and multiple Swiss-cheese defects (p < 0.01). CONCLUSIONS: 1) Intra-abdominal composite mesh is good tolerance. 2) The recurrence rate is low and within 1 year of the operation. 3) The long-term morbidity with LIHR is moderate. 4) The risk of intestinal injury is not predictable. 5) Reoperations can be performed with sufficient guarantee using laparoscopy.

Laparoscopic hernioplasty in secondary lumbar hernias.

BACKGROUND: Lumbar hernia is an uncommon defect of the posterior abdominal wall, and surgical treatment is still controversial. The aim of this study was to analyze the utility of the laparoscopic approach in the repair of these hernias. MATERIALS AND METHODS: We undertook a descriptive analysis of 15 patients diagnosed with lumbar hernia who underwent surgery with transabdominal laparoscopy between 1997 and 2004. The following variables were analyzed: clinical data, intraoperative and postoperative complications, operative time, length of hospital stay, analgesic consumption, and recurrences. The technique was evaluated aesthetically by measuring the abdominal perimeter using a tape measure. The mean follow-up was 32 months (range, 12-55 months). RESULTS: Intraoperative morbidity consisted of two cases of bleeding caused by the mechanical suture. Postoperative morbidity consisted of 3 cases of hematomas, 2 of seromas, and 2 of transitory pain. Seven patients (47%) were treated as day cases, and only one required admission due to pain. At 12-month follow-up we found one recurrence and a significant reduction in abdominal perimeter (P < 0.05). CONCLUSION: The transabdominal laparoscopic approach offers good clinical and aesthetic results both for the patient and the hospital, as almost half of the cases can be treated as day cases. We believe it should be considered the technique of choice for incisional lumbar hernia repair.

Open vs laparoscopic repair of spigelian hernia: a prospective randomized trial.

HYPOTHESIS: The elective treatment of a spigelian hernia is still under discussion, fundamentally owing to its rarity. The purpose of the study is to analyze the elective surgical treatment of spigelian hernia. DESIGN: A prospective, randomized controlled trial. SETTING: University teaching hospital. PATIENTS AND INTERVENTIONS: Two surgeons performed 11 conventional and 11 laparoscopic repairs for a spigelian hernia, alternating roles as primary surgeon and assistant. Each time the type of technique was randomly chosen using a computerized program. MAIN OUTCOME MEASURES: Epidemiological, clinical, and surgical factors are analyzed according to treatment, ie, the open or laparoscopic approach. RESULTS: The statistical study shows no significant differences for epidemiological or diagnostic factors, but it does show significant advantages for laparoscopy in terms of morbidity (P<.05) and hospital stay (P<.001). CONCLUSION: The approach using extraperitoneal laparoscopy is the technique that offers best results in the elective treatment of spigelian hernia.

Outpatient laparoscopic incisional/ventral hernioplasty: our experience in 55 cases.

Laparoscopic repair of ventral and incisional hernias is still a controversial therapeutic option. The purpose of this article is to evaluate the results of laparoscopic surgery on ventral hernias in an outpatient surgery unit of a university hospital. Fifty-five patients consecutively underwent laparoscopic surgery for ventral/incisional hernias in the outpatient unit. The patients' clinical features, hernia type, intraoperative, and postoperative complications and reasons for hospital admission are studied. Forty-two patients (76%) were discharged on the day of the surgery. Thirteen (24%) required hospital admission; 9 admissions were predictable (5 for intraoperative occurrences and 4 for associated surgery) and 4 were unpredictable (all for uncontrolled pain; 31%). We found no case of hospital admission for vomiting, urinary retention, or dizziness. Statistical analysis of the patients requiring admission showed no significant correlation with their clinical features or with the site, size, or recurrence of the abdominal wall defect (P > 0.05). Laparoscopic repair of ventral and incisional hernias can be done as a highly efficient ambulatory procedure, and morbidity and hospital admission with this technique do not depend on the type of hernia.

Immediate, early, and late morbidity with laparoscopic ventral hernia repair and tolerance to composite mesh.

The laparoscopic repair of ventral hernias is still a controversial therapeutic option, and little is known of its medium- and long-term morbidity. The purpose of the study is to evaluate the postoperative morbidity of laparoscopic ventral hernia repair and analyze the clinical factors that might be related to it. 86 consecutive patients who had ventral hernia and underwent endoscopic surgery in a Universitary teaching hospital. Epidemiological, clinical, postoperative complications, tolerance, aesthetic evaluation of the wall and recurrence rate are analyzed. The mean follow-up (100%) was 42 months (range: 1-5 years) and included clinical and ultrasonographic evaluation. The overall postoperative morbidity rate was 23.2%, with one case of mortality following a sepsis due to intestinal perforation; the rate of re-admissions and recurrences was 3.5%. Statistically significant relationships were shown between the complications and infra-umbilical location (P < 0.001), age over 60 years and female sex (P < 0.05). The dynamic ultrasound study showed 91% and 94% of the patients to be adhesion-free at 1 and 3 years respectively. Aesthetic assessment of the wall at 3 years showed persistent asymmetries in 5% of the patients and a 92% degree of personal satisfaction. The morbidity with laparoscopic ventral hernia repair is not negligible. The surgeon must know these complications and be able to treat them appropriately.

[Controversies in the current management of traumatic abdominal wall hernias]. / Controversias en el manejo actual de las hernias traumáticas de pared abdominal.

The management of traumatic abdominal wall hernias is controversial. We performed a MEDLINE search and report a personal series of 10 patients. Cases were classified according to the cause of injury. Fifty-six percent were caused by car accidents and 14% by bicycle accidents. Diagnosis was clinical in 22% and surgical in 13% and intra-abdominal lesions were found in 67%. Treatment was delayed in 12%. In our series, 55% were lumbar hernias due to traffic accidents and all were associated with pelvic fracture. Treatment was delayed in 50%, including laparoscopic surgery with good results. In conclusion, traumatic hernias due to road traffic accidents are frequently associated with intra-abdominal lesions. The diagnostic technique of choice is computed tomography and delayed surgery (laparoscopy) is an effective option.

Anatomical and surgical study of totally extraperitoneal laparoscopic hernioplasty.

BACKGROUND: Laparoscopic surgery provides direct access to the extraperitoneal inguinal space for a clear, amplified view of the anatomical structures. However, the variety of terms used to describe the fascial elements has partly prevented the promulgation of this approach. MATERIAL/METHODS: Two hundred patients received surgery for inguinal hernia at an outpatient surgery unit by means of totally extraperitoneal laparoscopy. Regional anatomical dissection was performed during the operation, which was filmed for later analysis. DISCUSSION: The totally extraperitoneal laparoscopic technique is described anatomically, including management of the internal spermatic fascia to create an opening for the use of fenestrated meshes. The technical maneuvers are discussed, with comparison of other possible methods of approach. CONCLUSIONS: From our experience we would recommend: 1) a consensus on terminology is necessary for dissemination of the TEP approach; 2) the ISF must be dissected to avoid ruptures of the sac and ensure parietalization; 3) the "sling of the TF" must be preserved, and 4) the TEP approach does not require dissection medial or inferior to the Cooper ligaments.

[Laparoscopic repair of secondary lumbar hernias: open vs. laparoscopic surgery. A prospective, nonrandomized study]. / Reparación laparoscópica de las hernias lumbares secundarias: cirugía abierta frente a laparoscópica. Estudio prospectivo no aleatorizado.

INTRODUCTION: Lumbar hernia is an uncommon defect of the posterior abdominal wall and its surgical treatment remains controversial. The aim of the present study was to evaluate the utility of laparoscopy versus open surgery. PATIENTS AND METHOD: We performed a prospective, nonrandomized study of 16 patients with secondary lumbar hernias who underwent surgery between January 1997 and January 2003. Nine patients underwent laparoscopy and 7 underwent open surgery. The variables analyzed were clinical features, hospital data (operating time and length of hospital stay), patient comfort (analgesic consumption and return to normal daily activity) and recurrences. Hospital costs were also analyzed. RESULTS: No differences were found between the two groups in age or history, although the size of laparoscopically-repaired defects was smaller. Mean operating time, postoperative morbidity, mean length of hospital stay, analgesic consumption, and return to daily activities were significantly lower in the laparoscopic group (P<.01). No statistically significant differences in the cost of the process were found according to surgical approach but significant differences were found in final cost after including the cost of readmissions and recurrences (P<.01). CONCLUSIONS: In our series, the laparoscopic approach was more effective than traditional open surgery in the repair of secondary lumbar hernias while the cost of the two procedures was the same.