Laparoscopic repair vs open surgery for incisional hernias: a comparison study.

BACKGROUND: Incisional Hernias complicate 2-11% of laparotomies and the primary closure of the defect is followed by recurrence in 20-46% of patients. In spite of introduction of prosthetic materials and new techniques the rate of failure reduced but a gold standard has not been defined. Laparoscopic approach, recently introduced appears promisingly effective but only few and small series have been published. MATERIALS AND METHODS: Two series of patient, 11 treated by laparoscopic repair (LR) and 15 undergone to open prosthetic repair (OR) are compared with regard to age, sex, previous surgery, number of fascial defects, size and location of hernias, ASA status, operating time, intra and postoperative complications, length of hospital stay, follow up evaluation and hernia recurrence. Prosthetic materials were e-PTFE in LR group and e PTFE or Polypropilene in OR group. Peripherical hernias have been excluded from the study. RESULTS: In LR group has been observed a longer mean operative time and a shorter hospital stay than in OR group. No intraoperative complication was observed in LR and 1 in OR group. Early and late complications were more frequent in OR than in LR group but the removal of prosthesis was not needed in any case. Mean follow up is 40 months for OR and 18 for LR group with no recurrences in both groups. CONCLUSIONS: Laparoscopic repair of incisional hernias appears in our experience as good as open prosthetic repair, with all generic vantages related with mini-invasive approach and the specific one of lesser manipulation of prosthesis and fewer infective complications.