Laparoscopic extraperitoneal hernioplasty of incisional hernia

Abstract

Laparoscopic repair of incisional hernias involves intraperitoneal placement of a mesh,which may lead to adhesion formation and fistulation.The creation of a wide peritoneal flap around the hernial defect helps in placement of a mesh extraperitoneal . The aim of this study is to determine the feasibility and effectiveness of laparoscopic extraperitoneal repair of incisional hernia. Methods: Between June 2007 to May 2009, 47 patients 21 males and 26 females, the age range 23-55 years (mean age 45.8 years) presenting with incisional hernia underwent attempted laparoscopic incisional hernia repairs with a tension free transabdominal preperitoneal mesh repair. Results: Mean operative time was 110 minutes (range from 85 to 165 min.). The mean postoperative hospitalization was 1.2 days (range from 1 to 3 days). Conversion of the laparoscopic procedure to conventional open repair occurred in two patients (4.2%). The number of hernial defects found during operation ranged from one to three, with an average of 1.4 defects per patient. The diameters of the hernial defects varied from 5 to 10 cm, with a mean diameter of 6.2 cm. There were no visceral or other intraoperative complications. The follow-up period was calculated from the date of operation and ranged from 2 to 24 months with a mean of 13 months. Recurrence rate occurred in one patient only (2.1%) and was detected 13 months postoperative. Postoperative morbidities included wound bruising (8 patients), seroma (9 patients) which gradually resolved after one to six weeks, and prolonged suture site pain (4 patients) which gradually resolved after 8 weeks. Conclusion: laparoscopic extraperitoneal placement of a mesh is feasible and appears to be an advance over laparoscopic intraperitoneal placement of a mesh for incisional hernias.