Principles of laparoscopic repair of ventral hernias

Abstract

BACKGROUND: Laparoscopic repair of incisional hernias, which basically means an intraperitoneal onlay mesh technique, is becoming increasingly popular as it reduces trauma to the abdominal wall compared with open techniques. METHODS: Review of the literature on laparoscopic repair of incisional hernias. RESULTS: The recent literature reveals low recurrence and conversion rates with acceptable morbidity in terms of unrecognized enterotomies. The main advantage of the laparoscopic repair over conventional techniques is the reduced rate of wound complications. The question of material often posed by opponents of laparoscopic repair can be answered today. Several materials are available that provide incorporation into the abdominal wall and prevent formation of adhesions to the intestine. A very recent development (polyvinylidene fluoride) seems to be most attractive because of (i) the primary pore size so that 2 meshes can be overlapped, and (ii) elasticity similar to the human abdominal wall. CONCLUSIONS: Although most incisional hernias can be repaired laparoscopically, profound knowledge of the hernia disease itself and different treatment approaches are necessary to provide the best procedure for the individual patient in the sense of tailored surgery.