Ventral and Incisional Hernias: Differences and Indications for Laparoscopic Surgery

Abstract

In a consensus meeting of the European Hernia Society (EHS), a consensus was reached on the decision to separate primary ventral hernias (PVH) and incisional hernias (IH) into two entities, since in the participants’ opinion primary ventral hernias have a different etiopathology compared with incisional abdominal wall hernias resulting from failure of a previous incision [1]. A classification for primary abdominal wall hernias and a division into subgroups for incisional abdominal wall hernias, concerning the localization of the hernia, were formulated [1]. Interestingly the outcome and results of laparoscopic repair of PVH and IH have consistently been pooled together in case series and randomized clinical trials [2–10]. Even recent systematic reviews and meta-analysis comparing laparoscopic and open hernia repair have included RCTs that analyzed a mix of PVH and IH in the laparoscopic repair group [2, 11–16]. This meant that when analyzing the results, no distinction was made between primary ventral hernias and incisional hernias nor was any information given on the proportion of umbilical hernias, epigastric hernias, and incisional hernias identified in the entire patient group analyzed [17]. It was only at the beginning of 2015 that Awaiz et al. [17] and Al Chalabi et al. [18] published the first meta-analyses and systematic reviews on laparoscopic vs open incisional hernia repair [19].