Abdominal Wall Hernias


The laparoscopic approach is an increasingly used alternative method for repair of incisional hernias. The repair generally is performed intra-abdominally and involves placement of an intraperitoneal mesh prosthesis to cover the hernia defect. The contents of the hernia should be reduced, but the sac itself is not removed. There should be a 4- to 6-cm margin of mesh lateral to the hernia defect. The mesh should then be anchored in place with sutures and staples. Early results show that the technique is safe, simple, and effective, with results that are equivalent to, if not better than, the results of open repair. Early recurrence rates are reported at 1% to 10% and complication rates at 10% to 25%. Length of hospital stay and pain medication requirements are less than with open repair. A recent meta-analysis of 45 published series comparing open and laparoscopic ventral hernia repairs concluded that laparoscopic repair is associated with fewer wound-related (3.8% vs. 16.8%) and overall complications (22.7% vs. 41.7%) and has a lower rate of recurrence (4.3% vs. 12.1%) when compared to open repairs (Pierce R. et al. Surg Endosc, in press). Contraindications to laparoscopic ventral hernia repair include inability to establish pneumoperitoneum safely, an acute abdomen with strangulated or infarcted bowel, loss of abdominal domain, or the presence of peritonitis.