Laparoscopic Ventral Hernia Repair
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Laparoscopic ventral hernia repair involves placing mesh over the hernia defect using laparoscopic techniques. It has advantages over open repair such as lower wound complications, recurrence rates, hospital stay and pain. While more technically challenging, it is effective for primary and recurrent hernias. Outcomes are better in non-obese patients, with obese patients having higher recurrence rates and longer operating times.
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Laparoscopic Ventral Hernia Repair
- 1. LAPAROSCOPIC Ventral Hernia Repair George S. Ferzli, MD, FACS Professor of Surgery, State University of New York
- 14. Sizing the mesh LeBlanc KA. Incisional hernia repair; Laparoscopic Techniques. World J Surg , 2005 29 1073-1079
- 26. Heniford BT, Park A, Ramshaw B, Veoller G: Laparoscopic repair of ventral hernias in nine years’ experience with 850 consecutive hernias. Ann Surg Volume 238, Number 3, September 2003; 391-400 Variable Patients with Complications Patients without Complications Mean defect size (cm) 202 105 Mean operating time (min) 142 116 Mean LOS (d) 4.7 1.8 Previous hernia repair (% of patients) 47 32 Hernia recurrence rate (%) 10.6 3.2
- 27. Heniford BT, Park A, Ramshaw B, Veoller G: Laparoscopic repair of ventral hernias in nine years’ experience with 850 consecutive hernias. Ann Surg Vol. 238, Number 3, September 2003; 391-400 Variable Patients with Hernia Recurrence Patients without Hernia Recurrence Mean defeat size (cm 2 ) 184 124 Mean operating time (min) 149 118 Previous hernia repair (% of patients) 63 35 Complication rate (%) 32 12
- 28. Heniford BT, Park A, Ramshaw B, Veoller G: Laparoscopic repair of ventral hernias in nine years’ experience with 850 consecutive hernias. Ann Surg Vol. 238, Number 3, September 2003; 391-400 Complication No. (%) of Patients Prolonged ileus 25 (3.0) Seroma > 6 wk 21 (2.6) Suture site pain > 8 wk 13 (1.6) Intestinal/bladder injury 14 (1.7) Cellulitis of trocar site 9 (1.1) Mesh infection 6 (0.7) Hematoma or post-op bleeding 3 (0.4) Urinary retention 10 (1.2) Fever of unknown origin 3 (0.4) Respiratory distress 8 (1.0) Cardiac event 6 (0.7) Trocar site herniation 7 (0.9) Clostridium difficile infection 3 (0.4) Total 112 (13.2)
- 35. Lap vs Open Non-Randomized Number of Patients Mean LOS (Days) Complication Rate Recurrence Rate Holzman 1997 21 Lap 16 Open 1.6 v. 4.9* 23% v. 31%* 9.5% v. 12.5% Park 1998 56 Lap 49 Open 3.4 v. 6.5* 18% v. 37%* 10.7% v. 34.7%* Ramshaw 1999 79 Lap 174 Open 1.7 v. 2.8* 19% v. 31%* 2.5% v. 19.5%* Chari 2000 14 Lap 14 Open 5 v. 5.5 NA NA DeMaria 2000 21 Lap 18 Open 0.8 v. 4.4* 19% v. 50%* 5% v. 0%
- 36. Lap vs Open Prospective Randomized Number of Patients Mean LOS (Days) Complication Rate Recurrence Rate Carbajo 1999 30 Lap 30 Open 2.2 v. 9.1* 6.7% v. 57%* 0% v. 5%* McGreevy 2003 65 Lap 71 Open 1.1 v. 1.5 8% v. 21% NA
- 38. Metanalysis of Lap v. Open Goodney et al. Archives Surgery 2002 October 137 (10): 114 322 Lap 390 Open P Value Complications 14% 27 % .003* LOS 2 days 4 days 0.02* OR Time 99 minutes 96 minutes 0.38
- 39. Cost comparison Lap Open P-value Carbajo (1999) 12461 8273 NA McGreevy (2003) 9316 5858 0.01