Ventral hernia repair by the laparoscopic approach.

An analysis of these results indicates that laparoscopic hernia repair can be performed safely by experienced laparoscopic surgeons, and with lower perioperative complication rates than for open hernia repair. Although the follow-up period for the laparoscopic repair is only 2 or 3 years, the recurrence rate is likely lower than with open repair. Most patients with ventral hernias are candidates for this laparoscopic repair if safe access and trocar placement can be obtained. The choice of mesh often provokes a debate among surgeons, but little practical difference in the results seems to exist between the two types of mesh available. Although the ePTFE mesh has a good theoretic basis for promoting tissue ingrowth on the parietal side of the mesh and minimizing adhesions to the bowel side of the mesh, data indicate that no difference in outcome exists related to adhesions or fistula formation (Tables 1 and 2), so surgeon preference and cost of the prosthesis should be the deciding variables. Fistulas are of concern because of the experience with mesh in the trauma patient and in the treatment of severe abdominal wall infections, when abdominal wall reconstruction often is performed in contaminated wounds in the acute phases and leaves the mesh exposed without soft tissue coverage. These conditions do not apply for most cases of elective hernia repair. Laparoscopic ventral hernia repair offers advantages over the conventional open mesh repair and may decrease the hernia recurrence rate to 10% to 15%. When properly performed, the laparoscopic approach does not and should not compromise the principles for successful mesh repair of ventral hernias.