Laparoscopic incisional and ventral hernioplasty: lessons learned from 200 patients.

Our first 100 patients and our second 100 patients who underwent a laparoscopic repair of incisional and ventral hernias were compared and evaluated. This analysis revealed that the second group was approximately 9 years older with more comorbid medical conditions. In all, 15% were incarcerated hernias, and 21% were recurrent. Seven operations were converted to the open repair because of adhesions in five patients and either a small or large bowel injury in two patients. There were no complications related to enterotomy. Older and more infirm patients in the second group did not significantly affect outcomes. The average size of the hernia defects was 111 cm2. The average size of the prosthesis was 257.5 cm2. Larger prostheses were used in the second group. With more experience, the recurrence rates have declined from 9% to 4%. The etiology of these recurrences differed in these two groups of patients. Removal of the prosthetic due to infection was a predictable recurrence in two patients. A new hernia below the original hernia has caused us to repair the entire incision that had the initial hernia. Only one technical failure was noted, due to fracture of the suture during transfascial placement and clamping of the suture. It is not recommended to grasp any suture that remains in the patient during this hernioplasty. Recurrences were reduced because of the use of an increased overlap of the biomaterial and the use of dual methods of fixation (tacks and transfascial sutures).