Laparoscopic Repair of Ventral Incisional Hernias: Pros ... - SASSiT

96 TURNER & PARK
scar or to perform associated procedures such as abdominoplasty concurrently
is available only with the open approach.
Risk factors for recurrence of hernia include a larger hernia defect, longer
operating times, previous hernia repairs, and morbid obesity [47]. In a metaanalysis
comparing short- and long-term outcomes for patients undergoing
laparoscopic or open incisional hernia repair, a trend toward lower hernia
recurrence rates following laparoscopic repair when compared with an
open repair was noted but failed to achieve statistical significance [35]. Other
authors have identified defective wound healing and an impaired scarring
process as equal to technical error in hernia recurrence [58].
Shorter hospital stays and significantly less major morbidity have been
demonstrated recently after laparoscopic ventral hernia repairs in a 10-year
institutional cohort study [59]. Cost, however, may represent a relative disadvantage
to the laparoscopic approach. Operating room supply costs can be
significantly greater with laparoscopic than with open repairs ($2237 versus
$664). The operative time was significantly longer as well (149 versus 89 minutes)
[32]. These figures probably reflect the positioning, port placement, and
specialized equipment needed to perform a laparoscopic hernia repair.
Overall hospital costs for these patients, however, were slightly lower,
reflecting the shorter length of stay of the laparoscopic patient (1 0.2
days versus 2 0.6 days). The same authors demonstrated a slightly higher
rate of postoperative encounters within 30 days of laparoscopic hernia
repairs, with an associated additional cost.
Summary
There has been substantial literature generated on the topic of incisional
hernia repair and the laparoscopic and open approaches. Each has advantages
and disadvantages. The collective results of all of these studies suggest
that laparoscopic ventral hernia repairs have reduced perioperative morbidity,
fewer wound complications, and lower rates of hernia recurrence. These
benefits suggest that for many patients laparoscopy is an appropriate
approach for the repair of incisional hernias in both straightforward and
complex presentations. There is still a role for the traditional open approach,
primarily in patients who have a specific contraindication to a minimally
invasive approach or in whom additional procedures are planned.
Additionally, advances in the development of new prosthetic materials,
new devices, and techniques for prosthetic placement may further reduce
postoperative morbidity, minimize recurrences, and improve patient care.
Acknowledgment
The authors acknowledge the thoughtful editing of this article provided
by Rosemary Klein.