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

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Table 1 (continued ) Author Year Study design Type of repair N Recurrence (%) Morbidity (%) McGreevy, et al [64] 2003 Prospective Laparoscopic 65 Not reported 8 Open 71 21 Park, et al [43] 1998 Prospective Laparoscopic 56 11 18 Open 49 35 37 Olmi, et al [55] 2007 Case Control Laparoscopic 85 2 16 Open 85 1 29 Raftopoulos, et al [65] 2003 Retrospective Laparoscopic 50 2 28 Open 22 18 45 Ramshaw, et al [12] 1999 Retrospective Laparoscopic 79 3 19 Open 174 21 26 Robbins, et al [54] 2001 Prospective Laparoscopic 36 Not reported 22 Open 18 28 Wright, et al [67] 2002 Retrospective Laparoscopic 90 1 22 Open 90 6 36 90 TURNER & PARK
LAPAROSCOPIC REPAIR OF VENTRAL INCISIONAL HERNIAS 91 cover the hernia. Table 2 summarizes published comparisons of laparoscopic and open herniorrhaphies with placement of prosthetic material. Surgical experience In addition to the surgical technique used, surgical experience in incisional hernia procedures is considered to be of marked importance. A retrospective study comparing simple suturing (241 repairs) with mesh implantation (180 repairs) performed at a university hospital on 348 patients over a 25-year period concluded that the recurrence rate for surgeons averaging 20 or more operations (8%) was significantly better than the recurrence rate for surgeons averaging fewer than 10 operations (33%). When only mesh implantation was considered, the same study again recorded that increased experience on the part of the surgeon equated to a decreased recurrence rate, specifically from 18% to 8%. The study concluded that 16 mesh repairs, at minimum, were requisite to achieve a recurrence rate of less than 10% [27]. Similarly, the recurrence rate is affected by learning-curve mastery, with a high recurrence rate (15.7%) related to the technical learning curve associated with initial laparoscopic incisional herniorrhaphy experience falling to 10% as the learning curve was mastered [28]. The caution has been made that mastering incisional herniorrhaphy should not be considered until a ventral hernia repair series has been undertaken successfully [29]. One recent survey suggested that, after completion of residency, fellows felt competent, based on their quantitative experience, to perform ventral herniorrhaphies, a confidence extended to only two other laparoscopic proceduresdcholecystectomy and thoracoscopy [30]. In another survey, minimally invasive surgery fellows indicated that the number of ventral herniorrhaphies they expected to perform during their fellowships was comparable to the number they believed necessary to achieve optimal expertise and comfort [31]. Advantages The popularity of laparoscopic incisional hernia repair is increasing [32]. The early postoperative adverse events, overall safety, and clinical effectiveness of laparoscopic and open repair are similar. The laparoscopic approach offers several key advantages over the open approach, including low risks of infection and shortened hospital stay in addition to reductions in complication rates, postoperative pain, and postoperative ileus. The lower recurrence rates reported with laparoscopy are convincing, although they remain to be demonstrated conclusively. Even lowered overall hospital costs have been associated with laparoscopic hernia repair [18,23,33–36]. Another advantage of the laparoscopic approach is the ability to address an enterotomy without needing to convert to an open procedure with return
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Laparoscopic Repair of Ventral Incisional Hernias: Pros ... - SASSiT

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