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

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Table 2 Outcomes of laparoscopic incisional hernia repairs using prosthetic materials Author Year N Mean or median follow-up Conversion (%) Seroma (%) Mesh or wound infection (%) Recurrences (%) Aura, et al [66] 2002 86 37 months 1 2 0 7 Bageacu, et al [28] 2002 159 49 months 14 16 3 16 Ben-Haim, et al [67] 2002 100 19 months 4 11 0 2 Berger, et al [45] 2002 150 1–2 years 2 93 0 3 Birgisson, et al [68] 2001 64 9 months 0 5 3 0 Bower, et al [69] 2004 100 7 months 1 1 2 2 Carbajo, et al [29] 2003 270 44 months ! 1 12 0 4 Chowbey, et al [48] 2000 202 35 months 1 32 3 1 Eid, et al [53] 2003 79 34 months 1 4 0 5 Franklin, et al [6] 2003 384 47 months 4 3 1 3 Frantzides, et al [70] 2004 208 24 months 0 Not reported 1 1 Gillian, et al [26] 2002 100 Not reported 0 3 0 1 Heniford, et al [47] 2003 850 20 months 4 Most 2 5 Kirshtein, et al [71] 2002 103 26 months 3 Most 5 4 LeBlanc, et al [72] 2003 200 36 months 4 8 2 7 Olmi, et al [73] 2006 178 29 months 0 4 1 2 Perrone, et al [74] 2005 116 22 months 10 21 5 8 Rosen, et al [75] 2003 100 30 months 12 4 6 17 Sanchez, et al [76] 2004 90 12 months 6 9 0 3 Stickel, et al [36] 2007 62 14 months 2 Not reported 2 5 Toy, et al [77] 1998 144 7 months 0 16 3 4 92 TURNER & PARK
LAPAROSCOPIC REPAIR OF VENTRAL INCISIONAL HERNIAS 93 to the operating theater at a later date to perform a definitive laparoscopic hernia repair with prosthetic material. A recent series described nine patients who underwent attempted laparoscopic incisional hernia repair but were deemed inappropriate for immediate mesh placement because of enterotomy, need for bowel resection, or deserosalization. In an open approach, these patients probably would have had a less durable repair performed with absorbable mesh rather than risk prosthetic infection. The laparoscopic approach allowed each patient to be monitored as an inpatient with a planned return to the operating room for placement of mesh for definitive repair without sacrificing any of the established benefits of the minimally invasive approach [37]. The use of mesh is, without doubt, the reason for the reduced recurrence associated with incisional hernia repairs. A number of different prosthetic meshes have been formulated. When mesh is used as an underlay prosthesis, a key consideration should be whether the mesh will be in direct contact with the intra-abdominal viscera. Some newer prosthetic materials, expanded polytetrafluoroethylene (ePTFE), for example, have an adhesion barrier on the intestinal side that minimizes the risk of adhesions and fistulization. The other side of the prosthetic material is in direct contact with the abdominal wall and is corrugated to promote rapid ingrowth. Other materials, however, such as polypropylene, although in common use for some time, are contraindicated for placement in direct contact with the intestine. A recent study comparing preperitoneal and intraperitoneal placement of polypropylene found significantly higher rates of small bowel resection (21% versus 0%), surgical site infection (26% versus 4%), and enterocutaneous fistula (5% versus 0%) with intraperitoneal placement of polypropylene in patients who subsequently underwent repeat laparotomy or laparoscopy [38]. Several newer materialsdincluding hydrophilic prosthetic materials that are easily managed in the laparoscopic fielddare currently in use. There were early indications that hydrophilic material might provide bowel protection [39]. One such mesh in common use is Parietex (Sofradim, Trevoux, France), whose hydrophilic absorbable film has been credited with protecting the mesh from contact with viscera during integration, thus minimizing intra-abdominal adhesions and viscera erosion [40,41]. Long-term data on these adhesion barriers are still lacking, however. An additional benefit of the laparoscopic approach is that a single procedure allows large or multiple hernias to be repaired without extending the incision and also allows identification and repair of previously clinically silent defects. Placement of additional 5-mm trocars as necessary often is tolerated well by patients and does not contribute significantly to postoperative discomfort [42]. Another demonstrated laparoscopic advantage treated more fully elsewhere in this article is the ability to evaluate the abdominal wall fully with substantially improved visualization [43]. Laparoscopic adhesiolysis allows the abdominal wall to be inspected in a more thorough way, permitting
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Laparoscopic Repair of Ventral Incisional Hernias: Pros ... - SASSiT

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