Laparoscopic Repair of Ventral Hernia Laparoskopische Reparation von Narbenhernien

Abstract

Summary: Background: Recently, it has become widely accepted that prosthetic material is needed for the repair of incisional hernias. Therefore, the laparoscopic approach with an intraperitoneal onlay mesh technique seems to be promising. No dissection of the abdominal wall is necessary, implying reduced surgical trauma. The laparoscopic technique is based on the intraperitoneal coverage of the whole scar with a mesh that provides ingrowth of tissue on one side and prevents adhesions on the other side. Methods: Based on published and own experiences we compare the results of the laparoscopic and the conventional technique. Furthermore, we can clearly define the indication and pitfalls of the laparoscopic repair and present recommendations concerning the prevention of complications. Results: Since 1993, some series have been published that clearly demonstrate excellent results in terms of very low infection and recurrence rates. Most recurrences are explained by technical mistakes. No mesh-related intestinal complications such as fistula formation or ileus due to adhesions between mesh and bowel have been described so far. Conclusions: The laparoscopic repair of incisional hernias represents a worthwhile extension of the surgical armamentarium and has almost completely replaced conventional repair in our department.