, Volume 17, Issue 5, pp 573–580 | Cite as

Laparoscopic repair for recurrent incisional hernias: a single institute experience of 10 years

  • G. Ferrari
  • C. Bertoglio
  • C. Magistro
  • V. Girardi
  • M. Mazzola
  • S. Di Lernia
  • R. Pugliese
Original Article



The treatment of recurrent incisional hernias (RIH) has been associated with unsatisfactory postoperative (PO) morbidity and high failure rates. The aim of this study is to retrospectively investigate our single-center experience of laparoscopic repair (LR) for RIH.


The case records of 69 patients with RIH who underwent LR in our institution between January 2002 and November 2011 were reviewed. The operative technique has been standardized and provides onlay placement of an ePTFE mesh fixed with titanium tacks. Patients’ demographic data and comorbidities, intraoperative course, PO complications and recurrences at follow-up were systematically collected and analyzed. The influence of defect’s size and obesity variables on clinical outcomes was also investigated.


The mean operative time was 147.6 ± 71.2 min and mean hospital stay was 5.8 ± 1.8 days. No conversion occurred while five intraoperative complications (7.2 %) were recorded: three bowel injuries treated by laparoscopic sutures, one omentum bleeding and one epigastric vessel lesion. PO mortality was null, while overall morbidity was 13 % (9 patients) with a prevalence of seroma lasting over 8 weeks in six patients (8.7 %). Along a mean follow-up of 41 months (range 6–119), recurrence rate was 5.7 % (4 patients). Univariate analysis for width of defects and BMI showed no significant influence on patients’ outcomes.


Surgical treatment for RIH remains controversial because of lack in literature of specific studies on this topic. Morbid obesity and large defects have been often associated with technical difficulties and worse results. Our 10 years’ experience with LR provided satisfactory results in terms of PO morbidity and recurrence rate, despite any kind of patient selection.


Recurrence Laparoscopic repair Incisional hernia 


  1. 1.
    Klinge U, Binnebösel M, Rosch R, Mertens P (2006) Hernia recurrence as a problem of biology and collagen. J Minim Access Surg 2(3):151–154PubMedCrossRefGoogle Scholar
  2. 2.
    Gecim IE, Kocak S, Esroz S, Bumin C, Aribal D (1996) Recurrence after incisional hernia repair : results and risk factors. Jpn Surg 26:607–609Google Scholar
  3. 3.
    Mc Kinlay RD, Park A (2004) Laparoscopic ventral incisional hernia repair : a more effective alternative to conventional repair of recurrent incisional hernia. J Gastrointest Surg 8:670–673CrossRefGoogle Scholar
  4. 4.
    Pierce RA, Spitler JA, Frisella MM, Matthews BD, Brunt LM (2007) Pooled data analysis of laparoscopic vs. open ventral hernia repair: 14 years of patient data accrual. Surg Endosc 21:378–386PubMedCrossRefGoogle Scholar
  5. 5.
    Rudmik LR, Schieman C, Dixon E, Debru E (2006) Laparoscopic incisional hernia repair: a review of the literature. Hernia 10:110–119PubMedCrossRefGoogle Scholar
  6. 6.
    Millikan KW, Baptista M, Amin B, Deziel DJ, Doolas A (2003) Intraperitoneal underlay ventral hernia repair utilizing bilayer expanded polytetrafluoroethylene and propylene mesh. Am Surg 69:287–291 Discussion 291–292PubMedGoogle Scholar
  7. 7.
    de Vries Reilingh TS, van Geldere D, Langenhorst B, de Jong D, van der Wilt GJ, van Goor H, Bleichrodt RP (2004) Repair of large midline incisional hernias with polypropylene mesh: comparison of three operative techniques. Hernia 8:56–59PubMedCrossRefGoogle Scholar
  8. 8.
    Uranues S, Salehi B, Bergamaschi R (2008) Adverse events, quality of life, and recurrence rates after laparoscopic adhesiolysis and recurrent incisional hernia mesh repair in patients with previous failed repairs. J Am Coll Surg 207(5):663–669PubMedCrossRefGoogle Scholar
  9. 9.
    Koehler RH, Voeller G (1999) Recurrences in laparoscopic incisional hernia repairs: a personal series and review of the literature. JSLS 3:293–304PubMedGoogle Scholar
  10. 10.
    LeBlanc KA, Whitaker JM, Bellanger DE, Rhynes VK (2003) Laparoscopic incisional and ventral herniorraphy: lessons learned from 200 patients. Hernia 7:118–1244PubMedCrossRefGoogle Scholar
  11. 11.
    Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E, Dietz UA, Eker HH, El Nakadi I, Hauters P, Pascual Hidalgo M, Hoeferlin A, Klinge U, Montgomery A, Simmermacher RKJ, Simons MP, Smietanski M, Sommeling C, Tollens T, Vierendeels T, Kingsnorth A (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13:407–414PubMedCrossRefGoogle Scholar
  12. 12.
    Ferrari GC, Miranda A, Di Lernia S, Sansonna F, Magistro C, Maggioni D, Scandroglio I, Costanzi A, Franzetti M, Pugliese R (2008) Laparoscopic repair of incisional hernia. Outcomes of 100 consecutive cases comprising 25 wall defects >15 cm. Surg Endosc 22:1173–1180PubMedCrossRefGoogle Scholar
  13. 13.
    Brown GL, Richardson JD, Malangoni MA, Tobin GR, Ackerman D, Polk HC Jr (1985) Comparison of prosthetic materials for abdominal wall reconstruction in the presence of contamination and infection. Ann Surg 201(6):705–711Google Scholar
  14. 14.
    Morales-Conde S (2012) A new classification for seroma after laparoscopic ventral hernia repair. Hernia 16:261–267PubMedCrossRefGoogle Scholar
  15. 15.
    Chevrel JP, Rath AM (2000) Classification of incisional hernias of the abdominal wall. Hernia 4:7–11CrossRefGoogle Scholar
  16. 16.
    Sauerland S, Walgenbach M, Habermalz B, Seiler CM, Miserez M. (2011) Laparoscopic versus open surgical techniques for ventral or incisional hernia repair. Cochrane Database Syst Rev 3:1–61Google Scholar
  17. 17.
    Forbes SS, Eskicioglu C, McLeod RS, Okrainec A (2009) Meta-analysis of randomized controlled trials comparing open and laparoscopic ventral and incisional hernia repair with mesh. Br J Surg 96(8):851–858 ReviewPubMedCrossRefGoogle Scholar
  18. 18.
    Verbo A, Petito L, Manno A, Coco C, Mattana C, Lurati M, Perdetti G, Rizzo G, Sermoneta D, Lodoli C, Nunziata J, D’Ugo D (2007) Laparoscopic approach to recurrent incisional hernia repair: a 3-year experience. J Laparoendosc Adv Surg Tech 17:591–595CrossRefGoogle Scholar
  19. 19.
    Heniford BT, Park A, Ramshaw BJ, Voeller G (2003) Laparoscopic repair of ventral hernias: nine years’ experience with 850 consecutive hernias. Ann Surg 238(3):391–399 discussion 399–400PubMedGoogle Scholar
  20. 20.
    Sharma A, Mehrotra M, Khullar R, Soni V, Baijal M, Chowbey PK (2011) Laparoscopic ventral/incisional hernia repair: a single centre experience of 1,242 patients over a period of 13 years. Hernia 15(2):131–139PubMedCrossRefGoogle Scholar
  21. 21.
    Sturt NJ, Liao CC, Engledow AH, Menzies D, Motson RW (2011) Results of laparoscopic repair of primary and recurrent incisional hernias at a single UK institution. Surg Laparosc Endosc Percutan Tech 21(2):86–89PubMedCrossRefGoogle Scholar
  22. 22.
    Moreno- Egea A, Castillo Bustos JA, Girela E, Aguayo-Albasini JL (2010) Long-term results of laparoscopic repair of incisional hernias using an intraperitoneal composite mesh. Surg Endosc 24:359–365PubMedCrossRefGoogle Scholar
  23. 23.
    Moreno-Egea A, Carrillo-Alcaraz A, Aguayo-Albasini JL (2012) Is the outcome of laparoscopic incisional hernia repair affected by defect size? A prospective study. Am J Surg 203(1):87–94PubMedCrossRefGoogle Scholar
  24. 24.
    Ferrari GC, Miranda A, Di Lernia S, Sansonna F, Magistro C, Franzetti ML, Maggioni D, Pugliese R (2008) Laparoscopic management of incisional hernias 15 cm in diameter. Hernia 12:571–576PubMedCrossRefGoogle Scholar
  25. 25.
    Ferrari GC, Miranda A, Sansonna F, Magistro C, Di Lernia S, Maggioni D, Franzetti ML, Costanzi A, Pugliese R (2009) Laparoscopic repair of incisional hernia located on the abdominal borders (a retrospective critical review). Surg Laparosc Endosc Percutan Tech 19:348–352PubMedCrossRefGoogle Scholar
  26. 26.
    Wassenaar EB, Schoenmaeckers EJP, Raymakers JTFJ, Rakic S (2009) Recurrences after laparoscopic repair of ventral and incisional hernia: lessons learned from 505 repairs. Surg Endosc 23:825–832PubMedCrossRefGoogle Scholar
  27. 27.
    Varela JE, Wilson SE, Nguyen NT (2010) Laparoscopic surgery significantly reduces surgical-site infections compared with open surgery. Surg Endosc 24:270–276PubMedCrossRefGoogle Scholar
  28. 28.
    LeBlanc KA, Elieson MJ, Corder JM (2007) Enterotomy and mortality rates of laparoscopic incisional and ventral hernia repair: a review of the literature. JSLS 11:403–407Google Scholar
  29. 29.
    Matthews B, Nalysnyk L, Estok R, Fahrbach K, Banel D, Linz H, Landman J (2008) Ultrasonic and nonultrasonic instrumentation. A systematic review and meta-analysis. Arch Surg 143:592–600PubMedCrossRefGoogle Scholar
  30. 30.
    Wassenaar E, Schoenmaeckers E, Raymakers J, van der Palen J, Rakic S (2010) Mesh-fixation method and pain and quality of life after laparoscopic ventral or incisional hernia repair: a randomized trial of three fixation techniques. Surg Endosc 24(6):1296–1302PubMedCrossRefGoogle Scholar
  31. 31.
    Ching SS, Sarela AI, Dexter SP, Hayden JD, McMahon MJ (2008) Comparison of early outcomes for laparoscopic ventral hernia repair between nonobese and morbidly obese patient populations. Surg Endosc 22(10):2244–2250PubMedCrossRefGoogle Scholar
  32. 32.
    Novitsky YW, Cobb WS, Kercher KW, Matthews BD, Sing RF, Heniford BT (2006) Laparoscopic ventral hernia repair in obese patients: a new standard of care. Arch Surg 141:57–61PubMedCrossRefGoogle Scholar
  33. 33.
    Zühlke HV, Lorenz EM, Straub EM, Savvas V (1990) Pathophysiology and classification of adhesions. Langenbecks Arch Chir Suppl II Verh Dtsh Ges Chir 1990:1009–1016Google Scholar

Copyright information

© Springer-Verlag France 2013

Authors and Affiliations

  • G. Ferrari
    • 1
  • C. Bertoglio
    • 1
  • C. Magistro
    • 1
  • V. Girardi
    • 1
  • M. Mazzola
    • 1
  • S. Di Lernia
    • 1
  • R. Pugliese
    • 1
  1. 1.Oncologic and Mini-invasive Surgery DepartmentNiguarda Cà Granda HospitalMilanItaly

Personalised recommendations