, Volume 23, Issue 5, pp 927–934 | Cite as

Laparoscopic management of recurrent ventral hernia: an experience of 222 patients

  • S. Dey
  • R. Parthasarathi
  • S. C. SabnisEmail author
  • R. Jain
  • P. Praveen Raj
  • P. Senthilnathan
  • S. Rajapandian
  • C. Palanivelu
Original Article
Part of the following topical collections:
  1. Forum on primary midline uncomplicated ventral hernia



To evaluate the predisposing factors and characteristics of recurrent ventral hernia (RVH) along with the feasibility and outcome of laparoscopy in managing RVH.


This study is a retrospective analysis of all patients with reducible or irreducible, uncomplicated RVH who underwent surgical management from January 2012 to June 2018.


Out of 222 patients, 186 (83.8%) were female, and 36 (16.2%) were male. The mean age was 54.1 ± 10.1 years; an average body mass index was 31 kg/m2 (19–47.9). The most common previous abdominal operations among female patients were cesarean sections (43.5%) and abdominal hysterectomy (36.6%). Most of the patients had a history of open mesh repair (43.7%) and open anatomical repair (36.9%). The median time of recurrence was 4 years (1–33 years). The median defect size was 10 cm2 (range 2–150 cm2), and 73% defects were in the midline. Total 181 of 222 (81.6%) patients underwent laparoscopic intraperitoneal onlay mesh plus (L-IPOM+), 19 (8.5%) laparoscopic-assisted IPOM+, 17(7.7%) laparoscopic anatomical repair, while remaining 5 (2.3%) patients required open mesh reconstruction. The median size of the composite mesh used was 300 cm2 (150–600 cm2). The mean operating time was 145 (30–330) min, and median blood loss was 15 (5–110) ml. The median hospital stay was 3 days, and median follow-up period was 37 months. The post-operative symptomatic seroma rate was 3.1%, and re-recurrence rate was 1.4%.


Obesity, old age, female sex, previous lower abdominal surgeries, and previous open repair of a hernia are factors associated with recurrence. Laparoscopic repair is feasible with excellent outcome in most of the patients.


Recurrent ventral hernia Laparoscopic hernia repair Intraperitoneal onlay mesh IPOM plus Incisional hernia 



The authors have not received any financial help for this research work.

Compliance with ethical standards

Conflict of interest

We authors Drs, Sumanta Dey, Ramakrishnan Parthasarathy, Sandeep C. Sabnis, Rohan Jain, Palanivelu Praveen Raj, Palanisamy Senthilnathan, Subbaiah Rajapandian, Chinnusamy Palanivelu, states that they have no conflict of interest to disclose.

Ethical approval

This study was approved by institutional ethical committee for human studies, and waiver of consent of was obtained, in view of retrospective study design, where atmost care has been taken to avoid disclosure of identity of any individual participant.

Human and animal rights

All procedures were carried out following the ethical standards of the responsible (institutional) committee on human experimentation and following the Helsinki Declaration of 1964 and later versions.

Informed consent

Informed and written consent was obtained from all the patients for the mentioned surgical procedure.


  1. 1.
    LeBlanc KA, Booth WV (1993) Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: preliminary findings. Surg Laparosc Endosc 3:39–41PubMedGoogle Scholar
  2. 2.
    Bittner R, Bingener-Casey J, Dietz U et al (2014) Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS)-part 1. Surg Endosc 28:2–29. CrossRefPubMedGoogle Scholar
  3. 3.
    Cobb WS, Kercher KW, Heniford BT (2005) Laparoscopic repair of incisional hernias. Surg Clin North Am 85:91–103. CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Hesselink VJ, Luijendijk RW, de Wilt JH et al (1993) An evaluation of risk factors in incisional hernia recurrence. Surg Gynecol Obstet 176:228–234PubMedGoogle Scholar
  5. 5.
    Chelala E, Baraké H, Estievenart J et al (2016) Long-term outcomes of 1326 laparoscopic incisional and ventral hernia repair with the routine suturing concept: a single institution experience. Hernia 20:101–110. CrossRefGoogle Scholar
  6. 6.
    Aabakke AJM, Krebs L, Ladelund S, Secher NJ (2014) Incidence of incisional hernia after cesarean delivery: a register-based cohort study. PLoS One 9:e108829. CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Agbakwuru E, Olabanji J, Alatise O et al (2009) Incisional hernia in women: predisposing factors and management where mesh is not readily available. Libyan J Med 4:66–69. CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Zhang Y, Zhou H, Chai Y et al (2014) Laparoscopic versus open incisional and ventral hernia repair: a systematic review and meta-analysis. World J Surg 38:2233–2240. CrossRefPubMedGoogle Scholar
  9. 9.
    Awaiz A, Rahman F, Hossain MB et al (2015) Meta-analysis and systematic review of laparoscopic versus open mesh repair for elective incisional hernia. Hernia 19:449–463. CrossRefPubMedGoogle Scholar
  10. 10.
    Picazo-Yeste J, Moreno-Sanz C, Sedano-Vizcaíno C et al (2017) Outcomes after laparoscopic ventral hernia repair: does the number of previous recurrences matter? A prospective study. Surg Endosc. CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    LeBlanc K (2016) Proper mesh overlap is a key determinant in hernia recurrence following laparoscopic ventral and incisional hernia repair. Hernia 20:85–99. CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Carter SA, Hicks SC, Brahmbhatt R, Liang MK (2014) Recurrence and pseudorecurrence after laparoscopic ventral hernia repair: predictors and patient-focused outcomes. Am Surgeon 80(2):138–48PubMedPubMedCentralGoogle Scholar
  13. 13.
    Moreno-Egea A, Carrillo A, Aguayo JL (2008) Midline versus nonmidline laparoscopic incisional hernioplasty: a comparative study. Surg Endosc 22:744–749. CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Misiakos EP, Patapis P, Zavras N et al (2015) Current trends in laparoscopic ventral hernia repair. JSLS. CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Ferrari G, Bertoglio C, Magistro C et al (2013) Laparoscopic repair for recurrent incisional hernias: a single institute experience of 10 years. Hernia 17:573–580. CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Davies SW, Turza KC, Sawyer RG et al (2012) A comparative analysis between laparoscopic and open ventral hernia repair at a tertiary care center. Am Surg 78:888–892PubMedPubMedCentralGoogle Scholar
  17. 17.
    Stirler VMA, Schoenmaeckers EJP, de Haas RJ et al (2014) Laparoscopic repair of primary and incisional ventral hernias: the differences must be acknowledged. Surg Endosc 28:891–895. CrossRefPubMedGoogle Scholar
  18. 18.
    Mercoli H, Tzedakis S, D’Urso A et al (2017) Postoperative complications as an independent risk factor for recurrence after laparoscopic ventral hernia repair: a prospective study of 417 patients with long-term follow-up. Surg Endosc 31:1469–1477. CrossRefGoogle Scholar
  19. 19.
    Perrone JM, Soper NJ, Eagon JC et al (2005) Perioperative outcomes and complications of laparoscopic ventral hernia repair. Surgery 138:708–716. CrossRefGoogle Scholar
  20. 20.
    Sharma A, Khullar R, Soni V et al (2013) Iatrogenic enterotomy in laparoscopic ventral/incisional hernia repair: a single center experience of 2,346 patients over 17 years. Hernia 17:581–587. CrossRefGoogle Scholar
  21. 21.
    Bittner R, Bingener-Casey J, Dietz U et al (2014) Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society [IEHS])—part 2. Surg Endosc 28:353–379. CrossRefGoogle Scholar
  22. 22.
    Sharma A, Mehrotra M, Khullar R et al (2008) Limited-conversion technique: a safe and viable alternative to conversion in laparoscopic ventral/incisional hernia repair. Hernia 12:367–371. CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Stoikes N, Quasebarth M, Brunt LM (2013) Hybrid ventral hernia repair: technique and results. Hernia 17:627–632. CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Yoshikawa K, Shimada M, Kurita N et al (2014) Hybrid technique for laparoscopic incisional ventral hernia repair combining laparoscopic primary closure and mesh repair. Asian J Endosc Surg 7:282–285. CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Palanivelu C, Jani KV, Senthilnathan P et al (2007) Laparoscopic sutured closure with mesh reinforcement of incisional hernias. Hernia 11:223–228. CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Palanivelu C, Rangarajan M, Parthasarathi R et al (2008) Laparoscopic repair of suprapubic incisional hernias: suturing and intraperitoneal composite mesh onlay. A retrospective study. Hernia 12:251–256. CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Tandon A, Pathak S, Lyons NJR et al (2016) Meta-analysis of closure of the fascial defect during laparoscopic incisional and ventral hernia repair. Br J Surg 103:1598–1607. CrossRefGoogle Scholar
  28. 28.
    Nardi M, Millo P, Brachet Contul R et al (2017) Laparoscopic ventral hernia repair with composite mesh: analysis of risk factors for recurrence in 185 patients with 5 years follow-up. Int J Surg 40:38–44. CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Chatzimavroudis G, Kalaitzis S, Voloudakis N et al (2017) Evaluation of four mesh fixation methods in an experimental model of ventral hernia repair. CrossRefGoogle Scholar
  30. 30.
    Reynvoet E, Deschepper E, Rogiers X et al (2014) Laparoscopic ventral hernia repair: is there an optimal mesh fixation technique? A systematic review. Langenbeck’s Arch Surg 399:55–63. CrossRefGoogle Scholar
  31. 31.
    LeBlanc KA (2007) Laparoscopic incisional hernia repair: are transfascial sutures necessary? A review of the literature. Surg Endosc 21:508–513. CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Praveen Raj P, Ganesh MK, Senthilnathan P et al (2015) Concomitant laparoscopic intraperitoneal onlay mesh repair with other clean contaminated procedures—study of feasibility and safety. J Laparoendosc Adv Surg Tech 25:33–36. CrossRefGoogle Scholar
  33. 33.
    Ross SW, Wormer BA, Kim M et al (2015) Defining surgical outcomes and quality of life in massive ventral hernia repair: an international multicenter prospective study. Am J Surg. CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Tsimoyiannis EC, Tsimogiannis KE, Pappas-Gogos G, Nikas K, Karfis E, Sioziou H (2008) Seroma and recurrence in laparoscopic ventral hernioplasty. JSLS J Soc Laparoendosc Surg 12(1):51Google Scholar
  35. 35.
    Yang PG, Tung LK (2016) Preperitoneal onlay mesh repair for ventral abdominal wall and incisional hernia: a novel technique. Asian J Endosc Surg 9:344–347. CrossRefGoogle Scholar
  36. 36.
    Arita NA, Nguyen MT, Nguyen DH et al (2015) Laparoscopic repair reduces incidence of surgical site infections for all ventral hernias. Surg Endosc 29:1769–1780. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Gastrointestinal and Minimal Access SurgeryGEM Hospital and Research CentreCoimbatoreIndia

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