Laparoscopic management of recurrent ventral hernia: an experience of 222 patients
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.
KeywordsRecurrent 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.
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 and written consent was obtained from all the patients for the mentioned surgical procedure.
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