, Volume 8, Issue 4, pp 323–331 | Cite as

Laparoscopic incisional and ventral hernia repair: Complications—how to avoid and handle

  • K. A. LeBlancEmail author


Complications will occur with any operative procedure. The possibility of this must be considered for laparoscopic incisional and ventral hernia repair (LIVH) as well. The most commonly reported of these include: intraoperative intestinal injury (1–3.5%), infection involving the prosthetic biomaterial (0.7–1.4%), seromas (2.6–100%), postoperative ileus (1–8%), and persistent postoperative pain (1–2%). The incidence of enterotomy can be reduced by careful dissection and judicious use of any energy source. Infection can be minimized by the use of perioperative antibiotics, an antimicrobially impregnated biomaterial, and careful manipulation of the prosthesis during the procedure. Seromas are so common that they should be expected but can be decreased by the use of a postoperative abdominal binder. Aspiration will be necessary in a few instances. Similarly, ileus is expected when there is significant bowel dissection and bleeding. Early ambulation and standard use of postoperative bowel care will aid in the treatment of this problem. Persistent pain will generally occur at the site of a transfascial suture. It cannot be predicted or prevented with certainty. When it occurs, local injection with bupivacaine, steroids, or non-steroidal agents will help, but occasionally, removal of the offending suture(s) will be required. The average recurrence rate for LIVH is approximately 5.6% in the literature. Rates as high as 15.7%, however, have been reported. Recurrence will be increased by inadequate prosthetic overlap of the fascial defect, infection that involves the biomaterial, which then requires its removal, and lack of the use of transfascial sutures. To prevent these risks, the surgeon must assure that there is at least a 3-cm overlap of all portions of the hernia defect and insist that sutures are used at 5-cm intervals to fix the biomaterial. Infection that requires explantation of the patch will generally result in recurrence, as this must be repaired primarily. Alternatively, the use of a collagen prosthesis may allow immediate repair, but this is associated with a high failure rate. A staged repair will be necessary in the future in most patients.


Laparoscopy Incisional hernia Complications Biomaterials 


  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.
    LeBlanc KA, Bellanger DE (2002) Laparoscopic Repair of Para-Ostomy Hernias. J Am Coll Surg 194:232–239CrossRefPubMedGoogle Scholar
  3. 3.
    Deol ZK, Shayani V (2003) Laparoscopic parastomal Hernia Repair. Arch Surg 138:203–205CrossRefPubMedGoogle Scholar
  4. 4.
    Hirasa T, Pickleman J, Shayani V (2003) Laparoscopic Repair of Parapubic Hernia. Arch Surg 1314–1317Google Scholar
  5. 5.
    Leber GE, Garb JL, Alexander AI, Reed WP (1998) Long-term complications associated with prosthetic repair of incisional hernias. Arch Surg 133:378–382CrossRefPubMedGoogle Scholar
  6. 6.
    White TJ, Santos MC, Thompson JS (1998) Factors affecting wound complications in repair of ventral hernias. Am Surg 64:276–280PubMedGoogle Scholar
  7. 7.
    DeMaria EJ, Moss JM, Surgerman HJ (2000) Laparscopic intraperitoneal polytetrafluoroethylene (PTFE) prosthetic patch repair of ventral hernia. Surg Endosc 14:326–329CrossRefPubMedGoogle Scholar
  8. 8.
    Robbins SB, Pofahl W, Gonzales RP (2001) Laparoscopic ventral hernia repair reduces wound complications. Am Surg 9:896–900Google Scholar
  9. 9.
    LeBlanc KA, Whitaker JM, Bellanger DE, Rhynes VK (2003) Laparoscopic incisional and ventral hernioplasty: Lessons learned from 200 patients. Hernia 7:118–124CrossRefPubMedGoogle Scholar
  10. 10.
    Ramshaw BJ, Esartia P, Schwab J, Mason EM, Wilson RA, Duncan TD, Miller J, Lucas GW, Promes J (1999) Comparison of Laparoscopic and Open Ventral Herniorrhaphy. Am Surg 65:827–832PubMedGoogle Scholar
  11. 11.
    Park A, Birch DW, Lovrics P (1998) Laparoscopic and open incisonal hernia repair: A comparison study. Surgery 124:816–822CrossRefPubMedGoogle Scholar
  12. 12.
    Carbajo MA, Martin del Olmo JC, Blanco JI, de la Cuesta C, Toledano M, Martin F, Vaqueto C, Inglada L (1999) Laparoscopic treatment vs. open surgery in the solution of major incisional and abdominal wall hernias with mesh. Surg Endosc 13:250–252CrossRefPubMedGoogle Scholar
  13. 13.
    McGreevy JM, Goodney PP, Birkmeyer CM, Finlayson RG, Laycock WS, Birkmeyer JD (2003) A prospective study comparing the complication rates between laparoscopic and open ventral hernia repairs. Surg Endosc 17:1778–1780CrossRefPubMedGoogle Scholar
  14. 14.
    Koehler RH, Voeller G (1999) Recurrences in Laparoscopic Incisional Hernia Repairs: A Personal Series and Review of the Literature. JSLS 3:293–304PubMedGoogle Scholar
  15. 15.
    Chari R, Chari V, Eisenstat M, Chung R (2000) A case controlled study of laparoscopic incisional hernia repair. Surg Endosc 14:117–119PubMedGoogle Scholar
  16. 16.
    Berger D, Bientzle M, Müller A (2002) Postoperative complications after laparoscopic incisional hernia repair. Surg Endosc 16:1720–1723CrossRefPubMedGoogle Scholar
  17. 17.
    Bageacu S, Blanc P, Breton C, Gonzales M, Porcheron J, Chabert M, Balique JG (2002) Laparoscopic repair of incisional hernias. Surg Endosc 16:345–348CrossRefPubMedGoogle Scholar
  18. 18.
    Carbajo MA, Martín del Olmo JC, Blanco JI, Toledano M, de la Cuesta C, Ferraras C, Vaquero C (2003) Laparoscopic approach to incisional hernia. Surg Endosc 17:118–122CrossRefPubMedGoogle Scholar
  19. 19.
    Rosen M, Brody F, Ponsky J, Walsh RM, Rosenblatt S, Duperier F, Fanning A, Siperstein A (2003) Recurrence after laparoscopic ventral hernia repair. Surg Endosc 17:123–128CrossRefPubMedGoogle Scholar
  20. 20.
    LeBlanc KA, Booth WV, Whitaker JM, Bellanger DE (2000) Laparoscopic Incisional and Ventral Herniorraphy in 100 Patients. Am J Surg 180:193–197CrossRefPubMedGoogle Scholar
  21. 21.
    Heniford TB, Park A, Ramshaw BJ, Voeller G (2000) Laparoscopic ventral and incisional hernia repair in 407 patients. J Am Coll Surg 190:645–650CrossRefPubMedGoogle Scholar
  22. 22.
    Voeller G (2003) Laparoscopic Repair in the Emergent Setting. In: LeBlanc KA (ed) Laparoscopic Hernia Surgery: An Operative Guide. Arnold Medical Publishers, London, England, pp 111–114Google Scholar
  23. 23.
    Moreno-Egea A, Castillo Bustos JA, Aguayo JI (2002) Day surgery for laparoscopic repair of abdominal wall hernias. Hernia 6:21–25CrossRefPubMedGoogle Scholar
  24. 24.
    Feingold DL, Widmann WD, Calhoun SK, Teigen EL, Crist L, Willekes LJ, Dykes NL, Liu EH, Lunga AA, Aranoff T (2003) Persistent post-laparoscopy pneumoperitoneum. Surg Endosc 17:296–299CrossRefPubMedGoogle Scholar
  25. 25.
    Toy FK, Bailey RW, Carey S, Chappuis CW, Gagner M, Josephs LG, Mangiante EC, Park AE, Pomp A, Smoot RT, Uddo JF, Voeller G (1998) Prospective, multicenter study of laparoscopic ventral hernioplasty. Surg Endosc 12:955–959CrossRefPubMedGoogle Scholar
  26. 26.
    Holzman MD, Purut CM, Reintgen K, Eubanks S, Pappas TN (1997) Laparoscopic ventral and incisional henioplasty. Surg Endosc 11:32–35CrossRefPubMedGoogle Scholar
  27. 27.
    Farooqui MO, Bazzoli JM (1976) Significance of Radiologic Evidence of Free Air Following Laparoscopy. J Reprod Med 16:119–125PubMedGoogle Scholar
  28. 28.
    Susmallian S, Gewurtz G, Ezri T, Charuzi I (2001) Seroma after laparoscopic repair of hernia with PTFE patch: Is it really a complication? Hernia 5:139–41CrossRefPubMedGoogle Scholar
  29. 29.
    Kirshtein B, Lantsberg L, Avinoach E, Bayma M, Mizrahi S (2002) Laparoscopic repair of large incisional hernias. Surg Endosc 16:1717–1719CrossRefPubMedGoogle Scholar
  30. 30.
    Lin BHJ, Vargish T, Dachman AH (1999) CT findings after Laparoscopic Repair of Ventral Hernias. AJR Am J Roentgenol 172:389–392PubMedGoogle Scholar
  31. 31.
    Chowbey PK, Sharma A, Khullar R, Baijal M, Vashistha A (2000) Laparoscopic Ventral Hernia Repair. J Laparoendosc Adv Surg Tech A 10:79–84PubMedGoogle Scholar
  32. 32.
    Gillian GK, Geis WP, Grover G (2002) Laparoscopic Incisional and Ventral Henria Repair (LIVH): An Evolving Outpatient Technique. JSLS 6:315–322PubMedGoogle Scholar
  33. 33.
    Tsimoyiannis EC, Siakas P, Glantzouissis G, Koulas S, Mavridou P, Gossios KI (2001) Seroma in Laparoscopic Ventral Hernioplasty. Surg Laparosc Endosc Percutan Tech 11:31–321Google Scholar
  34. 34.
    Parker HH, Nottingham JM, Bynoc RP, Yost MJ (2002) Laparoscopic Repair of Large Incisional Hernias. Am Surg 68:530–534PubMedGoogle Scholar
  35. 35.
    Carbonell AM, Harold KL, Mahmutovic A, Hassan R, Matthews BD, Kercher KW, Sing RF, Heniford BT (2003) Local injection for the treatment of suture site pain after laparoscopic ventral hernia repair. Am Surg 69:688–692PubMedGoogle Scholar
  36. 36.
    Park A, Heniford BT, LeBlanc KA, Voeller GR (2001) Laparoscopic repair of incisional hernias. Part 2: Surgical technique. Contemp Surg 57:225–238Google Scholar
  37. 37.
    Franklin ME, Dorman JP, Glass JL, Balli JE, Gonzales JJ (1998) Laparoscopic Ventral and Incisional Hernia Repair. Surg Laparosc Endosc 8:294–299CrossRefPubMedGoogle Scholar
  38. 38.
    Wright BE, Niskanen BD, Peterson DJ, Ney AL, Odland MD, VanCamp J, Zera RT, Rodriguez JL (2002) Laparoscopic ventral hernia repair: Are There Comparative Advantages over Traditional Methods of Repair? Am Surg 68:291–296PubMedGoogle Scholar
  39. 39.
    Ben-Haim M, Kuriansky J, Tal R, Zmora O, Mintz Y, Rosin D, Ayalon A, Shabtai M (2002) Pitfalls and complications with laparoscopic intraperitoneal expanded polytetrafluoroethylene patch repair of postoperative ventral hernia. Surg Endosc 16:785–788CrossRefPubMedGoogle Scholar
  40. 40.
    LeBlanc KA (2000) Current Considerations in Laparoscopic Incisional and Ventral Herniorraphy. JSLS 4:131–139PubMedGoogle Scholar
  41. 41.
    LeBlanc KA (2001) The Critical Technical Aspects of Laparoscopic Repair of Ventral and Incisional Hernias. Am Surg 67:809–812PubMedGoogle Scholar
  42. 42.
    Roth JS, Park AE, Witzke D, Mastrangelo MJ (1999) Laparoscopic incisional/ventral herniorraphy: A 5-year experience. Hernia 4:209–214CrossRefGoogle Scholar
  43. 43.
    Aura T, Habib E, Mekkaoui M, Brassier D, Elhadad A (2002) Laparoscopic Tension-Free Repair of Anterior Abdominal Incisional and Ventral Hernias with an Intraperitoneal Gore-Tex Mesh: Prospective Study and Review of the Literature. J Laparoendosc Adv Surg Tech A 12:263–267CrossRefPubMedGoogle Scholar
  44. 44.
    Heniford BT, Ramshaw BJ (2000) Laparoscopic ventral hernia repair. Surg Endosc 14:419–423CrossRefPubMedGoogle Scholar
  45. 45.
    Hesselink VJ, Luijendijk RW, de Wilt JHW, Heide R, Jeekel J (1993) An evaluation of risk factors in incisional hernia recurrence. Surg Gynecol Obstet 176:228–234PubMedGoogle Scholar
  46. 46.
    Thoman DS, Phillips EH (2002) Current status of laparoscopic ventral hernia repair. Surg Endosc 16:939–942CrossRefPubMedGoogle Scholar
  47. 47.
    Raftopoulos I, Vanuno D, Khorsand J, Kouraklis G, Lasky P (2003) Comparison of open and laparoscopic prosthetic repair of large ventral henias. JSLS 7:227–232PubMedGoogle Scholar
  48. 48.
    Heniford BT, Park A, Ramshaw BJ, Voeller G (2003) Laparoscopic repair of ventral hernias: nine years experience with 850 consecutive hernias. Ann Surg 238:391–400CrossRefPubMedGoogle Scholar
  49. 49.
    van’t Riet M, de Vos van Steinwijk PJ, Kleiniensink GJ, Steyerberg EW, Bonjer HJ (2002) Tensile strength of mesh fixation methods in laparoscopic incisional hernia repair. Surg Endosc 16:1713–1716CrossRefPubMedGoogle Scholar
  50. 50.
    LeBlanc KA, Stout RW, Kearney MT, Paulson DB (2003) Comparison of Adhesion Formation Associated with Pro-Tack (U S Surgical) versus a New Mesh Fixation Device, Salute (Onux Medical). Surg Endosc 17:1409–1417CrossRefPubMedGoogle Scholar
  51. 51.
    LeBlanc KA (2003) Tack Hernia—A New Entity. JSLS 7:383–387PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  1. 1.Minimally Invasive Surgery Institute Inc.Baton RougeUSA
  2. 2.Louisiana State University School of MedicineNew OrleansUSA

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