Consideration regarding Concomitant Operations during Laparoscopic Ventral Hernia Repair: Indications, Management and Trocar Position

Abstract

The patient undergoing laparoscopic ventral hernia repair may suffer from other surgical pathologies. These pathologies can be symptomatic prior to the repair of the ventral hernia or their symptoms can be manifested at a later stage. Theoretically, the surgical treatment of these concomitant pathologies, either by the laparoscopic or the open approach, can be postponed to a later time. However, this delay may complicate the previously performed ventral hernia repair by causing infection of the mesh or development of recurrent hernia. In addition, when laparoscopic treatment of concomitant intraabdominal pathologies are done at a later stage, severe intraabdominal adhesions can be encountered. For these reasons, we think that the surgeon must strive to treat associated pathologies simultaneously with ventral hernia repair. However, the surgeon’s decision whether or not to perform concomitant procedures must take into account the circumstances of each individual case. Some crucial points for consideration are: (1) whether the patient is symptomatic or not; (2) can the patient tolerate the concomitant procedure which means longer operation time and increased surgical injury; and (3) whether performance of the concomitant procedure may increase the likelihood for mesh infection.