The incarcerated hernia can be repaired laparoscopically if one can obtain a good laparoscopic view of the hernia and its contents, dissect the adhesions, and reduce the hernia.
In the multiply operated abdomen, the extent and density of adbesions are the main determinants of length and difficulty of laparoscopic ventral hernia repair. Adhesion formation is unpredictable; therefore, multiple previous operations do not preclude the laparoscopic approach provided that an entry point for the first trocar can be obtained and a pneumoperitoneum safely established.
Swiss-cheese hernias (multiple small defects) are actually a good indication for the laparoscopic approach because the number of fascial defects and extent of hernia formation are often greater than expected. The laparoscopic approach allows a clear delineation of all defects, so that the mesh prosthesis is tailored accordingly.
KeywordsAbdominal Wall Hernia Repair Laparoscopic Approach Ventral Hernia Laparoscopic Repair
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