Skip to main content
SpringerLink
Log in

Laparoscopic repair of primary versus incisional ventral hernias: time to recognize the differences?

  • Original Article
  • Published:
Hernia Aims and scope Submit manuscript

Abstract

Purpose

To elucidate the differences in the pathology of incisional and primary ventral hernias and the outcomes of their laparoscopic repair.

Methods

An operating room database of all laparoscopic ventral hernias performed between 2001 and 2009 was analyzed retrospectively. Patients were divided into two main groups: Group 1 (incisional hernias) and Group 2 (primary hernias). All P-values < 0.05 were considered to be significant.

Results

There were 121 patients in Group 1 (mean age: 60.35 years) and 100 patients in Group 2 (mean age: 51.94 years). There was a significantly higher percentage of females in Group 1 (70 vs. 28%, P < 0.0001). There were significantly more complex hernias (defined as multiple points of weakness on the anterior abdominal wall) in Group 1 (37 vs. 10%, P < 0.0001). A total of 89% of patients required lysis of adhesions in Group 1 as compared with 73% in Group 2 (P = 0.007). There was a significantly higher percentage of conversions in Group 1 (9%) compared with Group 2 (2%, P = 0.02). The mean mesh size was significantly larger in Group 1 (243.22 vs. 131.46 cm2). The mean length of procedure (LOP) was significantly longer in Group 1 (113.94 min) as compared with Group 2 (70.96 min). The overall morbidity rate was not significantly different between the two groups (23 vs. 16%). The mean length of stay (LOS) was significantly longer for Group 1 (2.2 vs. 0.75 days, P < 0.0001). Finally, 22.3% of the patients in Group 1 were discharged on the same day as compared with 59% of the patients in Group 2 (P < 0.0001).

Conclusions

The LOP and LOS are longer after the laparoscopic repair of incisional than for primary ventral hernias. This disparity should be kept in mind when counseling patients and while designing trials investigating laparoscopic ventral hernia repairs (LVHRs).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Schwartz S (2005) Principles of surgery. Chap 34: abdominal wall, omentum, mesentery, and retroperitoneum

  2. Rutkow IM (2003) Demographic and socioeconomic aspects of hernia repair in the United States in 2003. Surg Clin North Am 83(5):1045–1051

    Article  PubMed  Google Scholar 

  3. Lomanto D, Iyer SG, Shabbir A, Cheah WK (2006) Laparoscopic versus open ventral hernia mesh repair: a prospective study. Surg Endosc 20:1030–1035

    Article  CAS  PubMed  Google Scholar 

  4. Mudge M, Hughes LE (1985) Incisional hernia: a 10 year prospective study of incidence and attitudes. Br J Surg 72:70–71

    Article  CAS  PubMed  Google Scholar 

  5. Lewis RT, Wiegand FM (1989) Natural history of vertical abdominal parietal closure: Prolene versus Dexon. Can J Surg 32:196–200

    CAS  PubMed  Google Scholar 

  6. Höer J, Lawong G, Klinge U, Schumpelick V (2002) Factors influencing the development of Incisional hernia. A retrospective study of 2,983 laparotomy patients over a period of 10 years. Chirurg 73:474–480

    Article  PubMed  Google Scholar 

  7. National Center for Health Statistics (NCHS) (2007) Combined surgery data (NHDS and NSAS) data highlights. Available online at: http://www.cdc.gov/nchs/nhds/nhds_products.htm

  8. Sajid MS, Bokhari SA, Mallick AS, Cheek E, Baig MK (2009) Laparoscopic versus open repair of incisional/ventral hernia: a meta-analysis. Am J Surg 197:64–72

    Article  PubMed  Google Scholar 

  9. Rosen M, Brody F, Ponsky J, Walsh RM, Rosenblatt S, Duperier F, Fanning A, Siperstein A (2003) Recurrence after laparoscopic ventral hernia repair: a five-year experience. Surg Endosc 17:123–128

    Article  CAS  PubMed  Google Scholar 

  10. LeBlanc KA, Booth WV (1993) Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: preliminary findings. Surg Laparosc Endosc 3(1):39–41

    CAS  PubMed  Google Scholar 

  11. Schumpelick V (2000) Narbenhernie. In: Schumpelick V (ed) Hernien. Thieme, Stuttgart, pp 266–269

    Google Scholar 

  12. Chevrel JP, Ruth AM (2000) Classification of incisional hernias of the abdominal wall. Hernia 4:7–11

    Article  Google Scholar 

  13. Korenkov M, Paul A, Sauerland S, Neugebauer E, Arndt M, Chevrel JP, Corcione F, Fingerhut A, Flament JB, Kux M, Matzinger A, Myrvold HE, Rath AM, Simmermacher RK (2001) Classification and surgical treatment of incisional hernia. Results of an experts’ meeting. Langenbecks Arch Surg 386:65–73

    Article  CAS  PubMed  Google Scholar 

  14. Dietz UA, Hamelmann W, Winkler MS, Debus ES, Malafaia O, Czeczko NG, Thiede A, Kuhfuss I (2007) An alternative classification of incisional hernias enlisting morphology, body type and risk factors in the assessment of prognosis and tailoring of surgical technique. J Plast Reconstr Aesthet Surg 60(4):383–388

    Article  CAS  PubMed  Google Scholar 

  15. Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E, Dietz UA, Eker HH, El Nakadi I, Hauters P, Hidalgo Pascual M, Hoeferlin A, Klinge u, Montgomery A, Simmermacher RKJ, Simons MP, Smietański M, Sommeling C, Tollens T, Vierendeels T, Kingsnorth A (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13:407–414

    Article  CAS  PubMed  Google Scholar 

  16. Stoppa RE (1989) The treatment of complicated groin and Incisional hernias. World J Surg 13:545–554

    Article  CAS  PubMed  Google Scholar 

  17. Rives J, Pire JC, Flament JB, Palot JP, Body C (1985) Treatment of large eventrations. New therapeutic indications apropos of 322 cases. Chirurgie 111:215–225

    CAS  PubMed  Google Scholar 

  18. Wantz GE (1991) Incisional hernioplasty with Mersilene. Surg Gynecol Obstet 172:129–137

    CAS  PubMed  Google Scholar 

  19. Barbaros U, Asoglu O, Seven R, Erbil Y, Dinccag A, Deveci U, Ozarmagan S, Mercan S (2007) The comparison of laparoscopic and open ventral hernia repairs: a prospective randomized study. Hernia 11(1):51–56

    Article  CAS  PubMed  Google Scholar 

  20. Carbajo MA, Martín del Olmo JC, Blanco JI, Toledano M, de la Cuesta C, Ferreras C, Vaquero C (2003) Laparoscopic approach to Incisional hernia. Lessons learned from 270 patients over 8 years. Surg Endosc 17:118–122

    Article  CAS  PubMed  Google Scholar 

  21. Perrone JM, Soper NJ, Eagon JC, Klingensmith ME, Aft RL, Frisella MM, Brunt LM (2005) Perioperative outcomes and complications of laparoscopic ventral hernia repair. Surgery 138(4):708–715

    Article  PubMed  Google Scholar 

  22. 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 65:827–831

    CAS  PubMed  Google Scholar 

  23. Holzman MD, Purut CM, Reintgen K, Eubanks S, Pappas TN (1997) Laparoscopic ventral and incisional hernioplasty. Surg Endosc 11:32–35

    Article  CAS  PubMed  Google Scholar 

  24. Ballem N, Parikh R, Berber E, Siperstein A (2008) Laparoscopic versus open ventral hernia repairs: 5 year recurrence rates. Surg Endosc 22:1935–1940

    Article  PubMed  Google Scholar 

  25. Forbes SS, Eskicioglu C, McLeod RS, Okrainec A (2009) Meta-analysis of randomized controlled trials comparing open and laparoscopic ventral and Incisional hernia repair with mesh. Br J Surg 96:851–858

    Article  CAS  PubMed  Google Scholar 

  26. Gianetta E, de Cian F, Cuneo S, Friedman D, Vitale B, Marinari G, Baschieri G, Camerini G (1997) Hernia repair in elderly patients. Br J Surg 84:983–985

    Article  CAS  PubMed  Google Scholar 

  27. Townsend CM, Beauchamp RD, Evers M, Mattox KL (2007) Sabiston textbook of surgery, 18th edn. Chap 44: ventral hernias

  28. Read RC, Yoder G (1989) Recent trends in the management of incisional herniation. Arch Surg 124:485–488

    CAS  PubMed  Google Scholar 

  29. Bendavid R (2001) Abdominal wall hernias: principles and management. Chap 88: epidemiology of hernias in the female, p 617

  30. Robbins SB, Pofahl WE, Gonzalez RP (2001) Laparoscopic ventral hernia repair reduces wound complications. Am Surg 67(9):896–900

    CAS  PubMed  Google Scholar 

  31. Carbajo MA, Martín del Olmo JC, Blanco JI, de la Cuesta C, Toledano M, Martin F, Vaquero C, Inglada L (1999) Laparoscopic treatment vs open surgery in the solution of major incisional and abdominal wall hernias with mesh. Surg Endosc 13:250–252

    Article  CAS  PubMed  Google Scholar 

  32. Misra MC, Bansal VK, Kulkarni MP, Pawar DK (2006) Comparison of laparoscopic and open repair of incisional and primary ventral hernia: results of a prospective randomized study. Surg Endosc 20:1839–1845

    Article  CAS  PubMed  Google Scholar 

  33. Pring CM, Tran V, O’Rourke N, Martin IJ (2008) Laparoscopic versus open ventral hernia repair: a randomized controlled trial. ANZ J Surg 78:903–906

    Article  PubMed  Google Scholar 

  34. Raftopoulos I, Vanuno D, Khorsand J, Ninos J, Kouraklis G, Lasky P (2002) Outcome of laparoscopic ventral hernia repair in correlation with obesity, type of hernia, and hernia size. J Laparoendosc Adv Surg Tech A 12(6):425–429

    Article  PubMed  Google Scholar 

  35. Navarra G, Musolino C, de Marco ML, Bartolotta M, Barbera A, Centorrino T (2007) Retromuscular sutured incisional hernia repair: a randomized controlled trial to compare open and laparoscopic approach. Surg Laparosc Endosc Percutan Tech 17(2):86–90

    Article  PubMed  Google Scholar 

  36. Olmi S, Scaini A, Cesana GC, Erba L, Croce E (2007) Laparoscopic versus open Incisional hernia repair: an open randomized controlled study. Surg Endosc 21:555–559

    Article  Google Scholar 

  37. Asencio F, Aguiló J, Peiró S, Carbó J, Ferri R, Caro F, Ahmad M (2009) Open randomized clinical trial of laparoscopic versus open Incisional hernia repair. Surg Endosc 23:1441–1448

    Article  PubMed  Google Scholar 

  38. Heniford BT, Park A, Ramshaw BJ, Voeller G (2003) Laparoscopic repair of ventral hernias: nine years’ experience with 850 consecutive hernias. Ann Surg 238:391–400

    PubMed  Google Scholar 

Download references

Acknowledgments

The authors hereby declare that the manuscript has been derived from a clinical experiment that has adhered to the current ethical laws of the United States of America.

Conflict of interest statement

None.

Author information

Authors and Affiliations

  1. Department of Surgery, Abington Memorial Hospital, 604 Price Medical Building, 1200 Old York Road, Abington, PA, 19001, USA

    A. Kurian, S. Gallagher, A. Cheeyandira & R. Josloff

Authors
  1. A. Kurian
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Gallagher
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Cheeyandira
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. Josloff
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R. Josloff.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kurian, A., Gallagher, S., Cheeyandira, A. et al. Laparoscopic repair of primary versus incisional ventral hernias: time to recognize the differences?. Hernia 14, 383–387 (2010). https://doi.org/10.1007/s10029-010-0649-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10029-010-0649-0

Keywords

Search

Navigation