Introduction: In ventral hernia repairs, no single approach can adequately treat the full spectrum of this disease. This study reports our initial experience using a management algorithm incorporating both laparoscopic and open techniques for the repair of all ventral hernias.
Methods: Patients undergoing ventral hernia repair by a single surgeon from August 2005 to August 2007 were reviewed. Complex non-infected cases underwent open retro-rectus prosthetic repair (OP). Infected or contaminated cases were repaired with biologic mesh after fascial reapproximation (OB). Massive ventral hernias with loss of abdominal domain underwent staged ePTFE serial excision (SE). All other cases were initially approached laparoscopically (LP).
Results: 123 patients (LP=85, OP=17, OB=13, SE=8) were identified during the period. Patient demographic information was similar in these groups in terms of age (p=0.38), body mass index (p=0.34), American Society of Anesthesiology score (p=0.09), however, the number of prior laparotomies or failed hernia repairs was significantly less in the LP group (p<0.0001). The LP group also had the smallest defect (145 cm2, range 6-720 cm2) when compared with OB (252 cm2, range 48-600 cm2), OP (450cm2, range 32-1305 cm2) and SE group (584cm2, range 264-1258 cm2) (p<0.001). The conversion rate to open repair in the LP group was 11%, and was most commonly due to dense adhesions. Five enterotomies occurred intra-operatively (LP 2, OB 1, SE 2). The SE group had the longest hospital stay at 27 days (LP 4 day, OP 5 day, OB 9 day, p<0.001). There was no perioperative mortality noted. The LP group had the lowest overall post operative complication rate (LP 12%, OP 35%, OB 46%, SE 63%, p=0.0002) and a significantly lower wound infection rate (LP 5%, OP= 53%, OB 46%, SE 50%, p<0.0001). One patient developed an infected seroma 10 months after a LP repair eventually requiring mesh resection. There were no recurrences in the LP and OP group while one recurrence each was identified in OB and SE group.
Conclusion: This study demonstrates that a standardized approach to the management of ventral hernias can result in minimal post operative complications and low recurrence rate. In addition, the routine use of laparoscopic ventral hernia repairs resulted in significantly lower post operative wound complications without recurrences.