|Year : 2007 | Volume
| Issue : 3 | Page : 83-90
Laparoscopic incisional and ventral hernia repair
Amrit Pal Singh Bedi1, Tahir Bhatti2, Alla Amin2, Jamal Zuberi2
1 Diploma Laparoscopic Surgery, France
2 Department of General Surgery, Hemel Hempstead NHS, Hillfield Road, HP2 4AD UK
Amrit Pal Singh Bedi
A-32, Sector 50, Noida - 201 303, India
Source of Support: None, Conflict of Interest: None
Background : It has been more than a decade, since the introduction of laparoscopic management of ventral and incisional hernia. The purpose of this article was to systematically review the literature, analyze the results of Laparoscopic repair of ventral and incisional hernia and to ascertain its role. Materials and Methods: Pubmed was used for identifying the original articles. Both incisional and ventral hernia repair were included. Out of 145 articles extracted from Pubmed, 34 original studies were considered for review. More than three thousand patients were included in the review. Variables analyzed in the review were inpatient stay, defect size, mesh size, hematoma, seroma, wound infection, bowel perforation, obstruction, ileus, recurrence and pain. Qualitative analysis of the variables was carried out. Results: Seromas (5.45%) and post operative pain (2.75%) are the two common complications associated with this procedure. Recurrence rate was found to be 3.67%. Overall complication rate was 19.24%, with two deaths reported. Conclusion: The results suggest laparoscopic repair of ventral and incisional hernia as an effective procedure. Faster recovery and shorter in patient stay - makes it a feasible alternative to open repair.
Keywords: Incisional hernia, laparoscopy, mesh, repair, ventral hernia
|How to cite this article:|
Bedi AS, Bhatti T, Amin A, Zuberi J. Laparoscopic incisional and ventral hernia repair. J Min Access Surg 2007;3:83-90
To review the literature from 1995 to 2006 in a systematic manner and to analyze the results of laparoscopic incisional and ventral hernia repair.
| ¤ Introduction|| |
Postoperative incisional hernia is one of the most common surgical procedure being performed in General Surgery. The incidence of incisional hernia, as reported in literature is 3% to 20%. ,,,,,,,, The principle of laparoscopic incisional hernia repair is based on Rives-Stoppa repair, first published in 1985.  Original Rives -Stoppa repair involved extensive tissue dissection in a myofascial plane for placement of mesh. LeBlanc and Booth  first described laparoscopic repair of incisional hernia in 1993. Since than, many authors have published reports of laparoscopic incisional and ventral hernia repair (LIVHR). This procedure is fast emerging as an alternative to open technique. The purpose of this study was to review and analyze the results of different authors and determine the clinical status of laparoscopic incisional and ventral hernia repair.
| ¤ Materials and Methods|| |
English Language articles on Laparoscopic Incisional or Ventral hernia repair (LIVHR) from 1995 to 2006 were extracted from electronic databases. Pubmed and MEDLINE search was done using following terms "incisional hernia", "ventral hernia", "laparoscopy" and "repair" to find out relevant laparoscopic studies. Original prospective and retrospective observational studies and randomised control trials were included. Comparison studies between laparoscopic and open incisional/ventral hernia repair were also included. Laparoscopic repair data was extracted from comparison studies. In total 145 articles were found of interest. A cross-reference search was also carried out from the latter to include relevant manuscripts. Three different senior surgeons assessed these articles.
Review of literature or meta-analysis (only one found) was not included to avoid repetition bias. Studies that were excluded were animal experimental models, articles containing combined abdominoplasty or autoplasty, case reports and primary repair using suture. The latter exclusions were done to make the review more specific and clinically-oriented. Articles with less than 10 reported cases were also excluded from the study, to avoid bias from authors being in the learning curve.
Thirty four articles were finally included into the study based on the above criteria (Quality of Reporting of Meta-Analysis, QUOROM, flow diagram [Figure - 1]). The following parameters were studied including inpatient stay, defect size, mesh size, hematoma, seroma, wound infection, bowel perforation, ileus, obstruction, recurrence, chronic pain and other complications. Though quantitative analysis was not performed, qualitative assessment of parameters was done.
| ¤ Results|| |
3266 patients were analyzsed from 34 studies with an average age of 55.34 years. One hundred and eighty extra procedures were performed while doing the primary operation. Further results are summarised in [Table - 1],[Table - 2],[Table - 3],[Table - 4],[Table - 5] and [Figure - 2].
| ¤ Discussion|| |
To gain intra abdominal access, peritoneal insufflation is done usually away from the hernia site. ,, Left hypochondrium / subcoastal region has been found to be the preferred site for Verres needle insertion. , Open Hassan technique  and Visiport were other alternatives used for access. , To obtain triangulation, working ports are placed away from defect or lateral to the rectus muscle. ,,,,,
Whereever possible, dissection with diathermy should be avoided or used sparingly because of concerns that energy transmission can cause delayed bowel perforation.  Harmonic scalpel should be used with caution while doing adhesiolysis. ,,, Hydrodissection is another alternative to divide visceral adhesions with the parietes.  However, sharp dissection with scissors remains the safest tool. ,,,
A 30 degree scope would provide a good panoramic view. ,,,,,,, Mizrahi et al. ,  have used 45 degree scope for surgery.  In a series of 200 patients Le Blanc et al. ,  managed with a 0 degree scope. 
Longstanding hernia with incarcerated bowel can pose technical challenge. These have a higher chance of enterotomy rate during dissection.  Though they are not a contraindication for laparoscopic repair.  Incisional hernias extending to suprapubic or xiphoid region  are difficult to obtain a good overlap and fixation of mesh. Another demanding situation is repair of parastomal hernia where dissection and mesh placement is around hollow viscera. 
In laparoscopic hernia repair mesh can be placed intraperitonealy ,,, or in preperitoneal / extraperitoneal space. ,, At least 3 to 5 cm mesh overlap of the defect by the mesh has been recommended by different authors ,,,,,,,,, to obtain good results.
Spiral tackers are placed in concentric pattern ,, along the periphery of mesh in one or two rows. The depth of penetration for the spiral tackers is < 4 mm.  In obese patients, the tackers may not reach up to the fascial layers. However, this should not be the reason for not offering laparoscopic incisional hernia repair to a population with raised BMI (body mass index). ,, Transfascial sutures can be helpful in such a scenario.
Transfascial sutures are used for initial orientation, to fix the mesh and to prevent mesh migration. ,,,,, This technique can cause chronic postoperative pain. Sutures can be used to fix the mesh in centre or periphery. Some authors recommend transfascial sutures at the 12'o clock and the 6'o clock position. , The 3'o clock and the 9'o clock position is optional. 
The bowel lying underneath the mesh can be covered with omentum. This serves as a barrier. It also prevents adhesions  and fistulization ,, of bowel.
In this review, 90 patients had postoperative pain related to the wound site (2.75%).
Postoperative pain can lead to readmissions, hence increasing the morbidity and costs of laparoscopic procedure.  This complication of laparoscopic incisional hernia repair has been found to be under reported.  Godney et al. ,  have reported increased postoperative pain following laparoscopic ventral hernia repair when compared to open procedure. Different authors have used different period for defining chronic postoperative pain.
Sutures for mesh fixation may cause ischemic injuries to anterior abdominal wall musculature or neurovascular bundle which results in pain. Nerve entrapment in tacker is another possible explanation to the postoperative pain. , Heniford et al. , have reported chronic pain along the dermatomal  distributions. This on occasion has called for the extraction of tackers , or division of transfascial sutures.  Moreno-egea et al. ,  found laterally placed transfixation sutures are likely to be associated with postoperative pain outside the midline. Patients tend to tolerate the mid-line transfascial fixation sutures better. , Marcaine injections, NSAIDs and narcotics have been tried to treat this complication.  Seromas have also been associated with chronic postoperative pain.  Kua et al. ,  had to remove the mesh in a patient with persistent postoperative pain.
178 (5.45%) seromas were noted. Thirty seven of these seromas were aspirated (20.7 %). In laparoscopic hernia repair, the hernia sac is not excised. ,,,,,, This effectively leaves behind a potential space for seroma formation. It happens to be one of the complications inherent to this procedure. ,,,, Most seromas resolve with time, some requiring eight to 12 weeks for complete resolution. ,,,,,, Majority of the authors considered the seromas for conservative management. Occasionally it will give an ominous appearance of recurrence. , In such cases ultrasound of abdomen can be an useful diagnostic tool. , If followed-up using ultrasound, seromas have been reported to be ubiquitous.  Some surgeons ,, have advocated using dressing or abdominal binder to cause compression on abdominal wall to occlude the potential dead space. Rarely, they would require aspiration when persistent  or symptomatic. ,,,,,, No long-term complications have been noticed following seromas.  Though infection of hematoma has been noted in literature. 
One of the most important outcome measurements of hernia repair is recurrence. On analysis, in our study we found a recurrence rate 3.67%. Some authors feel using just the tackers, without suture, increases the chances of recurrence. ,, Transfascial sutures for mesh orientation and fixation has been shown to reduce recurrence. ,, Franklin et al. ,  found 73% of recurrence occurred in patients in whom transfascial sutures were not used. In these cases, only staples were relied upon to keep the mesh in place.  Transfascial sutures prevent the migration of prosthesis and hence recurrence. 
Recurrence rate is likely to improve with experience  and improved techniques of adequate mesh overlap at the periphery of hernia.  Breakdown of transfascial sutures has been attributed as one of the causes of recurrence.  Eid et al. ,  on their long term follow-up (mean 34 months) found a recurrence rate of 5%. A rare complication is herniation of bowel between the mesh and abdominal wall.  Widely spaced tacks can cause bowel herniation between the tacks. , Delayed recurrence is known to occur and Le Blanc et al. ,  suggest at least three-year follow-up.
Wound infection / trocar site cellulitis
Wound infection is lower in laparoscopic hernia repair compared to open, as there is decreased extent of tissue dissection in the former. , Trocar site cellulitis seen in laparoscopic repair resolves with antibiotics. 
Mesh, wherever possible, should not be brought in touch with skin to avoid contamination by skin flora.  Leber et al. ,  along with others ,,,,, found polyester meshes to have highest incidence of infection, fistulisation and recurrence. Mesh infection required extraction in certain cases. ,,,,, Thirty one meshes had to be extracted in 16 studies. Porcine small intestine mucosa derivative has been used in infected environment , with good results as an alternative to mesh.
Laparoscopic hernia repair causes decreased incidence of ileus.  This is because of less handling of the intestines and lesser tissue dissection. Ileus usually settles down spontaneously. However, mechanical obstruction should be ruled out if it tends to persist beyond 72h.  Ben -Haim et al. ,  have reported prolonged ileus beyond five days.
Post procedure adhesive bowel obstruction increases the morbidity and may require reoperation. , Bageacu et al. ,  had to perform resection anastomosis for bowel obstruction presenting more than one year after primary procedure. Obstruction was secondary to mesh complication. Dual mesh using smooth surface towards peritoneal cavity decreases the chances of adhesions. Smooth surfaced side has ePTFE, which has less postoperative visceral adhesions. ,,,,,,
Enterotomies have been reported to occur in up to 6% of patients undergoing laparoscopic ventral hernia repair. ,,,, Enterotomy during the surgery may not necessarily mean conversion to open procedure. This depends upon the expertise of the operating surgeon. Although, it does increases the rate of mesh infection.  Hernia repair by some surgeons was deferred in cases of recognized enterotomy. , Missed bowel perforation can have disastrous consequences. Delayed diagnosis of bowel perforation would result in mesh infection and ultimately extraction. ,, Clinical parameters need to be monitored and should be supplemented by radiological evidence if such kind of complication is suspected. Intracorporeal knotting ,, can be done to manage serosal tear of bowel, if required.
Postoperative fever of unknown origin prolongs the hospital stay and overall has financial bearings.  It has been reported in four studies. ,,, Heniford et al. , performed diagnostic laparoscopy in patients with unexplained postoperative fever to exclude abdominal pathology, with negative results. 
In 40 (1.2 %) patients, a wound hematoma or significant bleeding at wound/trocar site was noted. ,,,,,, This is a well known complication in laparoscopic surgery. Intraabdominal pressure during laparoscopy causes tamponade effect on vessels and hence the bleeding, arterial or venous, may manifest after surgery. 
Enterocutaneous fistula was reported in two cases in a study by Bageacu et al .,  Both the cases required surgical intervention for treatment. There have only been two deaths reported in the review , (0.06%).
Conversion to open
Seventy four (2.26%) cases required to be converted to open procedure. Technical difficulties in dissection and defining the right plane can result in conversion.  Surgeons experience is also an important factor towards conversion to open repair. Malignancy,  dense adhesions ,,,,, and incarcerated hernia , remain common contributory factors towards conversion. Bowel injury ,,, which cannot be dealt with laparoscopically  is another cause for conversion. Spillage of enteral contents increases the chances of wound infection.
| ¤ Conclusion|| |
Laparoscopic repair of incisional hernia has a learning curve and increased operative time. , This form of surgery requires advanced laparoscopic skills. , It has been recommended for incisional and ventral hernia greater than 3 cm in diameter. ,,,,,,,,
LIVHR has shown promising results and is being widely accepted. It results in shorter hospital stay and lower short-term complications when compared to open repair.  Less incidence of wound infection, early return of bowel activity and faster resumption of normal activities ,,,, favor LIVHR. Shorter hospital stay is translated into lesser overall cost of procedure.  It is also feasible to perform this procedure as day case surgery. ,,, Monro-Egea et al. ,  performed 76% of cases as day care.
Laparoscopic repair allows viewing of hernia defects, which are not apparent clinically and treat multiple hernias located in different quadrants of abdomen through same incision. , It also allows dissection in the right anatomical plane. 
Seromas tend to be a common complication with LIVHR, which tends to settle down conservatively. Placing tacks and transfascial sutures judiciously can avoid recurrence and chronic postoperative pain. Meticulous tissue plane dissection can avoid bowel perforation. Hernias included in this study are clinically a heterogeneous group. We feel this provides strength to the study as a greater cross-section of incisional and ventral hernia was studied. The data from the observational studies has not been combined statistically but essentially summarized and this makes it a qualitative review. The evidence provided by this study would be 2++ according to grading system of "Levels of evidence". More prospective randomized controlled trials are required to establish the role of Laparoscopic incisional and ventral hernia repair.
| ¤ References|| |
|1.||Cobb WS, Kercher KW, Heniford BT. Laparoscopic repair of incisional hernias. Surg Clin North Am 2005;85:91-103. [PUBMED] [FULLTEXT]|
|2.||De Maria EJ, Moss JM, Sugerman HJ. Laparoscopic intraperitoneal polytetrafluoroethylene prosthetic patch repair of ventral hernia. Surg Endosc 2000;14:326-9. |
|3.||Mudge M, Hughes LE. Incisional hernia: A 10 year prospective study of incidence and attitudes. Br J Surg 1985;72:70-1. [PUBMED] |
|4.||Leber GE, Garb JL, Alexander AI, Reed WD. Long term complications associated with prosthetic repair of incisional hernias. Arch Surg 1998;133:378-82. |
|5.||Le Blanc KA, Booth WV. Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: Preliminary findings. Surg Laparosc Endosc 1993;3:39-41. |
|6.||Schoetz DJ Jr, Coeller JA, Veidenheimer MC. Closure of abdominal wounds with polydioxanone: A prospective study. Arch Surg 1988;123:72-4. |
|7.||Bucknall TE, Cox PJ, Ellis H. Burst abdomen and incisional hernia: A prospective study of 1129 major laparotomies. Br Med J (Clin Res Ed) 1982;284:931-3. [PUBMED] [FULLTEXT]|
|8.||Hesselink VJ, Luijendik RW, de Wilt JH, Heide R, Jeekel J. An evaluation of risk factors in incisional hernia recurrence. Surg Gynecol Obstet 1993;176:228-34. |
|9.||Santora TA, Roslyn JJ. Incisional hernia. Surg Clin North Am 1993;73:557-70. [PUBMED] |
|10.||Stoppa RE. The treatment of complicated groin and incisional hernias. World J Surg 1989;13:545-54. [PUBMED] |
|11.||Moreno-Egea A, Castillo JA, Girela E, Canteras M, Aguayo JL. Outpatient laparoscopic incisional / ventral hernioplasty: Our experience in 55 cases. Surg Lap Endosc Percut Tech 2002;12:171-4. |
|12.||Aura T, Habib E, Mekkaoui M, Brassier D, Elhadad A. Laparoscopic tension-free repair of anterior abdominal wall incisional and ventral hernias with an intraperitoneal Gore-Tex mesh: Prospective study and review of literature. J Laparoendosc Adv Surg Tech A 2002;12:263-7. [PUBMED] [FULLTEXT]|
|13.||Kua KB, Coleman M, Martin I, O'Rourke N. Laparoscopic repair of ventral incisional hernia. ANZ J Surg 2002;72:296-9. [PUBMED] [FULLTEXT]|
|14.||Bageacu S, Blanc P, Breton C, Gonzales M, Porcheron J, Chabert M, et al . Laparoscopic repair of incisional hernia: A retrospective study of 159 patients. Surg Endosc 2002;16:345-8. |
|15.||Bamehriz F, Birch DW. The feasibility of adopting laparoscopic incisional hernia repair in general surgery practice: Early outcomes in an unselected series of patients. Surg Laparosc Endosc Percutan Tech 2004;14:207-9. [PUBMED] [FULLTEXT]|
|16.||Ben-Haim M, Kuriansky J, Tal R, Zmora O, Mintz Y, Rosin D, et al . Pitfalls and complications with laparoscopic intraperitoneal expanded polytetrafluoroethylene patch repair of postoperative ventral hernia. Surg Endosc 2002;16:785-8. [PUBMED] [FULLTEXT]|
|17.||Bower CE, Reade CC, Kirby LW, Roth JS. Complications of laparoscopic incisional-ventral hernia repair: The experience of a single institution. Surg Endosc 2004;18:672-5. [PUBMED] [FULLTEXT]|
|18.||Chowbey PK, Sharma A, Khullar R, Soni V, Baijal M. Laparoscopic ventral hernia repair with extraperitoneal mesh: Surgical technique and early results. Surg Laparosc Endosc Percutan Tech 2003;13:101-5. [PUBMED] [FULLTEXT]|
|19.||Eid GM, Prince JM, Mattar SG, Hamad G, Ikrammudin S, Schauer PR. Medium-term follow-up confirms the safety and durability of laparoscopic ventral hernia repair with PTFE. Surgery 2003;134:599-603-4. [PUBMED] [FULLTEXT]|
|20.||Franklin ME Jr, Gonzalez JJ Jr, Glass JL, Manjarrez A. Laparoscopic ventral and incisional hernia repair: An 11-year experience. Hernia 2004;8:23-7. [PUBMED] [FULLTEXT]|
|21.||Franklin ME, Dorman JP, Glass JL, Balli JE, Gonzalez JJ. Laparoscopic ventral incisional hernia repair. Surg Laparosc Endosc 1998;8:294-9. [PUBMED] |
|22.||Heniford BT, Park A, Ramshaw BJ, Voeller G. Laparoscopic ventral and incisional hernia repair in 407 patients. J Am Coll Surg 2000;190:645-50. [PUBMED] [FULLTEXT]|
|23.||Koehler RH, Voeller G. Recurrences in Laparoscopic Incisional hernia repairs: A personal series and review of the literature. J Soc Laparoendosc Surg 1999;3:293-304. |
|24.||LeBlanc KA, Whitaker JM, Bellanger DE, Rhynes VK. Laparoscopic incisional and ventral hernioplasty: Lessons learned from 200 patients. Hernia 2003;7:118-24. [PUBMED] |
|25.||LeBlanc KA, Booth WV, Whitaker JM, Bellanger DE. Laparoscopic incisional and ventral herniorraphy in 100 patients. Am J Surg 2000;180:193-7. [PUBMED] [FULLTEXT]|
|26.||McGreevy JM, Goodney PP, Birkmeyer CM, Finlayson SR, Laycock WS, Birkmeyer JD. A prospective study comparing the complication rates between laparoscopic and open ventral hernia repairs. Surg Endosc 2003;17:1778-80. [PUBMED] [FULLTEXT]|
|27.||Mizrahi S, Lantsberg L, Kirshtein B, Bayme M, Avinoah E. The experience with a modified technique for laparoscopic ventral hernia repair. J Laparoendosc Adv Surg Tech A 2003;13:305-7. [PUBMED] [FULLTEXT]|
|28.||Muysoms F, Daeter E, Vander Mijnsbrugge G, Claeys D. Laparoscopic intraperitoneal repair of incisional and ventral hernias. Acta Chir Belg 2004;104:705-8. [PUBMED] |
|29.||Park A, Birch DW, Lovrics P. Laparoscopic and open incisional hernia repair: A comparison study. Surgery 1998;124:816-22. [PUBMED] [FULLTEXT]|
|30.||Park A, Gagner M, Pomp A. Laparoscopic repair of large incisional hernias. Surg Laparosc Endosc 1996;6:123-8. [PUBMED] |
|31.||Parker HH 3 rd , Nottingham JM, Bynoe RP, Yost MJ. Laparoscopic repair of large incisional hernias. Am Surg 2002;68:530-4. |
|32.||Raftopoulos I, Vanuno D, Khorsand J, Ninos J, Kouraklis G, Lasky P. Outcome of laparoscopic ventral hernia repair in correlation with obesity, type of hernia and hernia size. J Laparoendosc Adv Surg Tech A 2002;12:425-9. [PUBMED] [FULLTEXT]|
|33.||van't Riet M, Vrijland WW, Lange JF, Hop WC, Jeekel J, Bonjer HJ. Mesh repair of incisional hernia: Comparison of laparoscopic and open repair. Eur J Surg 2002;168:684-9. |
|34.||Olmi S, Magnone S, Erba Luigi. Results of Laparoscopic versus open abdominal and incisional hernia repair. J Soc Laproendosc Surg 2005;9:189-95. |
|35.||Verbo A, Petito L, Pedretti G, Lurati M, D'Alba P, Coco C. Use of a new type of PTFE mesh in Laparoscopic incisional hernia repair: The continuing evolution of technique and surgical expertise. Int Surg 2004;89:27-31. [PUBMED] |
|36.||Chari R, Chari V, Eisenstat M, Chung R. A case controlled study of laparoscopic incisional hernia repair. Surg Endosc 2000;14:117-9. [PUBMED] [FULLTEXT]|
|37.||Holzman MD, Purut CM, Reintgen K, Eubanks S, Pappas TN. Laparoscopic ventral and incisional hernioplasty. Surg Endosc 1997;11:32-5. [PUBMED] [FULLTEXT]|
|38.||Lau H, Patil NG, Yuen WK Lee F. Laparoscopic incisional hernioplasty utilising on-lay expanded polytetrafluoroethylene DualMesh: Prospective study. Hong Kong Med J 2002;8:413-7. |
|39.||Tagaya N, Mikami H, Aoki H, Kubota K. Long term complications of laparoscopic ventral and incisional hernia repair. Surg Laparosc Endosc Percutan Tech 2004;14:5-8. [PUBMED] [FULLTEXT]|
|40.||Tsimoyiannis EC, Tassis A, Glantzounis G, Jabarin M, Siakas P, Tzourou H. Laparoscopic intraperitoneal onlay mesh repair of incisional hernia. Surg Laparosc Endosc 1998;8:360-2. [PUBMED] |
|41.||Misra MC, Bansal VK, Kulkarni MP, Pawar DK. Comparison of laparoscopic and open repair of incisional and primary ventral hernia: Results of a prospective randomised study. Surg Endosc 2006;20:1839-45. |
|42.||Lomanto D, Iyer SG, Shabbir A, Cheah WK. Laparoscopic versus open ventral hernia mesh repair: A prospective study. Surg Endosc 2006;20:1030-5. [PUBMED] [FULLTEXT]|
|43.||Earle D, Seymour N, Fellinger E, Perez A. Laparoscopic versus open incisional hernia repair. Surg Endosc 2006;20:71-5. [PUBMED] [FULLTEXT]|
|44.||Motson RW, Engledow AH, Medhurst C, Adib R, Warren SJ. Laparoscopic incisional hernia repair with a self-centring suture. Br J Surg 2006;93:1549-53. [PUBMED] [FULLTEXT]|
|45.||Ramshaw BJ, Esartia P, Schwab J, Mason EM, Wilson RA, Duncan TD, et al . Comparison of Laparoscopic and open ventral herniorrhaphy. Am Surg 1999;65:827-32 [PUBMED] |
|46.||Rosen M, Brody F, Ponsky J, Walsh RM, Rosenblatt S, Duperier F, et al . Recurrence after laparoscopic ventral hernia repair. Surg Endosc 2003;17:123-8. [PUBMED] [FULLTEXT]|
|47.||Carbajo MA, Martin del Olmo JC, Blanco JL, de la Cuesta C, Toledano M, Martin F, et al . Laparoscopic treatment vs. open surgery in the solution of major incisional and abdominal wall hernias with mesh. Surg Endosc 1999;13:250-2. |
|48.||van't Riet M, De Vos van Steenwijk PJ, Kleinrensink GJ, Steyerberg EW, Bonjer HJ. Tensile strength of mesh fixation methods in laparoscopic incisional hernia repair. Surg Endosc 2002;16:1713-6. [PUBMED] [FULLTEXT]|
|49.||Moreno-Egea A, Liron R, Girela E, Aguayo JL. Laparoscopic repair of ventral and incisional hernias using a new composite mesh. Surg Laparosc Endosc Percutan Tech 2001;11:103-6. |
|50.||Goodney PP, Birkmeyer CM, Birkmeyer JD. Short-term outcomes of laparoscopic and open ventral hernia repair: A meta-analysis. Arch Surg 2002;137:1161-5. [PUBMED] [FULLTEXT]|
|51.||Heniford BT, Le Blanc KA, Voeller GR. Laparoscopic repair of incisional hernias: Surgical technique. Contemp Surg 2001;57:225-36. |
|52.||Chowbey PK, Sharma A, Khullar R, Mann V, Baijal M, Vashistha A. Laparoscopic ventral hernia repair. J Laparoendosc Adv Surg Tech A 2000;10:79-84. [PUBMED] |
|53.||Susmallian S, Gewurtz G, Ezri T, Charuzi I. Seroma after laparoscopic repair of hernia with PTFE patch: Is it really a complication? Hernia 2001;5:139-41. [PUBMED] |
|54.||Varghese TK, Denham DW, Dawes LG, Murayama KM, Prystowsky JB, Joehl RJ. Laparoscopic ventral hernia repair: An initial institutional experience. J Surg Res 2002;105:115-8. [PUBMED] [FULLTEXT]|
|55.||Robbins SB, Pofhal WE, Gonzalez RP. Laparoscopic ventral hernia repair reduces wound complications. Am Surg 2001;67:896-900. |
|56.||Temudom T, Siadati M, Sarr MG. Repair of complex giant or recurrent ventral hernias by using tension free intraperitoneal prosthetic mesh (Stoppa technique): Lessons learned from our initial experience (fifty patients). Surgery 1996;120:738-44. [PUBMED] |
|57.||George CD, Ellis H. The results of incisional hernia repair: A twelve year review. Ann R Coll Surg Engl 1986;68:185-7. [PUBMED] |
|58.||Bauer JJ, Salky BA, Gelernt IM, Kreel I. Repair of large abdominal wall defects with expanded polytetrafluoroethylene (PTFE). Ann Surg 1987;206:765-9. [PUBMED] [FULLTEXT]|
|59.||Amid PK, Shulman AG, Lichtenstein IL, Sostrin S, Young J, Hakakha M. Experimental evaluation of a new composite mesh with the selective property of incorporation to the abdominal wall without adhering to the intestines. J Biomed Mater Res 1994;28:373-5. [PUBMED] |
|60.||Franklin ME Jr, Gonzalez JJ Jr, Glass JL. Use of porcine small intestinal submucosa as a prosthetic device for laparoscopic repair of hernias in contaminated fields: 2-year follow-up. Hernia 2004;8:186-9. [PUBMED] |
|61.||Cushieri A, Steele R J C, Moosa AR. Disorders of the abdominal wall and peritoneal cavity. Essential Surg Pract 2002;4:156-7. |
|62.||Law NW. A comparison of polypropylene mesh, expanded polytetrafluoroethylene patch and polyglycolic acid mesh for the repair of experimental abdominal wall defects. Acta Chir Scand 1990;156:759-62. [PUBMED] |
|63.||Gillion JF, Begin GF, Marecos C. Expanded PTFE patches used in the intraperitoneal or extraperitoneal position for repair of incisional hernias of the anterolateral abdominal wall. Am J Surg 1997;174:16-9. |
|64.||Costanza MJ, Heniford BT, Arca MJ, Mayes JT, Gagner M. Laparoscopic repair of recurrent ventral hernia. Am Surg 1998;64:1121-7. [PUBMED] |
|65.||Toy FK, Bailey RW, Carey S, Chappuis CW, Gagner M, Josephs LG, et al . Prospective multicenter study of laparoscopic ventral hernioplasty: Preliminary results. Surg Endosc 1998;12:955-9. [PUBMED] [FULLTEXT]|
|66.||Berger D, Bientzle M, Muller A. Postoperative complications after laparoscopic incisional hernia repair: Incidence and treatment. Surg Endosc 2002;16:1720-3. |
|67.||Le Blanc KA. Laparoscopic incisional and ventral hernia repair: Complications-How to avoid and handle. Hernia 2004;8:323-31. |
|68.||Sander LM, Flint LM, Ferrara JJ. Initial experience with laparoscopic repair of incisional hernias. Am J Surg 1999;177:227-31. |
|69.||Larson GM. Ventral hernia repair by the laparoscopic approach. Surg Clin North Am 2000;80:1329-40. [PUBMED] |
[Figure - 1], [Figure - 2]
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5]
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| ||Journal of Ultrasound. 2014; |
|[Pubmed] | [DOI]|
||Randomized Clinical Trial on the postoperative use of an abdominal binder after laparoscopic umbilical and epigastric hernia repair
| ||M. W. Christoffersen,B. H. Olsen,J. Rosenberg,T. Bisgaard |
| ||Hernia. 2014; |
|[Pubmed] | [DOI]|
||Chronic abdominal pain after ventral hernia due to mesh migration and erosion into the sigmoid colon from a distant site: a case report and review of literature
| ||S. G. Millas,T. Mesar,R. J. Patel |
| ||Hernia. 2013; |
|[Pubmed] | [DOI]|
||A new classification for seroma after laparoscopic ventral hernia repair
| ||S. Morales-Conde |
| ||Hernia. 2012; |
|[VIEW] | [DOI]|
||Results of laparoscopic repair of primary and recurrent incisional hernias at a single UK institution
| ||Sturt, N.J.H. and Liao, C.C.L. and Engledow, A.H. and Menzies, D. and Motson, R.W. |
| ||Surgical Laparoscopy, Endoscopy and Percutaneous Techniques. 2011; 21(2): 86-89 |
||Laparoscopic repair of abdominal ventral hernias [Tehnica abordului laparoscopic al defectelor parietale abdominale ventral mediane]
| ||Nicolau, A.E. |
| ||Chirurgia (Romania). 2010; 107(6): 817-822 |
||Laparoscopic repair of incisional hernias located on the abdominal borders: A Retrospective critical review
| ||Ferrari, G.C., Miranda, A., Sansonna, F., Magistro, C., Di Lernia, S., Maggioni, D., Franzetti, M., Pugliese, R. |
| || Surgical Laparoscopy, Endoscopy and Percutaneous Techniques. 2009; 19(4): 348-352 |
||Laparoscopic Repair of Incisional Hernias Located on the Abdominal Borders
| ||Giovanni Carlo Ferrari,Angelo Miranda,Fabio Sansonna,Carmelo Magistro,Stefano Di Lernia,Dario Maggioni,Maurizio Franzetti,Andrea Costanzi,Raffaele Pugliese |
| ||Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 2009; 19(4): 348 |
|[Pubmed] | [DOI]|