Minimally invasive treatment of ventral incisional hernias: case series and technical notes.

An experience in laparoscopic prosthesic repair (LPR) of ventral incisional hernias (VIH) is reported,with 41% of cases treated using two ports. Aim of the present paper is to point out some technical aspects of the procedure.Methods.Between March 2006 and July 2011, 132 patients underwent VIH LPR.Mean age was 65.1 years (range 27-93);mean ASA score was 2.1;mean BMI was 30.2 (range 21-38);M/F ratio was 50/82.Different types of mesh have been used. Two trocars were used in 54 patients (41%),three in 74 (56%) and 4 in 4 (3%).Follow-up for complications and hernia recurrence was performed postoperatively.Results. Mean defect area was 148.75 cm2 (range 38-250 cm2);mean mesh area was 413 cm2 (range 100-750).Mean operative time was 76.1 minutes (range 20-150). Two trocars were used in 54 patients (41%),three in 74 (56%) and 4 in 4 (3%). In 7 patients (5.3%) a strangulated hernia was present,a recurrent hernia in 9 (6.8%)Mean hospital stay was 4.1 days (range 2-18).Conversion rate was 1.5% (2 patients).Complications occurred as follows:seroma in 4 patients (3%);prolonged ileus in 1 patient (0.75%);serious abdominal wall pain in 2 patients (1.5%); small bowel obstruction in 1 case (0.75%).One patient (0.75%) died within 30 days because of systemic sepsis [mortality (0.75%);reoperation rate (0.75%)].The number of trocars used did not affect morbidity. Recurrence rate was 2.3% (3 patients).Conclusions.VIH LPR is feasible and safe, with low recurrence and complication rates even with a “two-port” technique. As far as we are concerned, we report the largest subset of patients undergone VIH LPR using a two-port technique.Further studies need to be performed to establish its real impact on surgical practice