2011, Number 3
Laparoscopic incisional and ventral hernioplasty
Blas AR, Castelán HES, Blas MR, Blas MMC, Osorio CLC, García GMA, Cano MBR, JLópez VJO, Domínguez ACP
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Language: Spanish
References: 6
Page: 89-96
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ABSTRACT
Objective: To present our experience and preliminary results in laparoscopic incisional and ventral hernioplasty (hernia repair) using a tissue separating mesh (polyester for the parietal side and an anti-adhesive film –teflon– for the visceral side) in 18 patients. Background: Laparoscopic incisional and ventral hernioplasty (hernia repair) (LIVH) was firstly described in 1993 by Karl LeBlanc. Incisional hernias develop in 2% to 20% of the incisions through laparotomy, resulting in about 90,000 incisional hernioplasties a year in the United States. Unfortunately, the traditional open surgery for incisional hernia repair is carried out with a considerable soft-tissue dissection. Certainly, the aforementioned tissues are of a poor quality and require the performing aponeurosis flaps and the placing of drains. During the last decade, laparoscopic incisional hernia has gained a lot of recognition as an alternative to open procedures. Material and methods: We performed a descriptive, retrospective, and transversal study, which recorded the results from 18 patients having an incisional ventral hernia diagnosis. The patients were operated between October 12, 2009, and August 1, 2011, with a post-operative follow-up period at 8, 15, and 30 days, at 3, 6, and 12 months. These follow-up will be continued at 2, 3, 4, and until 15 years. Every patient was performed a laparoscopic incisional and ventral hernioplasty (hernia repair) using a tissue separating mesh (polyester for the parietal side and an anti-adhesive film –teflon– for the visceral side). The fixation system was of trans-facial sutures of non-absorbable filaments at four cardinal points, and the rest of the mesh circumference was fixed by absorbable tackers. Results: From 18 patients suffering from incisional or ventral hernias, 12 of them were from the female gender (66.6%), and 6 from the male gender (33.3%), with ages ranging from 22 to 69 years old and with an average of 45.5 years old. With regard to relapse, 11 of the patients were recurrent (61.1 %), and there were 7 cases with primary hernia (38.8%), the trans-operative bleeding was of 5-50 mL with an average of 27.5 mL, and a surgical time ranging from 60 to 180 minutes, with an average of 120 minutes. Sixteen patients were not administrated antibiotics (88.8%); they were given just to 2 patients (11.1%). Within the most frequent comorbidities, we found obesity in 9 patients (50%), systemic arterial hypertension in 7 patients (38.8%), 5 patients without it (27.7%), 3 patients presenting tobacco and alcohol addiction (16.6%), 2 patients suffering from diabetes mellitus (11.1%), 1 patient with uremic syndrome (5.5%), 1 patient with chronic kidney insufficiency (5.5%), and 1 patient presenting the human immunodeficiency virus (HIV) (5.5%). Up to the moment, seromas (fluid build-up), hematomas and relapse have not been present. There were no infection cases and other complications related to the prosthetic material either. Conclusions: According to our experience in laparoscopic incisional and ventral hernioplasty, we consider that it is an excellent therapeutic choice for patients cursing incisional and ventral hernias, even in those cases which present relapse, in obese patients and in those ones having other comorbidities. The technique presents minimal bleeding, scarce use of antibiotics, and all the advantages from laparoscopic surgery. It is necessary to keep on doing our best towards the improvement of this technique, and perform a highly controlled post-operative follow-up period, at least of 15 years long.REFERENCES