Comparison of laparoscopic and open repair of incisional and primary ventral hernia: results of a prospective randomized study |
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Authors: | M C Misra V K Bansal M P Kulkarni D K Pawar |
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Institution: | (1) Department of Surgical Disciplines and Anaesthesiology, All India Institute of Medical Sciences, 5th Floor Room No. 5031, Teaching Block, New Delhi, 110029, India |
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Abstract: | Background Incisional hernia is an important complication of abdominal surgery. Its repair has progressed from a primary suture repair
to various mesh repairs and laparoscopic repair. Laparoscopic mesh repair is a promising alternative, and in the absence of
consensus, needs prospective randomized controlled trials.
Methods Between April 2003 and April 2005, 66 patients with incisional, primary ventral and recurrent hernias were randomized to receive
either open retrorectus mesh repair or laparoscopic mesh repair. These patients were followed up at 1-, 3-, and 6-month intervals
thereafter for a mean of 12.17 months (open repair group) and 13.73 months (laparoscopic repair group).
Results Lower abdominal hernias after gynecologic operations constituted the majority of the hernias (∼50%) in both groups. There
was no significant injury to viscera or vessel in either group and no conversions. The defect size was 42.12 cm2 in the open (group 1) and 65.66 cm2 in the laparoscopic group (group 2), and the prosthesis sizes were, respectively, 152.67 cm2 and 203.83 cm2. The hospital stay was 3.43 days in open group and 1.47 days in laparoscopic group (p = 0.007). There was no significant difference in the pain scores between the two groups. More wound-related infectious complications
occurred in the open group (33%) than in the laparoscopic group (6%) (p = 0.013). There was one recurrence in the open repair group (3%) and two recurrences in laparoscopic group (6%) (p = 0.55).
Conclusions Laparoscopic repair of incisional and ventral hernias is superior to open mesh repair in terms of significantly less blood
loss, fewer complications, shorter hospital stay, and excellent cosmetic outcome. |
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Keywords: | Incisional hernia Laparoscopic mesh repair Open mesh repair Primary ventral hernia Recurrent incisional hernia Polypropylene mesh Seroma Wound complications |
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