Recurrences after laparoscopic repair of ventral and incisional hernia: lessons learned from 505 repairs

Background  All hernia recurrences in a series of 505 patients who underwent laparoscopic repair of a ventral hernia (n = 291) or incisional hernia (n = 214) were analyzed to identify factors responsible for the recurrence. Methods  In all laparoscopic repairs, an expanded polytetrafluoroethylene prosthesis overlapping the hernia margins by ≥3 cm was fixed with a double ring of tacks alone (n = 206) or with tacks as well as sutures (n = 299). During the mean follow-up time of 31.3 ± 18.4 months, nine patients (1.8%) had a recurrence, eight of which were repaired laparoscopically. Operative reports and videotapes of all initial repairs and repairs of recurrences were analyzed. Results  All recurrences followed an incisional hernia repair (p < 0.001). Five recurrences developed after mesh fixation with both tacks and sutures and four after mesh fixation with tacks alone (p = 1.0). All recurrences were at the site of the apparently sufficient original incision scar: in eight patients, the recurrent hernia was attached to the mesh; in one, it developed in another part of the scar. All initial repairs had been performed without technical errors. Upon repair of the recurrences, a new, larger mesh was placed over the entire incision, not just the hernia. There were no re-recurrences during follow-up (mean 19.8 ± 10.3 months). Conclusions  Recurrence after incisional hernia repair appears to be due primarily to disregard for the principle that the whole incision—not just the hernia—must be repaired. Our experience supports the idea that the entire incision has a potential for hernia development. Insufficient coverage of the incision scar is a risk factor for recurrence after laparoscopic repair of ventral and incisional hernia.