Laparoscopic ventral incisional hernia repair: A more effective alternative to conventional repair of recurrent incisional hernia |
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Authors: | Rodrick?D?McKinlay Email author" target="_blank">Adrian?ParkEmail author |
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Institution: | (1) Department of Surgery, University of Maryland College of Medicine, Baltimore, Maryland;(2) Department of Surgery, Division of General Surgery, University of Maryland Medical Center, 22 South Greene Street-Room S4B, 21202 Baltimore, MD |
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Abstract: | Conventional repair of recurrent ventral incisional hernia is associated with a higher recurrence rate (30%-50%) than repair
of primary incisional hernia (11%-20%). Laparoscopic incisional hernia repair (LIHR) can significantly reduce the recurrence
rate of primary hernia to less than 5%. In this study, we evaluate the efficacy of repairing recurrent incisional hernia laparoscopically.
One-hundred and seventy consecutive patients undergoing LIHR between January 1995 and December 2002 were prospectively reviewed.
Patients with recurrent incisional hernia (n = 69) were compared to patients with primary incisional hernia (n = 101). Patient
demographics and perioperative and postoperative data were recorded prospectively. Follow-up was obtained from office visits
and telephone interviews. Statistical analysis was performed using the Student t test and the x
2test. Results are expressed as means ± standard deviation. The patients with recurrent incisional hernia had a mean of 1.9
± 1.3 previous repairs, higher body mass index (BMI) (34 ± 6 kg/m2 vs. 33 ± 8 kg/m2, P = 0.46), larger defect size (123 ± 115 cm2 vs. 101 ± 108 cm2, P = 0.06), and longer operative time (119 ± 61 minutes vs. 109 ± 44 minutes, P= 0.11). The complication rate was higher in the recurrent group (28% vs. 11%, P = 0.01), but the recurrence rate was not different (7% vs. 5%, P= 0.53). The mean time to recurrence was significantly shorter in the recurrent group (3 ± 2 months vs. 14 ± 7 months, P < 0.0001). The mean follow-up interval was 19 ± 18 months in the recurrent group and 27 ± 20 months in the primary group. Although
laparoscopic repair of recurrent incisional hernia resulted in a higher recurrence and complication rate than laparoscopic
repair of primary incisional hernia, the rates were lower than those reported for conventional repair of recurrent incisional
hernia. Laparoscopic repair of recurrent incisional hernia is an effective alternative to conventional repair.
Supported in part by Tyco/US Surgical Corporation through an educational grant to the University of Kentucky Center for Minimally
Invasive Surgery. |
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Keywords: | Laparoscopic surgery hernia primary incisional recurrent incisional hernia recurrence |
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