Laparoscopic Ventral and Incisional Hernia Repair with Closure of the Fascial Defect
Ventral and incisional hernia defects may be addressed by a variety of open or minimally invasive techniques. Laparoscopy is advantageous as it reduces wound morbidities, expedites return of bowel function, decreases hospital length of stay, and often offers superior cosmesis. Despite this, the vast majority of hernia repairs continue to be performed via traditional open surgical methods. In open hernia repair, recreation of the linea alba along with medializing of the rectus abdominis muscles to restore abdominal wall function is considered standard when possible. Yet, early experience with laparoscopic incisional hernia repair entailed simply bridging the primary fascial defect with mesh without closure. Recent evidence in favor of closure of the fascial defect suggests that it may reduce the rate of seroma formation, improve mesh integration, and reduce recurrence rates. Failure to close hernia defects may also lead to functional deficiencies and cosmetic dissatisfaction from bulging. This chapter overviews the approach at our center to laparoscopic ventral and incisional hernia repair with closure of the fascial defect.
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