Laparoscopic Techniques in the Repair of Large Defects

Abstract

In most cases, large abdominal wall hernias occur secondarily after abdominal surgery. Depending on the indication for surgery and the extent of the operation, incisional hernias develop in up to 11 % of cases after elective surgery. After emergency surgery or septic operations, up to 50 % of patients will have an incisional hernia. Patients with large abdominal wall defects with primary hernias have less-extensive adhesions than those with incisional or recurrent hernias. The latter have a history of several laparotomies and attempts at hernia repair with various techniques, and laparoscopic repair of such complicated hernias is often thought to be difficult, if not impossible. Laparoscopic surgery has two important components: adhesiolysis and tension-free closure of the abdominal wall defect with a synthetic mesh. With an experienced team and good surgical technique in compliance with safety guidelines, patients with large abdominal wall defects can by all means enjoy the advantages of laparoscopic surgery. Both the adhesiolysis and the tension-free closure provide for such advantages as considerably fewer postoperative adhesions and significant reduction in the recurrence rate. Further, the structures in the abdominal wall damaged by previous surgery are spared: Meshes and sutures from previous operations are left in place. Postoperative morbidity is low, and the patient has all the usual advantages of laparoscopic surgery.