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Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Online ISSN 1827-1782
D’Antonio D. 1, Bucci L. 1, Sivero L. 1, Antoniello L. 2, Bernardi C. 2, Baldon S. 2, Mazzucco C. 2, Formisano C. 1, Trevisan P. 3
1 Federico II University, Dipartimento di Chirurgia Generale, Geriatrica, Oncologica e Tecnologie Avanzate, Naples, Italy;
2 General Surgery Division, ULSS 17 Este-Monselice, Padua, Italy;
3 General Surgery Division Oncologic Center of Florence, Florence, Italy
Aim: An experience in laparoscopic prosthesic repair (LPR) of ventral incisional hernias (VIH) is reported, with 41% of cases treated using two ports. Aim of the present paper is to point out some technical aspects of the procedure.
Methods: Between March 2006 and July 2011, 132 patients underwent VIH LPR.Mean age was 65.1 years (range 27-93); mean ASA score was 2.1; mean BMI was 30.2 (range 21-38); M/F ratio was 50/82. Different types of mesh have been used. Two trocars were used in 54 patients (41%), three in 74 (56%) and 4 in 4 (3%). Follow-up for complications and hernia recurrence was performed postoperatively.
Results: Mean defect area was 148.75 cm2 (range 38-250 cm2); mean mesh area was 413 cm2 (range 100-750). Mean operative time was 76.1 minutes (range 20-150). Two trocars were used in 54 patients (41%), three in 74 (56%) and 4 in 4 (3%). In 7 patients (5.3%) a strangulated hernia was present,a recurrent hernia in 9 (6.8%)Mean hospital stay was 4.1 days (range 2-18). Conversion rate was 1.5% (2 patients). Complications occurred as follows: seroma in 4 patients (3%); prolonged ileus in 1 patient (0.75%); serious abdominal wall pain in 2 patients (1.5%); small bowel obstruction in 1 case (0.75%). One patient (0.75%) died within 30 days because of systemic sepsis [mortality (0.75%); reoperation rate (0.75%)]. The number of trocars used did not affect morbidity. Recurrence rate was 2.3% (3 patients).
Conclusion: VIH LPR is feasible and safe, with low recurrence and complication rates even with a “two-port” technique. As far as we are concerned, we report the largest subset of patients undergone VIH LPR using a two-port technique. Further studies need to be performed to establish its real impact on surgical practice.