Laparoscopic Ventral Hernia Repair

Park, Youngeun; Chung, Min

Abstract

Laparoscopic ventral hernia repair is performed less frequently than open repair because some ventral hernias are unsuitable for laparoscopic repair and the complications are more severe than those of open repair. However, currently, the incidence of laparoscopic hernia surgery has been gradually increasing. The technique for laparoscopic ventral hernia repair depends on the shape, size, location, number, recurrence, and symptoms of the hernia. Computed tomography (CT) is the most accurate method for identifying these factors. Ventral hernia repair begins with an approach to the peritoneal space. Having adequate space to place the mesh is the most important step in surgery. Cosmetic and medical results of primary closure of the hernia margin are superior to those of the bridging technique in laparoscopic ventral hernia repair. However, if primary closure is not possible, the component separation technique can be used to narrow the defect for primary repair of a ventral hernia. Making the abdominal skin flap during the conventional component separation technique can injure the perforator vessels in the abdominal wall, and an injured perforator shuts down the blood supply to the subcutaneous tissue of the abdomen, which then becomes necrotic. To prevent such complications, a perforator-preserving technique can be performed, such as the laparoscopic and posterior component separation techniques. Complications of laparoscopic ventral hernia repair include seroma, hemorrhage, intestinal injury, mesh infection, and recurrence. Mesh infection is one of the most severe complications that sometimes requires reoperation. To prevent infection, it is necessary to minimize contact between the mesh and skin during the surgical procedure.