Laparoscopical repair

Abstract

The incidence of incisional hernias after major abdominal surgery persists at around 20%, implicating the need of a safe and effective technique for repair [7, 23]. Today the need of meshes for augmentation of the abdominal wall is generally accepted because the hernia disease can be explained by a pathological scar formation [16]. The mostly recommended open sublay technique needs separation of the different layers of the abdominal wall, explaining the sometimes high rates of complications reported in the literature [11, 15, 22, 24]. Therefore the laparoscopic approach gains increasing acceptance. It has been generally demonstrated that the rate of wound complications is dramatically decreased after laparoscopic procedures [17, 22, 24, 25]. However, besides the possible complication of unrecognized enterotomy the recurrence rate is still under debate. Since the widespread application of the method the recurrence rates seem to be increasing sometimes exceeding 10% [1-6, 8-10, 13, 17, 22, 26]. The presentation should summarize our experience after more than 600 laparoscopic procedures done for incisional, umbilical, epigastric and parastomal hernias in terms of the reasons for recurrences as well as the treatment of this complication. © 2007 Springer-Verlag Berlin Heidelberg.