Study Examines Laparoscopic Effectiveness in Incisional Hernia Repair

A randomized controlled clinical trial by Hasan H. Eker, M.D., of Erasmus Medical Center, Rotterdam, the Netherlands, and colleagues examined laparoscopic versus open ventral incisional hernia repair with regard to postoperative pain and nausea, operative results, perioperative and postoperative complications, hospital admission and recurrence rate.

 The clinical trial included 206 patients from 10 hospitals who were divided equally to laparoscopic or open hernia repair between May 1999 and December 2006, with an average follow up period of 35 months. Patients with an incisional hernia larger than 3 cm and smaller than 15 cm, either primary or recurrent, were included.

Median (midpoint) blood loss during the operation was significantly less (10 mL vs 50 mL) as well as the number of patients receiving a wound drain (3 percent vs. 45 percent) in the laparoscopic group. Operative time for the laparoscopic group was longer (100 minutes vs. 76 minutes). Perioperative complications were significantly higher after laparoscopy (9 percent vs. 2 percent). At an average follow-up period of 35 months, a recurrence rate of 14 percent was reported in the open group and 18 percent in the laparoscopic group. The size of the defect was found to be an independent predicator for recurrence.

“Based on this large randomized clinical trial, laparoscopic incisional hernia repair is an effective technique with recurrence rates comparable with open repair,” the authors conclude.

(JAMA Surg. Published online March 20, 2013. 148[3]:259-263