Laparoscopic and open incisional hernia repair: A prospective randomized study

Abstract

As the number of major surgical procedures has increased in recent years, so there has been an increase in incisional hernias. With gained experience and new materials, laparoscopic repair of incisional hernia is now applied. This study was aimed to compare the results of incisional hernia repair with the open surgery or laparoscopic approach at the only centre in the region for laparoscopic incisional hernia repair. A total of 55 cases of incisional hernia at the General Surgery Clinic of SDU between November 2012 and 2014 were underwent laparoscopic ventral hernia repair (L-VHR) and conventional incisional hernia repair (C-VHR). From the L-VHR group 6 cases and from the C-VHR 9 cases were excluded from the study, as they did not meet the inclusion criteria or did not wish to participate in the study. The two techniques were compared in respect of operative time, length of hospital stay, postoperative pain scores, complications and recurrence. A total of 40 cases of incisional hernia repair were evaluated. The mean follow-up period was found as 12.75±4.19 months. No difference was determined between the characteristics of the patients due to age, body mass index, American Society of Anesthesiologists (ASA) score, comorbidities, hernia size, and follow-up. In the laparoscopic repair group, the postoperative pain scores, complication rates and duration of hospital stay were found significantly superior to those of the open technique group. While there was no mortality seen and wound complications as a morbidity were 0 % in the L-VHR (n = 0) and 20 % in C-VHR group (n = 4). In the comparison of mean operative time, the duration of surgery was significantly shorter in the laparoscopic repair group (67.25±19.23 min) compared to the open technique group (91.50±24.87 min) (p=0.001). Laparoscopic repair was associated with less postoperative pain (4.35±1.03 vs 5.60±1.31, p=0.002), lesser postoperative complications (5% vs. 35%, p=0.044), and shorter hospital stay (3.45±1.79 vs. 8.3±3.08, p=<0.001). The results of this study showed that laparoscopic incisional hernia repair when applied at an experienced laparoscopic surgery centre, is a method which can be applied safely with a short hospital stay and high patient satisfaction in patients who are obese and have large hernias and is therefore seen to be a good alternative to open surgery.