Laparoscopic Techniques in the Repair of Large Abdominal Wall Defects

Abstract

Large abdominal wall hernias are rarely primary, but frequently secondary to abdominal surgery. Depending on the indication and the extent of the operation, incisional hernias develop in up to 11% of cases after elective surgery. After emergency surgery or septic operations, up to 50% of patients will have an incisional hernia. Patients with large abdominal wall defects with primary hernias have less extensive adhesions than those with incisional or recurrent hernias. The latter have a history of several laparotomies and attempts at hernia repair with various techniques, and laparoscopic repair of such complicated hernias is often thought to be difficult, if not impossible. With improved technology and greater experience, laparoscopic repair is now feasible in most cases, even those with prior surgeries. Laparoscopic surgery has two important components: adhesiolysis and tension-free sublay coverage of the abdominal wall defect with a synthetic mesh. With an experienced team and good surgical technique in compliance with safety guidelines, patients with large abdominal wall defects can by all means benefit from the advantages of laparoscopic surgery. The adhesiolysis and the tension-free closure share the advantages of considerably fewer postoperative adhesions and significantly reduced recurrence rate. Further, the structures in the abdominal wall damaged by previous surgery are spared, as meshes and sutures from previous operations are left in place. Postoperative morbidity is low, and the patient has all the advantages of laparoscopic surgery.