Our Summary

This research paper reviews the current state and challenges of laparoscopic repair of ventral hernias, a surgical procedure that gained popularity in the late 1990s. The authors looked at factors related to patients and hernia defects, as well as technical considerations that have contributed to the success and failures of this method.

The paper suggests that the best candidates for this procedure are obese and diabetic patients with hernia defects no larger than 10 cm in width or with a “Swiss cheese” defect. It is critical for the mesh used in the procedure to overlap the healthy tissue by at least 5 cm in every direction and the defect to be closed to prevent reoccurrence or bulging over time.

The study found that complications related to the surgical site are less likely with the laparoscopic approach. Recurrence rates, patient satisfaction, and health-related quality of life results are similar to those of traditional open surgeries. However, there is still a lack of long-term data supporting this finding.

The research also found conflicting data on how to secure the mesh during the procedure. The choice of prosthetic material for placement inside the abdomen is still evolving.

The authors criticize the lack of high-quality, long-term studies in the field, noting that many existing studies are small, short-term, and non-randomized. However, they are hopeful that the recent development of large prospective databases will allow for more comprehensive, long-term studies.

In conclusion, the paper suggests that while this procedure has overcome many challenges since it was first introduced, there is still a need for better long-term studies to evaluate its effectiveness.

FAQs

  1. What are the best practices for laparoscopic ventral hernia repair (LVHR)?
  2. Who are the best candidates for laparoscopic ventral hernia repair?
  3. What are the current challenges and limitations in the field of laparoscopic ventral hernia repair?

Doctor’s Tip

A helpful tip a doctor might tell a patient about hernia repair is to follow post-operative instructions carefully, including avoiding heavy lifting and strenuous activity for a certain period of time to allow for proper healing of the surgical site. It is also important to attend follow-up appointments with your healthcare provider to monitor recovery progress and address any concerns or complications that may arise. Additionally, maintaining a healthy lifestyle through proper nutrition and regular exercise can help prevent future hernias from developing.

Suitable For

Patients who are obese and diabetic with a total defect size not exceeding 10 cm in width or a “Swiss cheese” defect are typically recommended for laparoscopic ventral hernia repair. Other factors such as overlap of mesh to healthy fascia, closure of the defect, and technical considerations play a role in determining the best candidates for this type of surgery. Complications related to surgical site occurrence are generally lower with the laparoscopic approach. Recurrence rates, satisfaction, and quality of life outcomes are similar to open repairs, but long-term data is still needed. The field of LVHR continues to evolve, with ongoing research and advancements in prosthetic materials and surgical techniques.

Timeline

Before hernia repair:

  1. Patient consults with a healthcare provider for evaluation of hernia symptoms.
  2. Patient undergoes physical examination and diagnostic tests to confirm the presence of a hernia.
  3. Patient discusses treatment options with the healthcare provider, including the possibility of hernia repair surgery.
  4. Patient schedules surgery and prepares for the procedure according to the healthcare provider’s instructions.

After hernia repair:

  1. Patient undergoes hernia repair surgery, either open or laparoscopic.
  2. Patient is monitored in the recovery room post-surgery and is discharged home or to a hospital room for further observation.
  3. Patient may experience some pain, swelling, and discomfort at the surgical site in the days following the procedure.
  4. Patient follows post-operative care instructions provided by the healthcare provider, which may include restrictions on physical activity, wound care, and pain management.
  5. Patient attends follow-up appointments with the healthcare provider to monitor healing and address any concerns.
  6. Over time, patient should experience a reduction in hernia symptoms and a return to normal activities as the surgical site heals and the hernia is repaired.

What to Ask Your Doctor

  1. What are the benefits of laparoscopic ventral hernia repair compared to open surgery?
  2. Am I a good candidate for laparoscopic ventral hernia repair based on my body weight, medical history, and hernia size?
  3. What are the potential risks and complications associated with laparoscopic ventral hernia repair?
  4. How long is the recovery time after laparoscopic ventral hernia repair compared to open surgery?
  5. How long can I expect the mesh used in the repair to last and what are the chances of recurrence?
  6. What type of mesh will be used in the repair and why?
  7. Will the hernia defect be closed during the repair or will the mesh be placed over the defect?
  8. How many laparoscopic ventral hernia repair surgeries have you performed and what is your success rate?
  9. Are there any specific post-operative instructions or restrictions I should follow after the surgery?
  10. What are the long-term outcomes and satisfaction rates for patients who undergo laparoscopic ventral hernia repair?

Reference

Authors: Tobler WD Jr, Itani KM. Journal: J Laparoendosc Adv Surg Tech A. 2016 Apr;26(4):281-9. doi: 10.1089/lap.2016.0095. Epub 2016 Mar 30. PMID: 27027828