Midline versus nonmidline laparoscopic incisional hernioplasty: a comparative study

• Published in: Surgical endoscopy Vol. 22; no. 3; pp. 744 - 749
• Main Authors: Moreno-Egea, A., Carrillo, A., Aguayo, J. L.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.03.2008; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Abdominal Wall - surgery; Aged; Biological and medical sciences; Digestive system. Abdomen; Endoscopy; Female; Follow-Up Studies; Gastroenterology; General aspects; Gynecology; Hepatology; Hernia, Ventral - diagnosis; Hernia, Ventral - surgery; Humans; Inguinal Canal; Investigative techniques, diagnostic techniques (general aspects); Laparoscopy - adverse effects; Laparoscopy - methods; Length of Stay; Lumbosacral Region; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Minimally Invasive Surgical Procedures - adverse effects; Minimally Invasive Surgical Procedures - methods; Pain Measurement; Pain, Postoperative - physiopathology; Postoperative Complications - physiopathology; Probability; Proctology; Prospective Studies; Risk Assessment; Surgery; Surgical Mesh; Treatment Outcome; Recurrence; Laparoscopy; Nonmidline incisional hernia; Morbidity; Classification; Hernia; Medicine; Endoscopic surgery; Relapse; Prognosis; Treatment; Nonmidline incisional hernia, Recurrence; Endoscopy; Comparative study
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-007-9480-9

Background Nonmidline incisional hernia is a surgical problem of major interest, but to date, little information on this problem is available. This study aimed to analyze the results of nonmidline laparoscopic incisional hernioplasty in a multidisciplinary abdominal wall unit over the past 10 years. Methods This prospective study examined a series of 199 patients undergoing surgery for incisional hernia via the laparoscopic approach: 146 midline and 53 nonmidline. A comparative analysis compared midline and nonmidline defects, and a descriptive analysis compared four nonmidline types: 18 lumbar, 11 subcostal, 14 inguinal, and 10 lateral. Clinical and follow-up parameters were assessed during a mean follow-up period of 64 months (range, 12–120 months). Results The nonmidline incisional hernias were significantly larger, involved more preoperative pain, and required a longer hospital stay than the midline incisional hernias ( p  < 0.001). Also, the intraoperative complications and the consumption of analgesics were more frequent in the nonmidline group ( p  < 0.05). The postoperative morbidity and recurrence rates were similar in the two groups. No statistical differences were noted between the four types of nonmidline incisional hernias. The most common nonmidline type was lumbar hernia (34%). Hematomas (17%) predominated in the inguinal types, and pain predominated in the lumbar types. Two early recurrences were diagnosed for poor mesh placement: one subcostal and one lumbar. Conclusions Laparoscopic incisional hernioplasty can be applied to nonmidline defects with the same rates of morbidity and recurrence as for patients with midline defects. The four types of nonmidline defects seem to have their own evolutionary characteristics.