Combined laparoscopic and open technique for the repair of large complicated incisional hernias

Abstract

Background: During laparoscopic incisional hernia repair, conversion to open surgery is sometimes needed, especially in cases of large complicated incisional hernias. No guidelines exist for determining when conversions should be considered. This study aimed to investigate the safety of a combined technique as an alternative to conversion in the laparoscopic repair of large complicated incisional hernias and to evaluate the impact of early conversion to the combined technique on patient outcome.

Methods: Beginning in November 2008, early conversion was initiated for patients with large complicated incisional hernia when dense extensive intraabdominal adhesions were present. Two cohorts of patients with large complicated incisional hernia were retrospectively analyzed: 21 patients before the initiation of early conversion (group 2) and 21 patients after its inception (group 1). The data analyzed included patient demographics, operative parameters, complications, and recurrence.

Results: No significant differences were found between the two groups with respect to age, gender, body mass index, coexisting conditions, number of previous laparotomies, number of previous repairs, or features of the hernia. Groups 1 and 2 differed significantly in terms of mean operative time (110.7 vs 138.8 min), enterotomy rate (0 vs 29 %), and postoperative hospital stay (4.7 vs 6.1 days). In group 1, early conversion to the combined technique was necessary for 16 patients (76 %), and no delayed conversion occurred. In group 2, delayed conversion to the combined technique was necessary for 11 patients (52 %), and no early conversion occurred. During the follow-up period, neither wound/mesh infection nor trocar-site hernia occurred.

Conclusion: The combined technique proved to be a safe and minimally invasive alternative to conversion in laparoscopic repair of large complicated incisional hernias. Early conversion to the combined technique was associated with less technical difficulty, deceased operative time, lower enterotomy rate, and shorter postoperative hospital stay.