Long-term follow-up of open and laparoscopic repair of large incisional hernias.

BACKGROUND

Long-term results after laparoscopic repair of large incisional hernias remain to be determined. The aim of this prospective study was to compare early and late complications between laparoscopic repair and open repair in patients with large incisional hernias.

METHODS

Only patients with a hernia diameter of ≥5 cm were included in this study and were prospectively followed. We compared 56 patients who underwent open incisional hernia repair with 69 patients who underwent laparoscopic repair. Median follow-up in the laparoscopic group was 32.5 months (range 1-62 months) and in the open group 65 months (range 1-80 months).

RESULTS

The demographic parameters were not significantly different between the two groups. However, the median hospital stay (6.0 days, range 1-23 days vs. 7.0 days, range 1-67 days; p=0.014) and incidence of surgical site infections (SSIs) (5.8% vs. 26.8%; p=0.001) were significantly lower in the laparoscopic group than in the open surgery group. Bulging of the implanted mesh was observed in 17.4% in the laparoscopic group and in 7.1% in the open group (p=NS). The recurrence rate was 18% in the open group and 16% in the laparoscopic group (p=NS). Multivariate analysis revealed that width of the hernia≥10 cm, SSI, and BMI≥30 kg/m2 were significant risk factors for hernia recurrence.

CONCLUSIONS

The incidence of SSIs was significantly lower after laparoscopic incisional hernia repair. At long-term follow-up, the recurrence rate was not different between the two techniques. Abdominal bulging is a specific problem associated with laparoscopic repair of large incisional hernias. Size of the hernia, BMI, and SSI are risk factors for hernia recurrence irrespective of the technique.