Management of non-midline incisional hernia by the laparoscopic approach: results of a long-term follow-up prospective study.

BACKGROUND

The role of the laparoscopic approach in the repair of non-midline incisional hernias is controversial due to the absence of adequate scientific studies. This study aimed to determine the safety and efficacy of laparoscopic repair for non-midline incisional hernias.

METHODS

This prospective clinical study was conducted in an abdominal wall unit of a teaching hospital. Patients underwent surgery for non-midline incisional hernias using the laparoscopic approach (n = 73) and were classified into three groups: subcostal, iliac, and lumbar. The primary end point was recurrence. The secondary end points were intraoperative parameters, comorbidity, and patient outcomes. The median follow-up period was 62 months (range, 36-170 months).

RESULTS

No hospital stay was needed for 34% of the patients. The remaining patients needed an average hospital stay of 2.7 days. The most frequent morbidity was hematoma. The overall recurrence rate was 8.2% and was higher for the subcostal hernias (25%). The three groups differed in size, local morbidity, and recurrence (P < 0.05). The independent risk factors for recurrence were size (hazard ratio [HR], 2.16; 95% confidence interval [CI], 1.08-4.33) and local morbidity (HR 30.62; 95% CI 1.22-768-82). The best predictor of recurrence was a hernia diameter greater than 15 cm. The only predictive factor of local morbidity was obesity (P < 0.007).

CONCLUSIONS

The laparoscopic approach is a safe and effective treatment for non-midline incisional hernias. Caution should be taken with subcostal hernias, obese patients, and a defect size greater than 15 cm. An algorithm is suggested to guide the "rational" treatment of non-midline incisional hernias.