ABSTRACT
Case selection is critical, and the operation itself should be thought through well in advance so that the theatre team have all the equipment and extras that might be required including special laparoscopic equipment, mesh, fixation devices and suture material for possible closure of the defect. Recurrent ventral and incisional hernias can be generally approached laparoscopically and, like most first-time laparoscopic repairs, can usually be managed as a day case or overnight stay. Fascial closure is recommended for port sites in the infracolic compartment 12 mm or larger but most of the evidence relates to midline defects, especially with laparoscopic cholecystectomy; for the oblique muscle-splitting incisions created by the bladeless entry ports, this may be unnecessary. Pulling too hard with laparoscopic graspers, no matter how ‘atraumatic’, may damage the bowel or cause bleeding and so alternative strategies can be necessary if the hernial contents do not reduce easily.
