ABSTRACT
Abdominal wall hernias are a common, yet complex, problem encountered by general surgeons. Despite the large volume of hernia repairs performed, there remains no clear consensus on any single best technique. Issues that contribute to this lack of agreement include advancements in laparoscopic technology, the influx of new mesh materials onto the market, and an increasingly complex patient population. Over the last two decades (1995-2015), the laparoscopic repair of ventral and incisional hernias has been validated by several published clinical studies and is one of the more common laparoscopic procedures performed. 1-6 It is based on the principles of the Rives-Stoppa repair, in which mesh is placed deep to the hernia defect and fixed with wide mesh coverage to healthy abdominal wall fascia using full-thickness permanent sutures. In contrast to open repair, the laparoscopic approach places mesh inside the peritoneal cavity, rather than in the retrorectus position, a technique made potentially safer by the advent of new bilayered biosynthetic materials that promote tissue ingrowth on one side and minimize the potential for ingrowth on the other. This positioning of mesh against the posterior aspect of the abdominal wall with wide overlap of the hernia defect has a potential mechanical advantage over previously described inlay and onlay techniques. Intra-abdominal pressures disperse forces over the entire abdominal wall, potentially holding the mesh in place if there is adequate overlap. Laparoscopic ventral hernia repair allows for clear visualization of the entire anterior abdominal wall, wide mesh coverage beyond the defect, and secure fixation to abdominal wall fascia.
