The Surgical Strategy And Technological Difficulties Of Laparoscopic Repair For Incisional Hernias Located On The Abdominal Borders

ObjectiveTo explore the surgical stragety and technological diffculties for incisional hernias located on the abdominal borders MethodsBetween April 2003 and Mar 2016,the clinical data of 143 patients with incisional hernias that located on abdominal borders underwent laparoscopic repair were retrospectively analyzed in our hospital.All surgeries were performed by surgeons in one laparoscopic team,and specific chosen surgical method was depended on the surgeon.The follow-up period ranged from 1 to 156 months(median 48 months).ResultsAmong 143 incisional hernias,there are 87(60.4%)suprapubic hernias,23(15.9%)subxiphoidal hernias,14(9.7%)subcostal incisional hernias and 19(13.9%)lumbar hernias.6 TAPP,6 IPOM and 75 TAPE were applied to 87(60.4%)suprapubic hernia repair;23 IPOM were utilized to 23(15.9%)subxiphoidal hernias repair;13 IPOM and 1 Hybrid were employed for 14(9.7%)subcostal incisional hernias repair;and the other 19(13.9%)lumbar hernias were repaired by using 19 TAPE.The max diameter of the hernia sac was2-30 cm and the average was 11.22±5.39 cm.Mean size of the hernia sac was 4-360cm2 and the average was 82.72±59.03cm2.Mean size of the mesh used was 60-600cm2 and the average was 278.90±114.39cm2.The average operative time was 52.34±16.51(20~100)minute.The rate of which used analgesics after operation was 9.79%(14/143).The average hospital stay was 5.3±3.5(3~33)day with the 142(99.3%)patients returned to unrestricted activities in two weeks.No patients were lost to follow up.4(2.8%)recurrence was found after surgery.The number of accumulative postoperative complications was 16/143(11.2%),including bladder injury in 1 case,intestine injury in 1 case,seroma in 8 cases,paralytic ileus in 4 cases,urinary irritation symptom in 1 case and wound infection in 1 case after operation.ConclusionsLIHR is reasonable and efficacious techniques to treat incisional hernias that are located abdominal borders,the specific surgical method is depended on the type and location of the borderline incisional hernias.Laparoscopic repairing of suprapubic hernia and lumbar hernia can adopt trans-abdominal partial extra-peritoneal(TAPE).In addition,laparoscopic repairing of subxiphoid hernia and subcostal hernia should adhere to the cardinal principles as follows: adequate exposure of the subphrenic space,adequate patch covering,and reinforced anchorage under the sternum and the arcus costarum.