Until recently, ventral hernias could pose a frustrating problem for surgeons and their patients. With traditional open repair, a recurrence of the hernia is common. So are infections involving the invasive incision and the mesh that is typically placed.

Today, a laparoscopic ventral hernia repair (LVHR) can be an excellent alternative to conventional surgery, offering:

• Lower recurrence rate of the hernia
• Shorter hospital stay
• Faster recovery time
• Less pain and scarring
• Fewer complications

With LVHR, the lengthy laparotomy is eliminated in favor of a few small abdominal incisions to accommodate the videoscope and surgical instruments. Like the tension-free open procedure, a sufficiently wide mesh prosthesis is used to close and cover the hernial defect. Generally, the mesh is anchored in a tension-free fashion, with tacks and transabdominal sutures, to the solid musculofascial layer.

Because LVHR offers better visualization of the hernia defect, the surgeon may be able to do a more adequate repair. That may explain the lower recurrence rate of MIP-treated ventral hernias reported by many authors.

(Flash animation: MIP ventral hernia vs. open procedure)

Generally, patients who have a fascial defect of 3 cm or more and meet the criteria for traditional open repair are considered candidates for LVHR. Patients with multiple smaller defects are also good candidates.

Contraindications include being unable to tolerate general anesthesia, loss of abdominal domain, history of frozen abdomen, acute strangulation or incarceration, and high-grade or complete bowel obstruction.

Like other laparoscopic procedures, a well-trained, experienced surgeon is important to help ensure your patients' optimal outcome.

As with all operative procedures, be sure to discuss surgical risks with your patients.