Laparoscopic ventral hernia repair in obese patients - A new standard of care

Hypothesis: Ventral abdominal hernias represent a frequent and often formidable clinical problem, especially in obese patients. Because laparoscopic ventral hernia repair (LVHR) results in few complications and a low recurrence rate, the use of minimally invasive techniques in this subgroup of patients may minimize perioperative complications and failure rates. Design: Retrospective review of prospectively collected data. Setting: Tertiary care hospital. Patients: One hundred sixty-three obese patients (body mass index [calculated as weight in kilograms divided by the square of height in meters], :30) who underwent LVHR at our institution between July 1, 1998, and December 31, 2003. Intervention: Laparoscopic ventral hernia repair with an expanded polytetrafluoroethylene mesh. Main Outcome Measures: Patient age, sex, body mass index, size of fascial defect and mesh, operating time, operative blood loss, length of hospitalization, complications, and hernia recurrences. Results: Ninety-eight women and 65 men,,with a mean body mass index of 38, underwent LVHR. Twenty patients (12.3%) had 21 postoperative complications. There was no perioperative mortality. The mean length of hospital stay was 2.6 days. The recurrence rate was 5.5% at a mean follow-up of 25 months (range, 1-73 months). Conclusions: A low rate of conversion to laparotomy, minimal perioperative morbidity, and the absence of perioperative mortality in this series indicate the safety of LVHR in obese patients with complex hernias. In addition, a success rate of more than 94.5% suggests improved efficacy of LVHR compared with the historical rates among control subjects undergoing open surgery. In experienced hands, LVHR may be the approach of choice for most patients with a body mass index of 30 or more.