Laparoscopic incisional hernia repair with a self-centring suture

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Abstract
Background Open incisional hernia repair is associated with high morbidity and recurrence rates. Laparoscopic approaches offer improved long-term results with low complication rates. Methods Laparoscopic repair was attempted in 117 consecutive patients (median age 68 (range 31–91) years, 50 men) undergoing 122 operations. A novel mesh centralization technique was employed. Data were recorded prospectively. Follow-up was by clinical review or telephone consultation. Results One hundred and eighteen procedures (96·7 per cent) were completed laparoscopically; four required conversion. Forty-one patients (35·0 per cent) had additional, unsuspected defects. The median mesh size was 225 (range 42–600) cm2. Median follow-up was 42 months. Small bowel enterotomy occurred in six patients. Fourteen postoperative seromas were successfully aspirated. Recurrence was detected in nine patients (7·7 per cent). One patient was readmitted with small bowel obstruction that settled with conservative management. There were no enterocutaneous fistulas. One patient died after operation from myocardial infarction. Conclusion Laparoscopic incisional hernia repair using a self-centring suture provides good long-term results with low complication rates.