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Jani. Mini-invasive Surg 2018;2:14 I http://dx.doi.org/10.20517/2574-1225.2018.08 Page 5 of 9

Table 1. Patient demographics
Demographics Data
Total number of patients in the series (n) 278
Male:female 123:155
2
Body mass index (kg/m ) 27 (range: 21-41)
Diabetes mellitus, n (%) 58 (20.9%)
Smoker, n (%) 17 (6.1%)
COPD, n (%) 26 (9.4%)
Mean ASA score 2.2 (range: 1-4)
COPD: chronic obstructive pulmonary disease; ASA: American Society of Anesthesiologists

Table 2. Operative and immediate post-operative findings
Characteristics Data
Operating time (min)
Para-umbilical hernia 55 (range: 36-68)
Incisional hernia 71 (range: 55-105)
Conversion to open Nil
Intra-operative bowel injury, n (%) 5 (1.8%)
Inability to suture the defect due to thinned out fascia 16/122 (13.1%)
(IPOM repair only) (incisional hernias), n (%)
Length of stay (days) 2.04 (range: 1-5)
IPOM: intra-peritoneal onlay mesh

RESULTS
Between January 2007 and January 2017, a total of 278 patients were posted for elective laparoscopic repair
of lower midline ventral hernias which, 156 (56.12%) were para-umbilical hernias and 122 (43.88%) were
incisional hernias. Majority of incisional hernias (n = 94, 77.1%) were in women following either a lower
segment caesarean section or hysterectomy or surgery for other gynecological pathology. In case of former
two instances, though the scar on skin was Pffanensteil, the defect in the fascia was oriented in the midline
vertical craniocaudal plane. Males outnumbered females in the group with para-umbilical hernias (n = 105,
67.3%). The patient demographics are summed up in Table 1.

A total of 35 patients had undergone prior hernia repair, of which 11 para-umbilical hernias had all suffered
a failed open repair. Of these, 8 were anatomical repairs while 3 were mesh repairs. Of the 24 incisional
hernias which were recurrent, 20 had undergone previous open repair while 4 had undergone laparoscopic
repair. Eighteen of the open repairs and all 4 of the laparoscopic repairs had received polypropylene mesh
augmentation as part of their primary repair. The width of the defect is reported separately for para-umbilical
hernias and incisional hernias. In case of para-umbilical hernias, the defect ranged 1-2.5 cm, with an average
of 1.2 cm. For incisional hernias, the defect width ranged 1-8 cm, with an average of 2.2 cm (SD 0.74 cm). The
operative and immediate post-operative findings are summarized in Table 2.

Diligent follow-up was maintained with an average follow-up of 4.6 years (range: 1-8 years). The outcomes
are summarized in Table 3.

DISCUSSION
This paper summarizes our experience in laparoscopic repair of lower midline ventral abdominal hernias
with the intention of carrying out an IPOM plus repair - closure of the fascial defect with reinforcement
from the peritoneal side with a composite mesh. The closure of the fascial defect has been described by
various techniques - interrupted or continuous, intracorporeal or extracorporeal . The extracorporeal
[15]
technique consists of placing multiple stab wounds on either side of the defect to pass the suture material