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• W2092131427 abstract "<b>Background: </b> Incisional hernias can be a significant problem after open abdominal surgery. Laparoscopic incisional hernia repair (LIHR) is conceptually appealing: a large, abdominal wall re-incision with potential wound-related ill effects is avoided and an intra-peritoneal onlay mesh is expected to provide security that is equivalent to open, retro-muscular mesh repair. As such, LIHR has gained substantial popularity despite sparse, randomised clinical data to compare with conventional, open repair. <b> Aim: </b> To enumerate and discuss important, controversial issues in patient-selection, technique and early post-operative care for LIHR. <b> Materials and Methods: </b> Pragmatic summary of comprehensive review of English language literature, discussion with experts and personal experience. <b> Outcomes:</b> Six important areas of some dispute were identified: 1. Size of abdominal-wall defect that is suitable for LIHR: Generally, defect-diameter > 10 cm is better served by open retromuscular repair with tension-free re-approximation of the edges of the defect. 2. Extent of adhesiolysis: Complete division of adhesions to the anterior abdominal wall may identify sub-clinical Swiss-cheese defects but incurs some risk of additional complications. 3. Intra-operative recognition of enterotomy: Possible options are either laparoscopic suture of bowel injury and simultaneous completion of LIHR, or staged LIHR or conversion to open suture-repair. 4. Choice of mesh: Composite meshes are regarded as the current standard of care but there is paucity of data regarding potential dangers of intra-peritoneal polypropylene mesh. 5. Technique of mesh-fixation: Trans-parietal sutures are more secure than tacks, with limited data to correlate with post-operative pain. 6. Alarm over post-operative pain: Unlike other advanced laparoscopic operations, the specificity of pain as a marker of intra-abdominal sepsis after LIHR remains unclear. <b> Conclusion</b> : Recognition of and attention to controversial issues will promote increased success of LIHR." @default.
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• W2092131427 date "2006-01-01" @default.
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• W2092131427 title "Controversies in laparoscopic repair of incisional hernia" @default.
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• W2092131427 doi "https://doi.org/10.4103/0972-9941.25670" @default.
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