Laparoscopic Ventral Hernia Repair

Laparoscopic Ventral Hernia Repair (LVHR) can be considered a minimally invasive approach to the abdominal wall. Intraperitoneal Onlay Mesh (IPOM) technique was first described in 1993, and its application for incisional hernia repair is now widely spread. Compared to the open technique, advantages can be found in a lower rate of recurrence and surgical site infection (SSI). The laparoscopic technique includes six fundamental steps: (1) adhesiolysis; (2) exposition of posterior rectal sheet; (3) hernia defect assessment; (4) mesh preparation; (5) pneumoperitoneum pressure reduction; and (6) mesh fixation. Adhesiolysis is usually the lengthiest and dangerous step of the intervention because of the high risk of bowel injury. IPOM plus is known as a variant of traditional IPOM, providing a defect closure prior to mesh placement. In both variants, the original defect must be covered with a prosthesis overlap of 5 cm minimum. Meshes used in the laparoscopic approach should induce a rapid and resistant parietal reaction and at the same time prevent and avoid adhesions on the intestinal loops. Mesh fixation can be performed with different methods: tacks, glues, transfascial sutures, or a combination of them. An adequate knowledge of the surgical steps, the operative theater setting, and of the surgical instruments required can surely optimize clinical results obtained by the laparoscopic IPOM technique.