Published online Nov 27, 2015. doi: 10.4240/wjgs.v7.i11.293
Peer-review started: April 29, 2015
First decision: June 24, 2015
Revised: September 12, 2015
Accepted: October 12, 2015
Article in press: October 13, 2015
Published online: November 27, 2015
Primary ventral hernias and ventral incisional hernias have been a challenge for surgeons throughout the ages. In the current era, incisional hernias have increased in prevalence due to the very high number of laparotomies performed in the 20th century. Even though minimally invasive surgery and hernia repair have evolved rapidly, general surgeons have yet to develop the ideal, standardized method that adequately decreases common postoperative complications, such as wound failure, hernia recurrence and pain. The evolution of laparoscopy and ventral hernia repair will be reviewed, from the rectoscopy of the 4th century to the advent of laparoscopy, from suture repair to the evolution of mesh reinforcement. The nuances of minimally invasive ventral and incisional hernia repair will be summarized, from preoperative considerations to variations in intraoperative practice. New techniques have become increasingly popular, such as primary defect closure, retrorectus mesh placement, and concomitant component separation. The advent of robotics has made some of these repairs more feasible, but only time and well-designed clinical studies will tell if this will be a durable modality for ventral and incisional hernia repair.
Core tip: This manuscript reviews the evolution and advances of laparoscopic ventral and incisional hernia repair. We discuss preoperative considerations, intraoperative factors including the type of mesh in conjunction with placement and fixation of the mesh, as well as postoperative issues such as complications, recurrence and quality of life. New evolving techniques such as minimally invasive components separation and robotic surgery are reviewed. In addition, some of the future directions of this exciting and rapidly developing field are explored. We hope you find this review helpful in summarizing the past advances in hopes that it may illuminate new avenues of research in minimally invasive ventral and incisional hernia repair.