Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Nov 27, 2015; 7(11): 293-305
Published online Nov 27, 2015. doi: 10.4240/wjgs.v7.i11.293
Evolution and advances in laparoscopic ventral and incisional hernia repair
Alan L Vorst, Christodoulos Kaoutzanis, Alfredo M Carbonell, Michael G Franz
Alan L Vorst, Christodoulos Kaoutzanis, Michael G Franz, Department of Surgery, Saint Joseph Mercy Health System, Ann Arbor, MI 48106, United States
Alfredo M Carbonell, Department of Surgery, Greenville Health System, University of South Carolina School of Medicine - Greenville, Greenville, SC 29605, United States
Author contributions: Vorst AL was the primary author of the manuscript; Kaoutzanis C designed the review and assisted with the writing of the manuscript; Carbonell AM and Franz MG provided expert opinion.
Conflict-of-interest statement: Dr. Carbonell is a consultant for Maquet Medical, and W.L. Gore and Associates, as well as speaker for Intuitive Surgical. None of the other authors has any relevant financial relationships to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Christodoulos Kaoutzanis, MD, Department of Surgery, Saint Joseph Mercy Health System, 5333 McAuley Drive, Reichert Health Building, Suite R-2111, Ann Arbor, MI 48106, United States.
Telephone: +1-734-8340597 Fax: +1-734-7122809
Received: April 29, 2015
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.

Keywords: Evolution, Advances, Laparoscopic ventral hernia repair, Laparoscopic incisional hernia repair, Laparoscopic ventral incisional hernia repair, Ventral hernia repair, Incisional hernia repair, Ventral hernia, Incisional hernia

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.