LAPAROSCOPIC MANAGEMENT OF VENTRAL HERNIA IN ACUTE PRESENTATION

Although laparoscopic repair of incisional hernia is a well established practice, little is known about the role of laparoscopy when incisional hernia is complicated by acute bowel obstruction. Based on literature, no evidence for this topic can be drawn. However data from a few case series suggest that this approach does not seem to be associated with increased complication and recurrence rates compared to the same procedure performed electively. Facing emergency hernia repair, the use of minimally invasive surgery is strongly influenced by surgeon’s laparoscopic skill to carefully perform adhesiolysis, to safety reduce the herniated bowel into the peritoneal cavity, and to repair the wall defect in the presence of distended bowel loops. Main critical factors in decision-making process for a laparoscopic approach are: degree of bowel obstruction, intestinal viability, size and location of hernia defect and defect/hernia sac ratio. Keeping an uncontaminated abdomen is the key for a laparoscopic mesh repair and a successful outcome. Herein we present our experience about the laparoscopic management of incarcerated ventral hernia by highlighting tips and tricks to safety and effectively perform this top-challenging approach.