Laparoscopic Repair of Non-Midline Ventral Hernias: A Single Center Experience

Abstract Background The laparoscopic intraperitoneal onlay mesh (IPOM) technique for the repair of non-midline ventral hernias (NMVH) is technically difficult and still controversial. The aim of this study is to retrospectively analyze our single center experience in the last 20 years performing the IPOM technique to NMVH. Method Between 2012 and 2022, 816 patients with ventral hernia underwent surgery using the IPOM technique, among these 101 were NMVH. We retrospectively analyzed peri- and post-operative complications in terms of clinical data and defect characteristics. Furthermore, NMVH data were compared with those of the midline ventral hernias group (MVH). Results Neither the clinical data nor the defect characteristics had a statistically significant impact on peri- and post-operative complications in the NMVH group (P .05). Post-operative complication rate was 14.8% in the NMVH group and 13.6% in the MVH group (P .05). Chronic postoperative pain was 2.9% in the NMVH group and 1.6% in the MVH group (P = .03). Recurrence rate was 2.9% in NMVH and 3.5% in MVH group (P .05). Conclusion Laparoscopic IPOM for non-midline incisional hernias is safe and feasible also in our experience. However, it may require the use of specific technical precautions and a more appropriate perioperative framework. Statistical analysis comparing non-midline with midline defects has documented similar rates of conversion and post-operative complications. Chronic postoperative pain has resulted statistically significantly higher in the non-midline group. Instead, the recurrence rate has resulted lower in the non-midline group, although without statistical significance.