Controversies in Laparoscopic Ventral hernia repair

Ventral hernia is one of the common anterior abdominal wall hernias after groin hernias. These hernias can be classified into primary hernias and secondary (incisional) hernias. Ventral hernia repair is a very common procedure performed in everyday surgical practice. Ventral/Incisional hernias are a frequent long-term complication of abdominal surgery. Roughly half of the incisional hernias develop within the first 2 years after abdominal surgery, and more than 70% manifest within 3 years. The recurrence rate of these hernias after primary suture repair exceeds 50%. However, after the prosthetic materials (meshes) were introduced in the repair procedure, this rate was reduced to 10–20%. The optimal approach with the best short- and long-term outcomes remains controversial. An increasing interest in laparoscopic surgery and its accessibility as well as the availability of innovative techniques have influenced the choice of repair. This chapter provides an overview of ventral hernias, their causes, risk factors, symptomatology, diagnosis, and different approaches to ventral hernia management, focusing mainly on laparoscopic surgery. Additionally, several controversies related to the technique will be discussed, such as mesh fixation, whether the hernia defect should be fixed or not, and mesh overlap. Pre- and post-operative care will also be covered.