ORIGINAL ARTICLE S. Olmi Æ L. Erba Æ S. Magnone Æ A. Bertolini E. Croce Prospective clinical study of laparoscopic treatment of incisional and ventral hernia using a composite mesh: indications, complications and results Received: 24 February 2005 / Accepted: 27 December 2005 / Published online: 12 April 2006 Ó Springer-Verlag 2006 Abstract The aim of this study is to establish the indications, safety, efficacy, feasibility and reproduc- ibility of the laparoscopic technique in treating defects in the abdominal wall, including those of large dimensions, to standardise the surgical technique and to confirm the performance of the composite prosthesis used (Parietex, Sofradim). The study encompassed the period from January 2001 to December 2004 and included 178 nonselected patients (108 women and 70 men), with an average age of 56 years (range: 26–77 years) and an average body mass index (BMI) of 30 (range: 26–40). These patients were treated for either abdominal hernia (156 patients; 89.7%)or a primary defect (22 patients; 10.3%). The dimensions of the abdominal hernias trea- ted varied from 4 to 26 cm (average: 12.1 cm). All patients were treated using the laparoscopic technique, and all meshes were placed in the intraperitoneal posi- tion. Eleven (7%) postoperative complications arose after an average follow-up period of 29 months (range: 1–48 months): seven seromas (4.4%) lasting for 4 weeks, with one becoming infected after being punctured repeatedly; we removed the infected prosthesis by lapa- roscopy; three (1.9%) patients with persistent neuralgia, which were resolved after 2 months with a prescription for FANS; one patient with a haematoma at the trocar site. There were also four recurrences (2.5%), all of which occurred between 1 and 3 months postsurgery: one in the ’small’ group of abdominal hernias (less than 9 cm) and three in the ’large’ group of abdominal hernias. With the exclusion of any primary defects, an adhesiolysis was carried out in 99.3% of the patients. In seven cases (4.4%) we carried out a raphe for sperito- nealisations of loops in the small intestine; in four patients (2.5%), following tenacious adhesion (one patient) and loops fixed to the previous scar by stitches (three patients), we carried out an intestinal perforation (ileus) which was sutured by laparoscopy. The average operating time was 65.6 min (range: 28–130 min), with an average postoperative period in the hospital of 2.1 days (range: 1–5 days). No conversion was observed, and mortality was zero. The results obtained during the clinical trial demonstrate the safety and efficacy of the laparoscopic technique and of the mesh used as well as the reproducibility of the technique in the intraperitoneal treatment of congenital and postincision defects in the abdominal wall, including those of large dimensions. Keywords Abdominal hernia Æ Composite mesh Æ Incisional hernia Æ Laparoscopy Introduction Abdominal hernia remains a frequent complication of abdominal surgery, with a reported incidence of 3–11% in patients having laparotomies and a greater than 23% incidence in patients who experience an infection of the laparotomy wound [1–5]. Approximately 90,000 men, women and children in the USA undergo surgery for abdominal hernia repair each year [2]. Abdominal hernia should be considered a progres- sive type of condition: due to intraabdominal pressure and lateral tension of the muscle walls, these abdom- inal hernias are subject to increases in volume and recurrence. Complications can also arise, such as incarceration and occlusion. The most frequent forms of hernia are median in type (75%), and of these more than 50% are located in the epigastric and S. Olmi Æ L. Erba Æ S. Magnone Æ A. Bertolini Æ E. Croce Second Surgical Department, Centre of Laparoscopic and Minimally Invasive Surgery, Ospedale san Gerardo, Monza, Italy S. Olmi (&) Via de Castillia 7, 20124 Milan, Italy E-mail: stefanoolmi@tiscali.it URL: www.erniacenter.com Tel.: +39-39-2333542 Fax: +39-39-2333418 Hernia (2006) 10: 243–247 DOI 10.1007/s10029-006-0073-7