Laparoscopic ventral hernia repair: extraperitoneal repair

Laparoscopic ventral hernia repair was reported for the first time early in the 1990s. It uses intraperitoneal onlay mesh placement to achieve a tension-free repair of the hernia. In the recent years, however there has been a rising concern regarding certain long-term complications involving intraperitoneal mesh placement. There is an evidence of mesh adhesion, fistula formation, and mesh migration into hollow organs including the small bowel, large bowel, and oesophagus resulting in various acute abdominal events. Due to such significant, though uncommon adverse events, some surgeons have favoured sublay repair for ventral and incisional hernias. There has been a search for a laparoscopic approach for ventral and incisional hernias that might preclude the mesh-induced visceral complications seen after intraperitoneal onlay mesh repair. This article aims to review and highlight the currently available methods and technical details of laparo-endoscopic extraperitoneal repair for ventral hernia, their potential advantages and disadvantages.