Published: 2021-06-28

Reducing operative morbidity among female patients combining laparoscopic hysterectomy and laparoscopic ventral hernia mesh repair procedures: a single centre 14 years experiences

Priti Agrawal, Rishi Kumar Agrawal, Jyotirmay Chandrakar


Background: During laparoscopic ventral hernia repair (LVHR) mesh is used and so this procedure is not combined with any other major surgery, due to the risk of mesh infection. We did laparoscopic hysterectomy (LH) with LVHR in our study group and found it to be safe procedure with excellent patient recovery and satisfaction rates. Aims and objectives of the study was to assess the short- and long-term clinical outcomes of doing LH and LVHR simultaneously. The primary objectives were to evaluate the intraoperative and post-operative complications, mesh infection rates, hernia recurrence rates and patient satisfaction rates for at least 4 years.

Methods: This prospective study was conducted at Aarogya Hospital and test tube centre from 1st January 2007 to 31st December 2016 and follow up completed by 31st December 2020. Total 100 women were included, willing for LH and LVHR simultaneously irrespective of the size of uterus and hernia defect size up to 7cms.

Results: Maximum number of patients 65% were in the age group of 45-55 years. 70% patients had previous surgeries commonest being LSCS in 46% cases. Hernia defect size was between 3-5 cm in length and width in 70% cases, requiring dual mesh fixation in 68% cases of size 15x15cms. Our recurrence rate for hernia was nil, 98% cases were highly satisfied with the surgical outcomes by the end of 4 years follow-up.

Conclusions: We emphasize that LH can be easily done with LVHR in combination reducing operative morbidity.


Dual mesh (Proceed, Symbotex), Incisional hernia, Laparoscopic hysterectomy, Laparoscopic ventral hernia repair, Umbilical hernia

Full Text:



Langbach O, Bukholm I, Benth JS, Rokke O. Long-term quality of life and functionality after ventral hernia mesh repair. Surg Endosc. 2016;30(11):5023-33.

Gillion JF, Sanders D, Miserez M, Muysoms F. The economic burden of incisional ventral hernia repair: a multicentric cost analysis. Hernia. 2016;20(6):819-30.

Shekhar C, Paswan B, Singh A. Prevalence, sociodemographic determinants and self-reported reasons for hysterectomy in India. Reprod Health. 2019;16(1):118.

Agrawal P, Agrawal R, Chandrakar J. Role of laparoscopy in vaginal hysterectomy for nonprolapsed uterus. J Obstet Gynecol India. 2007;57(2):151-4.

Agrawal P, Agrawal R, Chandrakar J. To Assess the safety of morcellation for removing uterine specimen during laparoscopic and vaginal hysterectomies for leiomyomas, J Obstet Gynecol India. 2016;66(S1):S567-72.

Agrawal P, Agrawal R, Chandrakar J. Prevention of vault prolapse in cases of procedentia using combined vaginal and laparoscopic approach for vault suspension: Agrawal’s technique. Int J Reprod Contracept Obstet Gynecol. 2021;10(1):296-302.

Puntambekar S, Shetty STS, Goel A, Chandak S, Panchal S. Single-centre experience of doing safe total laparoscopic hysterectomy: retrospective analysis of 1200 cases, J Obstet Gynaecol India. 2020;70(5):376-83.

Gillion JF, Lepere M, Barrat C, Cas O, Dabrowski A, Jurczak F, et al. Two-year patient-related outcome measures (PROM) of primary, ventral and incisional hernia repair using a novel three-dimensional composite polyester monofilament mesh: the symchro registry study. Hernia. 2019;23:767-81.

Lepere M, Gillion JF, Barrat C, Cas O, Dabrowski A, Jurczak F, et al. First year preliminary results on the use of a monofilament polyester mesh with a collagen barrier for primary and incisional ventral hernia repair. Int Surg. 2018;103(1-2):56-65.

Chelala E, Baraké H, Estievenart J, Dessily M, Charara F, Allé JL, et al. Long-term outcomes of 1326 laparoscopic incisional and ventral hernia repair with the routine suturing concept: a single institution experience. Hernia. 2016;20(1):101-10.

Narkhede R, Shah NM, Dalal PR, Mangukia C, Dholaria S. Postoperative mesh infection still a concern in laparoscopic era. Indian J Surg. 2015;77(4):322-6.

Nardi M, Millo P, Contul RB, Lorusso R, Usai A, Grivon M, et al. Laparoscopic ventral hernia repair with compositemesh: analysis of risk factors for recurrence in 185 patients with 5 years follow-up. Int J Surg. 2017;40:38-44.

Blanc K. Proper mesh overlap is a key determinant in hernia recurrence following laparoscopic ventral and incisional hernia repair. Hernia. 2016;20(1):85-99.

Kaufmann R, Halm JA, Eker HH, Klitsie PJ, Nieuwenhuizen J, Geldere DV, et al. Mesh versus suture repair of umbilical hernia in adults: a randomised, double-blind, controlled, multicentre trial. Lancet. 2018;391(10123):860-9.

Elango S, Perumalsamy S, Ramachandran K, Vadodaria K. Mesh materials and hernia repair. Biomed. 2017;7(3):16.

Baker JJ, Öberg S, Andresen K, Rosenberg J. Decreased re-operation rate for recurrence after defect closure in laparoscopic ventral hernia repair with a permanent tack fixated mesh: a nationwide cohort study. Hernia. 2018;22(4):577-84.

Baucom RB, Ousley J, Feurer ID, Beveridge GB, Pierce RA, Holzman MD, et al. Patient reported outcomes after incisional hernia repair-establishing the ventral hernia recurrence inventory. Am J Surg. 2016;212(1):81-8.

Bhanot P, Brenton R, Patel K. Proceed™ mesh for laparoscopic ventral hernia repair. JSLS. 2013;17:565-9.

Rogmark P, Petersson U, Bringman S, Ezra E, Österberg J, Montgomery A. Quality of life and surgical outcome 1 year after open and laparoscopic incisional hernia repair: prolove: a randomized controlled trial. Ann Surg. 2016;263(2):244-50.

Hauters P, Desmet J, Gherardi D, Dewaele S, Poilvache H, Malvaux P. Assessment of predictive factors for recurrence in laparoscopic ventral hernia repair using a bridging technique. Surg Endosc. 2017;31(9):3656-63.