Ventral Hernias. From Open Surgery to Minimally Invasive Techniques. Evolution of Ideas

The first techniques of repair of ventral hernias consisted of suture (Quenu-Mayo). It is now established that suturing can induce a relatively high percentage of recurrences, even for hernias 1-4 cm in size. Therefore, prosthetic repair is today recommended. Different techniques have been used, from the simple “postage stamp” method, to the more complex open retromuscular repair introduced by Alexandre. Some devices aimed at facilitating introduction of the patch in the retromuscular or intraperitoneal space through the hernia orifice have been used, such as the PHS, the Plug, the Ventralex or the CA.B.S.'air® and others. All of these methods have their own imperfections.
The IPOM technique, which was introduced with the emergence of laparoscopy, consists of fixing the patch to the inner aspect of the abdominal wall. This method provides shorter hospital stay and a lower risk of sepsis than open surgery. Nevertheless, it can result in pain due to the staples and intestinal adhesion formation, despite the use of patches equipped with antiadhesive barrier. For this reason, some surgeons are developing techniques which consist of placing the patch in the retromuscular space, according to the French School precepts in open surgery, either by minimally invasive open approach (MILOS), or by totally endoscopic approach (parietoscopy), such as eTEP in the USA and VTEP in France.