The complications do not differ from TEP laparoscopic hernioplasty, previously explained in another chapter in this text.

Laparoscopic ventral hernia repair has been reported to have lower recurrence rates, fewer surgical site infections, and shorter hospital stays compared to open repair. The seroma formation, eventration (or bulging of mesh or tissue), and hernia recurrence remain common complications. In order to avoid or minimize these problems, primary closure of the defect by laparoscopy has gained popularity because this intervention restores the muscle continuity. It decreases the dead space, but if the defect is large, the closure could result in excessive pain and reduce the respiratory capacity [2, 3].

Indications are defects in the midline no more than 6–10 cm in diameter and no multisacular hernias with sacs not in the midline.

With this technique, the mesh necessary to cover the defect decreases. The dynamics of the abdominal wall muscle are restored more optimally and more quickly.

The incidences of seroma, mesh, tissue eventration, and hernia recurrence are significantly lower. Subjective improvement in overall patient satisfaction, cosmetic satisfaction, and functional status was reported with closing the central defect.

This technique could be superior for treating ventral hernias due to lower complication rates and higher patient satisfaction and functional status [4].

The laparoscopic ventral hernia repair with preperitoneal placement of mesh minimizes the complications related to the intraperitoneal position of mesh and fixating devices. It allows safe use of conventional and less expensive polypropylene mesh.

Laparoscopically, ventral hernia repair is done by placing the mesh in either the preperitoneal (retromuscular) space or in the intraperitoneal onlay position. The placement of a large mesh in the preperitoneal space allows an even distribution of forces along the surface area of the mesh, which may account for the strength of repair and the decreased recurrence rates associated with it.

In intraperitoneal mesh placement, the direct contact of mesh with the abdominal contents cannot be avoided. The mesh behaves as a foreign material in relation to the abdominal contents and incites inflammatory reaction and adhesion formation [5, 6].

Following proper interface measures may not be possible. Severity of mesh-related complications depends on the position of the mesh in relation to the abdominal wall.

Diaz-Pizarro Graf and Chowbey demonstrated that preperitoneal placement of a polypropylene mesh is technically feasible and appears to have an advantage over laparoscopic intraperitoneal mesh placement for incisional hernia in selected patients [5, 6].

The fixation of the mesh can be done using tackers, fibrin glue, and new self-gripping meshes or with no fixation if the mesh is placed properly in the preperitoneal space. See Fig. 14.5.

The technique is feasible and safe when performed by experts. The preperitoneal placement of the mesh not only avoids the direct contact of the prosthesis with viscera but also provides additional security of fixation and can minimize complications. It allows safe use of conventional and less expensive meshes such as polypropylene mesh, which has high intrinsic tensile strength and good memory [7].