LAPAROSCOPIC APPROACH TO THE TREATMENT OF RECURRENT INCISIONAL HERNIA: TECHNICAL ADVANCES AND LONG-TERM OUTCOMES

Resumo

Recurrent incisional hernia represents a relevant challenge in abdominal wall surgery because of the anatomical changes resulting from previous procedures, the presence of adhesions, compromised tissue quality, and the risk of further recurrence. In this context, the laparoscopic approach has become established as an alternative to open repair, particularly because it allows access to the abdominal cavity through planes different from those previously dissected, wide visualization of the defect, and placement of prostheses with adequate overlap, in addition to a potential reduction in wound-related complications. At the same time, the evolution of laparoscopic repair, from the conventional intraperitoneal onlay mesh (IPOM) to strategies involving fascial defect closure, IPOM-plus, and minimally invasive extraperitoneal and retromuscular techniques, has substantially changed the principles of abdominal wall reconstruction. The objective of this study was to critically review the available evidence on the laparoscopic approach to the treatment of recurrent incisional hernia, with emphasis on technical advances, perioperative outcomes, recurrence, complications, and long-term outcomes. A narrative review of the literature was carried out using a structured search strategy for studies related to recurrent incisional hernia, laparoscopic repair, mesh placement, fascial closure, and surgical outcomes. The available evidence suggests that laparoscopic repair can provide satisfactory results in appropriately selected patients, with recurrence rates comparable to those of open repair and a lower occurrence of certain wound complications, although it carries specific risks, particularly bowel injury during adhesiolysis. Advances such as primary defect closure and improved prosthetic positioning have sought to restore abdominal wall function and reduce seroma, bulging, and recurrence. However, the technical and methodological heterogeneity of the studies, together with the scarcity of investigations specifically addressing recurrent hernias with prolonged follow-up, still limits definitive conclusions. It is concluded that laparoscopy holds a relevant position in the treatment of recurrent incisional hernia, but its indication should be individualized according to defect characteristics, previous procedures, clinical conditions, and the experience of the surgical team.