Choice of prosthetic biomaterial

Laparoscopic ventral herniorrhaphy is here to stay. But just like most other minimal access procedures, patient selection is paramount. Currently, laparoscopic repair requires intraperitoneal prosthetic material as a "patch." Repair of a congenital 2-cm umbilical hernia should not be undertaken with this approach )one end of the spectrum) nor should a multiply recurrent incisional hernia in a patient with known, severe intraperitoneal adhesions. The best approach requires good patient selection, honest acknowledgement of one's own laparoscopic skills, lack of a cavalier cowboyish attitude as the surgeon, and the insight that conversion to open repair is not a failure.