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.
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