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Aim: To give an overview of all negative outcomes of laparoscopic ventral hernia repair., Design: Retrospective cohort study, Methods: Data from all consecutive patients who underwent laparoscopic ventral or incisional hernia repair from January 2000 - May 2010 were summarized in a database. All operative and postoperative complications requiring invasive surgical or radiological intervention were analysed., Results: A total of 803 patients underwent laparoscopy for hernia repair. Conversion to an open operation (n=24; 3%) was needed in 15 cases due to severe adhesions and in 9 due to enterotomy. Laparoscopic repair was completed in 779 patients (97%). Mean follow-up was 35.6 months (SD: 20.3). There were 17 recurrences (2.2%). Other adverse events were: enterotomies (n = 14; 1.8%: 9 recognized intraoperatively and 5 presented postoperatively); postoperative death due to myocardial infarction (n = 1); death due to mesenteric ischemia (n = 1); intra-abdominal bleeding (n = 3); postoperative ileus (n = 2); ileus long after laparoscopy (n = 2); chronic pain (n = 12; 1.6%); trocar-site hernia (n = 7); late mesh infection (n = 5); symptomatic mesh bulging (n = 4); chronic seroma (n = 1)., Conclusion: Laparoscopic correction is an effective method of treating hernias of the abdominal wall and recurrence is low. A total of 8.9% of patients had complications requiring re-intervention. Of these only a quarter were recurrences. On its own, the percentage of recurrences is therefore an inadequate indicator of the outcomes of this operation.

A 76-year-old man presented with diffuse progressive abdominal pain. He had undergone endoscopic retrograde pancreaticocholangiography (ERCP) 5 weeks earlier for jaundice and increased levels of liver enzymes. A dilated biliary duct with multiple concrements had been seen, and a plastic endoprosthesis was placed. During a follow-up ERCP the stent was not found, and the obstruction was still present. Another stent was placed. Abdominal x-ray revealed migration of the first endoprosthesis to the distal jejunum and signs of ileus and free gas. CT showed that the stent was stuck in a perforated diverticulum of the sigmoid, surrounded by an abscess mass. The stent was removed by laparotomy, the perforation was closed, and a double-loop stoma was made. Two weeks after initial recovery, abdominal pain recurred. CT revealed a second dislocated stent with a perforation of the jejunum. Laparotomy was performed again with removal of the stent and repair of the perforation. Migration is a known complication of biliary endoprosthesis placement, and should be considered in cases of abdominal pain after ERCP. Perforations rarely occur and mostly affect areas of the bowel that are fixed or that present obstacles to normal elimination. Two perforations within a short period of time is an extremely rare complication of migration.