ventral hernias are the second most common type of abdominal wall hernias , after inguinal hernias . the majority of ventral hernias are incisional , occurring in 3% to 13% of laparotomy incisions , necessitating approximately 90 000 ventral hernia operations per year . the use of prosthetic material , such as polypropylene mesh , polytetrafluoroethylene , and marlex mesh has decreased rates of recurrence . however , wound complications with the use of mesh in open ventral hernia repair are significant . since 1992 , the laparoscopic technique has been applied to the repair of ventral hernias because of its many advantages including the absence of large subcutaneous flaps , a lower incidence of wound infection , and a reduction in postoperative pain and hospital stay . the lower recurrence rates are most likely due to the tension - free and intraperitoneal placement of the mesh . laparoscopy offers a clear view of the entire fascial defect , which is not always possible with the open technique , especially if a thus , the entire defect is completely circumscribed with the laparoscopic technique . the surgical technique described for laparoscopic ventral hernia repair varies by surgeon . however , all techniques reported use at least 3 port sites , with one or more being 10 mm . using this technique , either the primary surgeon or the first assistant is working in mirror - image . between july 2002 and january of 2003 , 3 patients underwent laparoscopic ventral hernia repair with mesh in which only two 5-mm ports were used for small incisional or ventral hernias . follow - up surveillance for complications and hernia recurrence was performed in the immediate postoperative period , 1 week to 2 weeks after surgery . additional follow - up was obtained by telephone interview 6 months to 12 months postoperatively . after the abdomen was prepped , an iodine impregnated adhesive drape dressing was placed on the patients ' abdomen . access to the abdomen was obtained in an area lateral to the hernia by using a veress needle . after exploration of the abdomen , a second 5-mm trocar was introduced under direct visualization on the opposite side of the fascial defect . adhesiolysis was performed to free the anterior abdominal wall , and the margins of the hernia defect were circumferentially cleared to a distance of at least 4 cm . a dual , expanded polytetrafluoroethylene ( eptfe ) mesh ( dualmesh , wl gore , flagstaff , az ) was used , ranging in size from 8.5 cm to 10 cm . once the mesh was place intracorporeally , the sutures were retrieved through the abdominal wall by using a laparoscopic suture passer . the sutures were tied extracorporeally , and the knots were buried in the subcutaneous tissues . the circumference of the mesh was then affixed , by using a 5-mm spiral tacking device , to the posterior abdominal wall at intervals of approximately 1 cm . after the abdomen was prepped , an iodine impregnated adhesive drape dressing was placed on the patients ' abdomen . access to the abdomen was obtained in an area lateral to the hernia by using a veress needle . after exploration of the abdomen , a second 5-mm trocar was introduced under direct visualization on the opposite side of the fascial defect . adhesiolysis was performed to free the anterior abdominal wall , and the margins of the hernia defect were circumferentially cleared to a distance of at least 4 cm . a dual , expanded polytetrafluoroethylene ( eptfe ) mesh ( dualmesh , wl gore , flagstaff , az ) was used , ranging in size from 8.5 cm to 10 cm . once the mesh was place intracorporeally , the sutures were retrieved through the abdominal wall by using a laparoscopic suture passer . the sutures were tied extracorporeally , and the knots were buried in the subcutaneous tissues . the circumference of the mesh was then affixed , by using a 5-mm spiral tacking device , to the posterior abdominal wall at intervals of approximately 1 cm . the size of the mesh used varied , based on the size of the original defect . additionally , no recurrences were noted after a mean follow - up of 9 months ( range , 6 to 12 ) . laparoscopic ventral hernia repair is a procedure that has gained acceptance among surgeons and patients over the last 5 years to 10 years . the documented advantages of laparoscopic surgery in general include faster recovery and return to normal activity , less postoperative pain , fewer wound - related complications , and a better cosmetic result . in addition , the intraperitoneal repair performed laparoscopically poses a significant mechanical advantage and is associated with less recurrence . we present 3 patients who underwent laparoscopic repair of a ventral hernia in which two 5-mm ports were used . these patients had no surgical complications , and the mean operating room times were acceptable . this technique offers all the advantages inherent to laparoscopic surgery , with the added benefit of the use of only two 5-mm ports . laparoscopic repair of ventral or incisional hernias can be performed using only two 5-mm ports . this technique can be done on an outpatient basis in a safe , timely fashion .
objective : high recurrence rates have been documented after primary repair of incisional hernias . 
 laparoscopic ventral and incisional hernia repairs have been performed with very low rates of recurrence . 
 we have modified the standard technique of laparoscopic repair in patients with small incisional and ventral hernias . 
 the purpose of this study was to document the technique utilizing only two 5-mm ports and demonstrate that it is safe , effective , and feasible.methods:three patients with small incisional or ventral hernias were examined . 
 the standard laparoscopic ventral hernia repair technique was modified as follows : two 5-mm ports were inserted on opposite sides of the defect . 
 the defects ranged from 2.5 cm to 4 cm in size . 
 expanded polytetrafluoroethylene mesh ( dualmesh , wl gore , flagstaff , az ) was used to cover the hernia defect , overlapping the defect margins circumferentially by 3 cm . 
 the mesh diameter ranged from 8.5 cm to 10 cm . 
 the mesh was inserted through a 5-mm skin incision site and affixed into position with transfascial sutures and spiral tacks.results:the operative time ranged from 53 minutes to 57 minutes . 
 all patients were discharged home the day of surgery and reported minimal postoperative pain . 
 follow - up ranged from 6 months to 1 year ; all patients were doing well without recurrence.conclusion:laparoscopic repair of ventral or incisional hernias can be performed using only two 5-mm ports . 
 this technique can be done on an outpatient basis in a safe , timely fashion .