**6. Postoperative outcome**

#### **6.1 Conversion to open surgery**

The conversion rate to open surgery depends on the surgeons experience, the surgical skills, and intraoperative complications such as bowel lesions or bleeding. In the literature conversion to open surgery is mostly due to adhesions, with an overall conversion rate of 10-15% [12, 13]. However, complete adhesiolysis is very important especially in large incisional hernia to gain enough place for the mesh fixation and therefore to minimize the recurrence rate.

#### **6.2 Operation time**

There is a wide range in duration of the operation comparing laparoscopic and open incisional hernia repair. Most studies revealed that operation time in laparoscopic incisional hernia repair is longer compared to open surgery [12-14]. However, there was always a statistically difference in all these studies. Longer operation time can be explained with the learning curve in laparoscopy. Furthermore the fixation technique of the mesh can be time consuming especially in large incisional hernia repair. On the other hand there are some studies with no difference or even a shorter operation time in laparoscopic surgery [15, 16].
