in the united states , 4 to 5 million patients undergo abdominal operations each year . , 5% of the general population has an umbilical or epigastric hernia , making ventral hernia repair one of the most commonly performed surgical procedures . approximately 90 000 this is attributed to a variety of reasons , including the loss of muscle strength in the anterior abdominal wall , and the prevalence of comorbidities that lead to increased intraabdominal pressure . in addition , advanced medical care has increased life expectancy in industrialized countries . by 2025 , 25% of the united states population is estimated to be over the age of 65 . while the presence of a ventral hernia in a young adult is considered an indication for repair , there may be some concerns about the safety of elective ventral hernia repair in the elderly population . laparoscopic ventral hernia repair has proven to be a safer and more effective procedure than open ventral hernia repair . whereas laparoscopic procedures were once avoided in the geriatric population , they are now considered a safe approach to manage the surgical needs of this growing population . the goal of this communication is to evaluate the safety and efficacy of laparoscopic ventral hernia repair in patients who exceed 65 years of age . the study retrospectively compared 155 patients of all ages who choose to undergo elective laparoscopic ventral hernia repair between july 2001 and july 2006 at michigan state university / kalamazoo center for medical studies . patients were classified according to their age into 2 groups , group a consisted of patients 65 years old . medical comorbidities and the general medical condition of all patients were evaluated and optimized before surgery . patients with pulmonary or cardiac comorbidities had a pneumoperitoneum established to the pressure of 12 mm hg instead the standard of 15 mm hg . all repair procedures were performed by a single surgeon ( the first author ) using the same operative technique and perioperative protocols . a baseline comparison was made between the 2 groups for patient demographics ( including weight , height , and body mass index ) , american society of anesthesia score ( asa ) , medial comorbidities , types of hernia , operative time , and the length of hospital stay . descriptive statistics were computed for all variables . to assess the difference between the 2 age groups of hernia patients , the t test was computed for the quantitative variables while the chi - square test and fisher 's exact test were used for categorical variables . all statistical analyses were done using sas version 9.1 ( cary , nc ) at 5% level of significance . descriptive statistics were computed for all variables . to assess the difference between the 2 age groups of hernia patients , the t test was computed for the quantitative variables while the chi - square test and fisher 's exact test were used for categorical variables . all statistical analyses were done using sas version 9.1 ( cary , nc ) at 5% level of significance . weight and body mass index where significantly higher in the younger age group ( group a ) . there was no difference in the american society of anesthesia ( asa ) score between the 2 groups ( table 1 ) . the older age group had an increased number of previous hernia repairs ( mean number of previous repairs , 0.72 vs. 0.61 ) . lysis of the resultant adhesions may explain the increase in the operative time ( mean or time , 125 minutes vs. 97 minutes ) . another reason for the longer operative time in older patients is the relatively small working space created by the lower pneumoperitoneum pressure used in patients with cardiac problems ( which is more common among older patients ) . there was no significant difference in the length of stay between the 2 groups ( table 2 ) . no significant difference was noted between the 2 groups regarding the number of hernia defects , size of the defects , or the surface area of the mesh required to close the defects . incisional hernia was the most common type of hernia between the 2 groups followed by umbilical hernia ; however , the prevalence of incisional hernia was significantly higher in the older age group , which can be explained by the longer past history of medical disease ( lead time effect ) ( table 2 ) . associated comorbidities were significantly more prevalent in the older age group , with hypertension being the most common ( 79% in group b vs. 31% in group a ) , followed by cardiac problems ( 42% in group b vs. 6% in group a ) . on the other hand , obesity ( bmi>30 ) was more prevalent among younger patients ( 37% in group a vs. 21% in group b ) . other comorbidities included pulmonary diseases , diabetes , hypothyroidism , and the presence of other hernias ( inguinal , hiatal , and others ) . these comorbidities were more or less equally distributed between the 2 groups ( table 3 ) . all procedures were completed laparoscopically except for those in 4 patients ( 3 in group a and 1 in group b ) due to extensive adhesions . the postoperative course was unremarkable except in 6 patients ( all of them are from the younger age group ) who developed a prolonged ileus secondary to extensive adhesiolysis . in addition , one patient in the older group developed a postoperative pulmonary embolism that was treated medically with anticoagulants . the most common complication was postoperative seroma formation ( 11% in group a , and 13% in group b ) . in most cases , these seromas were transient and resolved with conservative management ; a few cases did require aspiration . complications in both age groups not statistically significant . with a mean follow - up of 8 months ( range , 1 to 52 ) , 4 cases of recurrence were noted , 3 occurred in the younger group and only one in the older group . two of these cases ( one of each group ) were attributed to morbid obesity along with the lack of adequate transfascial sutures . one case of recurrence was secondary to persistent seroma , and one case was secondary to mesh infection that mandated mesh removal ( table 4 ) . ventral hernias are a common problem seen in the elderly population . in the united states , complications related to hernias are one of the most common causes of emergency surgery in patients above 50 years old . ventral hernias are the second most common cause of intestinal obstruction , representing 10% to 15% of cases . the geriatric population is more prone to develop electrolyte and acid base imbalances from intestinal obstruction . the management of these complications is significantly more difficult in elderly patients with relatively high morbidity and mortality . during the early days of laparoscopic surgery the rationale was that older patients have depressed myocardial and pulmonary functions that could be further compromised by a pneumoperitoneum . furthermore , laparoscopic procedures used to require significantly longer operative times when compared with open procedures , thus exposing the patients to the risks of prolonged anesthesia . however , with the increased experience of laparoscopy these concerns have proven to be inaccurate . the adverse effects of a pneumoperitoneum can be reduced by keeping the pressure below 12 mm hg , which allows adequate distension of the abdomen with minimal effects on cardiac and pulmonary function . in addition , the advances in both surgical techniques and available laparoscopic tools have reduced the operative time of most laparoscopic procedures to levels comparable to those of open procedures . furthermore , the safety profile of the currently available anesthetics is better than the earlier predecessors , which allows safe laparoscopy even in patients with comorbid conditions like liver cirrhosis . this has encouraged surgeons to perform more surgeries through the laparoscopic approach , especially when dealing with the elderly population . laparoscopic ventral hernia repair has proven to be a safe and effective alternative to the open approach . the recurrence rate following laparoscopic ventral hernia repair is reported to be 4.3% , compared with the recurrence rate of 41% to 52% after suture repair , and 12% to 32% recurrence for open mesh repair . in addition , the patient gets to avoid the large abdominal incisions with the resultant pain , limitation of activity , and the inflammatory , hormonal , and metabolic stress of surgery . recent health care advances have allowed patients to live longer and maintain a higher level of activity even through advanced age , making them both more tolerant to surgery and more liable to hernia complication . although the risks of open ventral hernia repair may exceed those of untreated ventral hernias , the risks associated with laparoscopy are significantly lower . based on this experience , the benefit of avoiding severe , life - threatening complications , such as incarceration and strangulation , exceed those of elective repair of ventral hernias through the laparoscopic approach in addition to the improvement in the quality of life of these patients . this report demonstrates the feasibility , adequacy , and efficacy of laparoscopic ventral hernia repair in the elderly population . the decision to perform or not to perform an elective hernia repair should depend on the patient 's condition and comorbidities regardless of the chronological age of the patient .