Background
To assess our experience in laparoscopic repair of ventral and incisional hernias(LRVIH) and the cost effectiveness of providing this service in a NHS district general hospital.

Material and Methods
Prospective single centre study of consecutive LRVIHs performed by one Consultant Surgeon over last 3 years. Patient demographics and periprocedural details were recorded in standard proforma. Hernias were classified according to EHS classification. Costs were calculated from NHS payment by result(PBR) tariffs.

Results
85 patients with mean(SD) age 56.5(14.2) years and BMI of 31.8(6.1)kg/m2 underwent repairs for 19(22.3%) primary ventral hernias, 48(56.4%) incisional hernias and 18(21.1%) recurrent incisional hernias. The median(i.q.r.) defect size was 25(16-111)cm2; operating time 65(55- 110)minutes; length of hospital stay 1(0.5-1)bed-days; 16 patients had complications: 8(9.4%)seromas, 1(1.1%)haematoma, 4(4.7%)respiratory complications; 3(3.5%)conversions to open procedures and 1(1.1%)re-operation for small bowel obstruction. There were 5(5.8%)recurrences. Median cost of repair was £1318(1079-1702) and hospital income per procedure was £1747(1163-2534), resulting in a median profit of £280(-28to800)per procedure. Repairing hernias with total width >10cm or total surface area >25cm2 was significantly higher than smaller defects (P<0.001).

Conclusion
LRVIH is safe and cost-effective especially for smaller hernias. Current PBR tariffs for larger hernias may need renegotiating to make such repairs more cost-effective.