Abstract
Background
Generous overlap by a well-transfixed mesh is important in laparoscopic ventral hernia repair (LVHR). Mesh is usually introduced through a 10-mm trocar and fixed by tackers or transfixed by sutures. Ten-millimeter trocar sites are more prone to hernia development. Transfixation done using a suture passer inflicts some trauma and the site may become painful. This study reports a mesh insertion technique avoiding a 10-mm myofascial port, double-breasted fascial closure of the hernial defect, and transfixation in a relatively atraumatic manner.
Methods
This prospective study was conducted by enrolling the patients attending our surgery clinic. They were candidates for LVHR. Informed consent was obtained from each patient before the procedure. The study was approved by the Ethical Review Board of the Hospital and conducted as per good clinical practice (GCP) guidelines.
Results
Between April 2004 and June 2006, 29 ventral hernia patients were enrolled without any exclusion. All patients had LVHR performed with this technique. Mean operative time and hospital stay were 65 min and <1 day, respectively. There were no perioperative complications, conversion, infection, trocar site or recurrent herniation or mortality. The majority of the patients were operated on as day-care surgery. Patients were followed up telephonically for the first 48 h and then by visiting us regularly. There was no postoperative visible bulge.
Conclusion
Mesh insertion by avoiding 10-mm trocar, double-breasted defect closure, and transfixation using atraumatic needles is a technically easy, safe, and patient-friendly procedure.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Zerey M, Heniford BT (2006) Laparoscopic versus open surgery for ventral hernia repair—which is best? Nat Clin Pract Gastroenterol Hepatol 3(7):372–373
Nimeri AA, Brunt LM (2006) Laparoscopic ventral hernia repair: 5-mm port technique and alternative mesh insertion method. J Am Coll Surg 202(4):708–710
Bingener J, Buck L, Richards M, Michalek J, Schwesinger W, Sirinek K (2007) Long-term outcomes in laparoscopic vs open ventral hernia repair. Arch Surg 142(6):562–567
Shaher Z (2007) Port closure techniques. Surg Endosc 21(8):1264–1274
Boldo E, Perez de Lucia G, Aracil JP, Martin F, Escrig J, Martinez D, Miralles JM, Armelles A (2007) Trocar site hernia after laparoscopic ventral hernia repair. Surg Endosc 21(5):798–800
Carlson MA, Petersen A (2007) Technique for the insertion of large mesh during minimally invasive incisional herniorrhaphy. Surg Endosc 21(7):1243–1244
LeBlanc KA (2007) Laparoscopic incisional hernia repair: are transfascial sutures necessary? A review of the literature. Surg Endosc 21(4):508–513
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213
Agarwal B, Agarwal S, Gupta M, Mishra A, Mahajan K (2008) Laparoscopic ventral hernia meshplasty with ‘Double breasted’ fascial closure of hernial defect A new technique. J Laparoendosc Adv Surg Tech A 18:222–229
Novitsky YW, Cobb WS, Kercher KW, Matthews BD, Sing RF, Heniford BT (2006) Laparoscopic ventral hernia repair in obese patients: a new standard of care. Arch Surg 141(1):57–61
Counter S (2006) Laparoscopic ventral hernia repair: 5-mm port technique and alternative mesh insertion method. J Am Coll Surg 203(3):403
Muysoms FE, Cathenis KK, Claeys DA (2007) “Suture hernia”: identification of a new type of hernia presenting as a recurrence after laparoscopic ventral hernia repair. Hernia 11(2):199–201
Chelala E, Thoma M, Tatete B, Lemye AC, Dessily M, Alle JL (2007) The suturing concept for laparoscopic mesh fixation in ventral and incisional hernia repair: mid-term analysis of 400 cases. Surg Endosc 21(3):391–395
Smietanski M, Bigda J, Iwan K, Kolodziejczyk M, Krajewski J, Smietanska IA, Gumiela P, Bury K, Bielecki S, Sledzinski Z (2007) Assessment of usefulness exhibited by different tacks in laparoscopic ventral hernia repair. Surg Endosc 21(6):925–928
Losanoff JE, Basson MD, Laker S, Weiner M, Webber JD, Gruber SA (2007) Sutured laparoscopic mesh fixation. Surg Endosc Jun 26 [Epub ahead of print]
Golash V (2006) Modification of Gore suture passer instrument. Surg Endosc 20(10):1619–1620
Bariol SV, Stewart GD, Tolley DA (2005) Laparoscopic suturing: effect of instrument handling on suture strength. J Endourol 19(9):1127–1133
Jin J, Rosen M (2007) Laparoscopic component separation for complicated ventral hernia repair. SAGES Abstract ID 15365 Poster Session Proceedings, vol 1
Acknowledgement
We are grateful to Ms Pooja Pant, Krishna Adit, and Nayan Agarwal for their valuable help in documentation and preparation of manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Agarwal, B.B., Agarwal, S. & Mahajan, K.C. Laparoscopic ventral hernia repair: innovative anatomical closure, mesh insertion without 10-mm transmyofascial port, and atraumatic mesh fixation: a preliminary experience of a new technique. Surg Endosc 23, 900–905 (2009). https://doi.org/10.1007/s00464-008-0159-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-008-0159-7