Technique for introducing large composite mesh while performing laparoscopic incisional hernioplasty.
BACKGROUND
Incisional hernias are treated laparoscopically in an increasing number of cases. The simplest technique is the peritoneal onlay technique. Composite mesh, consisting of one layer of polypropylene mesh, destined to face the abdominal wall, and one layer of less adhesion-inducing material, destined to face the bowel, has been developed in an effort to avoid intraperitoneal adhesion formation and viscus erosion. While probably superior, this type of mesh is very bulky, easily damaged, and hence extremely difficult to be safely introduced through conventional trocars.


METHODS
We present a simple technique to safely introduce intraperitoneally large sheets of composite mesh, without the need for larger-bore cannulas. After temporarily removing one of the 10 mm trocars, the mesh is rolled as tightly as possible and placed in a sterile bag, which is then easily introduced intraperitoneally through the trocar opening.


RESULTS
Between September 1999 and January 2000 the technique was successfully used in 12 patients.


CONCLUSIONS
This simple trick protects the mesh while making its intraperitoneal introduction straightforward. It is quick, cheap, and easily reproducible.
Himpens
J M
JM
Department of Thoracic, Abdominal and Minimally Invasive Surgery, St Blasius Hospital, 50 Kroonveldlaan, Dendermonde 9200, Belgium. Jacques.Himpens@ping.be
Leman
G M
GM
Deloose
K R
KR
D000328:Adult; D000368:Aged; D004322:Drainage / Q000379:methods; D005260:Female; D059685:Herniorrhaphy; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011126:Polypropylenes; D019736:Prostheses and Implants; D013526:Surgical Mesh; D016896:Treatment Outcome
D011126:Polypropylenes