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.
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.


CONCLUSIONS
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.
Agarwal
Brij B
BB
Department of General Surgery, Sir Ganga Ram Hospital, New Delhi 110060, India. endosurgeon@gmail.com
Agarwal
Sneh
S
Mahajan
Krishan C
KC
D000328:Adult; D000368:Aged; D004867:Equipment Design; D000071938:Fasciotomy; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D013526:Surgical Mesh; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D016896:Treatment Outcome; D055815:Young Adult