title: Laparoscopic transcutaneous closure of central defects in laparoscopic incisional hernia repair.
abstract: OBJECTIVE
  The aim of this technical report is to investigate the safety, efficacy, and outcome of transcutaneous closure of central defects (TCCD) for laparoscopic incisional hernia repair (LIHR).
  
  
  METHODS
  Twenty-two patients with incisional hernias underwent a LIHR-TCCD repair. After clearance of the abdominal wall from adhesions, laparoscopic central closures were performed transcutaneously with 0-polypropelene sutures placed every 1 cm of the defect starting at the cranial-most edge of the hernia and ending at the caudal-most edge of the hernia. A standard LIHR was performed with coated polyester mesh placed with at least 6 cm of overlap with mesh on all borders. Transfascial sutures with 0-polypropelene sutures were placed every 4 cm circumferentially, and titanium tacks were used to secure the mesh to the peritoneum every 1 cm.
  
  
  RESULTS
  The mean age was 52 years and the mean body mass index was 35 kg/m. The mean hernia defect was 4.7 cm×7.2 cm with a mean area of 37 cm. There were no mortalities and no major perioperative morbidities. Minor complications included 2 (9%) cases of pneumonia/pneumonitis. There were no clinically significant seromas, no radiographic or clinical eventrations, and no hernia recurrences with a mean follow-up of 21 months.
  
  
  CONCLUSIONS
  LIHR-TCCD is safe and technically feasible in incisional hernias of width <10 cm. By closing the central defect, seromas and eventrations can be reduced.
authors.affiliation: Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Michael E. DeBakey Veteran's Affairs Medical Center, Houston, TX, USA. ml3@bcm.edu
authors.forename: Mike K
authors.initials: MK
authors.lastname: Liang
authors.forename: Anuradha
authors.initials: A
authors.lastname: Subramanian
authors.forename: Samir S
authors.initials: SS
authors.lastname: Awad
mesh_terms: D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D046449:Hernia, Abdominal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome; D058106:Wound Closure Techniques