title: Double rolling and center hitch technique for laparoscopic ventral hernia repair.
abstract: BACKGROUND
  Intraperitoneal onlay mesh repair is an established modality to treat large ventral hernias. Various techniques of laying the mesh are utilized. We present the Double Rolling and Center Hitch technique to lay a large intraperitoneal onlay mesh.
  
  
  OBJECTIVE
  The aim of the study is to devise and adopt a method to reduce the difficulty in manoeuvring a large mesh inside the peritoneal cavity. It should also help in correct placement of mesh and decrease the operative time.
  
  
  METHODS
  The DRACH technique was used in eighteen patients with large ventral hernias between May 2010 and September 2011. The Mesh size used was 15x20cm and more (considered to be large mesh).
  
  
  RESULTS
  All the procedures were completed successfully. Mesh handling was significantly easier with the DRACH technique. The average mesh deployment time (MDT) was 15mins. In all cases the mesh was adequately centred with a margin of 3-5cm from the defect.
  
  
  CONCLUSIONS
  The DRACH technique can be employed to lay large intraperitoneal meshes in order to reduce the handling difficulties associated with large meshes, and to aid in better placement of meshes so as to centered over the defect.
authors.affiliation: Institute of Minimal Access, Metabolic and Bariatric Surgery, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Asfar
authors.initials: A
authors.lastname: Ali
authors.forename: Parveen
authors.initials: P
authors.lastname: Bhatia
authors.forename: Sudhir
authors.initials: S
authors.lastname: Kalhan
authors.forename: Mukund
authors.initials: M
authors.lastname: Khetan
authors.forename: Suviraj
authors.initials: S
authors.lastname: John
authors.forename: Vivek
authors.initials: V
authors.lastname: Bindal
keywords: Intraperitoneal onlay mesh; laparoscopy; large mesh; ventral hernia