title: Hybrid technique for laparoscopic incisional ventral hernia repair combining laparoscopic primary closure and mesh repair.
abstract: BACKGROUND
  Incisional ventral hernia is one of the most common surgical complications after laparotomy. Laparoscopic repair of incisional ventral hernia has been conducted recently, and the advantages of this procedure have been reported. However, in large orifice cases, the recurrence rate is increased. To improve recurrence rates in large cases, a hybrid method combining laparoscopic primary closure and mesh repair can be applied.
  
  
  METHODS
  Monofilament thread was inserted into the abdominal cavity for hernia closure and pulled from the other side of the orifice. The same procedure was performed from the upper side to the lower side without closure, and all thread was placed in line. Both sides of the thread were then introduced to the midline of the incision through a subcutaneous route. This procedure was conducted with an introducer. All threads were tied, and then a mesh was placed.
  
  
  CONCLUSIONS
  Hybrid techniques already combine mini-laparotomy for hernia closure and subsequent laparoscopic intraoperative onlay mesh for reinforcement, but such techniques require laparotomy. In our technique, closure of the linea alba does not require laparotomy. All procedures were performed laparoscopically. This procedure is very easy and safe, and does not require the abdominal cavity to be opened. Thus, hybrid methods are effective for treating cases of incisional hernia involving a large orifice.
authors.affiliation: Department of Surgery, University of Tokushima, Tokushima, Japan.
authors.forename: Kozo
authors.initials: K
authors.lastname: Yoshikawa
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Shimada
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Kurita
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Sato
authors.forename: Takashi
authors.initials: T
authors.lastname: Iwata
authors.forename: Jun
authors.initials: J
authors.lastname: Higashijima
authors.forename: Motoya
authors.initials: M
authors.lastname: Chikakiyo
authors.forename: Masaaki
authors.initials: M
authors.lastname: Nishi
authors.forename: Hideya
authors.initials: H
authors.lastname: Kashihara
authors.forename: Chie
authors.initials: C
authors.lastname: Takasu
authors.forename: Noriko
authors.initials: N
authors.lastname: Matsumoto
authors.forename: Syohei
authors.initials: S
authors.lastname: Eto
mesh_terms: D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D013526:Surgical Mesh; D013536:Suture Techniques
keywords: Hybrid technique; incisional ventral hernia repair; laparoscopic