A highly effective method of fixing the mesh in open ventral hernia repair

Abstract

The ideal method of ventral hernia repair is yet to be defined. We herein present a method of intraperitoneal mesh fixation which is easy, fast and secure. With this method we can achieve an open surgery for hernia repair with all its advantages and with minimal stress to the patient. The skin incision is limited to just over the hernia opening. No other dissection in the subcutaneous layer is made. Adhesionlysis is performed and the mesh is prepared by placing multiple sutures circumferentially at its edge at one to one and a half cm intervals. Small skin stab wounds with an 11 blade are made corresponding to these points. The mesh is being introduced into the abdominal cavity and each suture is pulled out using a suture-grasping device and tied subcutaneously, thus securing a full thickness abdominal muscular/fascial wall fixation. Between February 2003 and June 2007, we performed 106 incisional and ventral hernia mesh repairs using our fixating technique. Twenty-four patients (22.6%) were treated for recurrent hernias. Of the 106 patients, 14 (13.2%) had a hernia defect ≤ 4 cm and the remainder a larger one. The mean age was 62 years (range 27–84). The average time spent in the operating room was 52 minutes (range 28–112). No intraoperative complications were recorded and two superficial minor wound infections were managed conservatively. Twenty-eight (35%) patients complained of pain at points corresponding to suture knots lasting for more than two months. All patients were successfully treated conservatively. To date, none of the patients has had a recurrence of their hernia. Our proposed method of mesh fixation in open ventral hernia repair is a safe, effective, quick and easily-learned method with a low morbidity and low recurrence rate.