A simplified laparoscopic approach to ventral hernia repair: a new "finned" mesh configuration with defect closure.

Abstract

Despite the proven benefits of laparoscopic abdominal hernia repair (LAHR), only 25% of elective ventral hernia repairs are currently performed using this method. This surprising trend may be due to the current limitations of LAHR including lack of defect closure, high seroma rates, and longer OR times. To address these challenges, a new method was developed that uses an innovative "finned" mesh configuration to combine defect closure via open dissection and laparoscopic underlay mesh placement. A new "finned" mesh is sutured within the defect edges using a traditional open method and then approached laparoscopically for final fixation onto the peritoneal surface of the abdominal wall. The "fin" provides a perpendicular plane for suturing to avoid unintentional contact with any underlying viscera, centers the mesh symmetrically around the closed defect, and prevents mesh migration without stay sutures. A retrospective review was performed on 108 consecutive patients that had a ventral, incisional, or umbilical hernia repaired using the "finned" mesh between 2007 and 2013. The mean follow-up was 40.83months. Average operating time was 64.84min (range 25-144min) with an average length of stay of 0.80days (range 0-10days). There were two intraoperative complications (1.85%): one small bowel injury and one unexplained incidence of tachycardia. Major post-operative complications included two recurrences (1.85%) and one small bowel obstruction (0.96%). Fourteen minor post-operative complications were observed (12.96%), with the most common being post-operative ileus (n=4) and urinary retention (n=3). There were zero incidents of seroma, wound infection, or mesh infection in this study. This innovative laparoscopic method incentivizes surgeons to embrace the technique and its universally accepted advantages by mitigating the most challenging aspects of LAHR. Promising results indicate a potential new standard of care for ventral hernia repair.