Continuous Laparoscopic Closure of the Linea Alba with Barbed Sutures Combined with Laparoscopic Mesh Implantation (IPOM Plus Repair) As a New Technique for Treatment of Abdominal Hernias.

Reiko Wiessner,Alexander Gehring,Thomas Vorwerk,Claudia Tolla-Jensen

doi:10.3389/fsurg.2017.00062

Abstract

Despite extensive experience and significant reduction of complications in recent years, laparoscopic treatment of complex abdominal hernias is a challenge even for the experienced endoscopic surgeon. Patients with severe incisional hernias or symptomatic rectus diastasis benefit from the closure of the linea alba as a morphological and physiological reconstruction of the abdominal wall followed by mesh implantation. Occasionally, an additional component separation is necessary. In open surgery, this is associated with very large wound areas, postoperative seromas, poor wound healing and, in the worst case, mesh infections. To avoid these complications, we operate these complex reconstructions completely endoscopically. Our concept is based on a laparoscopic closure of the linea alba through an ongoing, barbed non-resorbable 1–0 suture (polybutester) and final reinforcement by an intraperitoneal-onlay mesh (IPOM-Plus). For the treatment of complex abdominal hernias with a width of more than 10 cm, we performed an endoscopic anterior bilateral component separation. This allows the surgeon to combine the advantages of the open abdominal wall reconstruction with those of laparoscopic hernia repair. Between May 2015 and June 2017, we treated 42 patients with abdominal hernias by laparoscopic continuous hernia defect closure and complementary mesh implantation, whereby a complex reconstruction with additional endoscopic anterior component separation was performed in five patients. In this article, we will present this innovative technique of endoscopic/laparoscopic hernia repair in complex abdominal hernias.

Highlights

The treatment of severe abdominal wall hernias is a challenge, both conventionally and laparoscopically
The size of the hernia gap, in particular with the classical IPOM as bridging method, has a great influence on the shear forces to the mesh and, on possible bulging phenomenon and the forces acting on the fixation points [1]
In an abdominal wall model, it could be proved that the mesh overlap should be proportional to the size of the hernia defect [2]

Summary

Introduction

The treatment of severe abdominal wall hernias is a challenge, both conventionally and laparoscopically. In an abdominal wall model, it could be proved that the mesh overlap should be proportional to the size of the hernia defect [2]. The standard IPOM reaches its limits with large defects. In addition to functional morphological aspects of the abdominal wall reconstruction, the closure of the linea alba has the advantage that a sufficient overlap with a mesh is again possible. In cases with very large hernia defects, the technique reaches its limits. We have established a surgical technique in our clinic where patients receive a laparoscopic closure of the linea alba with an intracorporal, continuous, nonresorbable, self-sustaining suture, and final reinforcement by an intraperitoneal-onlay mesh. Large abdominal wall defects first receive a bilateral endoscopic anterior component (EAK) separation followed by the IPOM Plus technique

Methods

Results

Conclusion