English

Abstract

BACKGROUND Incisional hernias are a common occurrence following midline laparotomy. Numerous techniques have been employed in the management of this common condition. Randomized trials and evidence based medicine help us in deciding what the optimal treatment is in a particular condition. This is often not possible in case of hernia due to the heterogeneity of population. Laparoscopy is gaining popularity in the management of this condition as results are comparable to open surgery with lesser post-operative pain. The placement of mesh intraperitoneally as in laparoscopic intraperitoneal onlay mesh repair has its own disadvantage such as mesh erosion into viscera. Placement of mesh endoscopically as an onlay repair seems to be a good option, more so in the developing world, considering the prohibitive cost of composite mesh. The purpose of this study was to analyze the technical ease, reproducibility, outcome, postoperative pain and complications of laparoendoscopic hybrid technique in the management of abdominal wall hernia. METHODS This technique combines the benefits of minimal invasive surgery and ease of onlay mesh repair, while reducing wound related problems associated with open surgery. It involves first a laparoscopic approach in entry, reducing the contents, visualizing the sac followed by endoscopic dissection using the same trocar anterior to abdominal wall in the subcutaneous plane. This is followed by sac dissection, suturing the abdominal wall and placing an onlay mesh RESULTS Fifteen patients have been operated; no subcutaneous drains were placed. A polypropylene onlay mesh was used and fixation done with suturing. No major complications were seen. There was no subcutaneous emphysema. CONCLUSIONS The laparoendoscopic hybrid technique offers advantage of being minimally invasive and having lower wound related complications, with early ambulation and decreased hospital stay. It is also technically easier to suture the defect and allow complete excision of the sac. However a randomized trial is necessary and larger series are required to compare the results with other established techniques. KEY WORDS Incisional Hernia, Laparo - Endoscopic - Onlay Mesh, Surgical Techniques, SCOLA