Laparoscopic geometrical repair of ventral hernia

Abstract

Recurrence after ventral hernia repair is a common problem worldwide. Laparoscopic mesh repair has been associated with fewer recurrences and also minimal morbidity. The technique of the laparoscopic repair is based on the principle described by Stoppa, however the hernial sac is not dissected and is left behind. This minimizes difficult dissection, blood loss and large incisions. The mesh in laparoscopic repair is fixed intraperitoneally using tackers or with the dual method of tackers and sutures, but some kind of suture fixation is mandatory. We describe a technique of fixing the mesh with sutures only. Over a period of 52 months 88 ventral hernias were repaired using the suture only technique. The mean size of the defect was 9.0cm (65.0cm2) and the mean size of mesh used was 19.5cm (293.5cm2). Our technique involves fixing the mesh with sutures circumferentially in two circles. The tackers and staplers were not used. The sutures are placed at fixed intervals, in fixed numbers and in fixed positions as mapped out with the help of circular protractors, compass and ruler. The protractors helped us in standardizing the placement intervals of sutures and in the orientation of the mesh. The orientation is maintained even for a very large mesh. There was no infection of the mesh, recurrence or mortality. The patient experienced minimal wound pain and the recovery was quicker. This is the only technique of laparoscopic ventral hernia repair we are aware of in which the suture intervals, position of the sutures and the number of sutures are standardized. This approach is suitable for all types of ventral hernia. It is safe, cost-effective and, so far, recurrence free.