Laparoscopic treatment of an umbilical hernia using a new composite mesh

Abstract

A case is reported of a recurrent umbilical hernia treated using an intraperitoneal Parietex® Composite mesh through a laparoscopic approach. Three trocars were inserted in the left flank. According to the size of the defects (3×5cm), a 15 × 10cm composite mesh was selected. The edges of the defects and the shape and size of the mesh centered on the hernia were drawn on the anterior abdominal wall. A reference point was positioned 1 cm outside each angle of the mesh. After the hydrophilic and absorbable film had been hydrated, the mesh was rolled, the film inside, and introduced within the peritoneal cavity. The mesh was carefully oriented with the smooth side on the viscera, porous side towards the wall. A 2mm cutaneous incision was performed at each reference point. An absorbable suture was inserted in the cutaneous incision, routed through the wall and the mesh, and finally brought out through the same incision. Using such a method, a transparietal subcutaneous suture was obtained in each corner and the mesh could be perfectly centered on the defect. The 1 cm distance between each corner of the mesh and the emerging tip of the needle induced a moderate tension within the mesh which balanced the relaxation of the wall during the exsufflation of the pneumoperitoneum. The final fixation of the mesh was then obtained using non-absorbable metallic devices. Hospital discharge was after 2 days and the patient returned to a normal activity within 10 days. After a three-month follow-up, no complication attributed to the laparoscopic approach or to the intraperitoneal position of the mesh had been reported.