A Laparoscopic Approach to Components’ Separation and Incisional/Ventral Hernia Repair

Raymond J Ippolito, MD, Beth A Collins, MD. Hospital of Saint Rapheal New Haven, Connecticut

Advances in surgical techniques and improvements in synthetic and biological meshs have allowed for the repair of large and complicated hernias that would not have been attempted in the past. Components’ separation has provided for excellant mobilization of the abdominal wall musculature which enables even large defects to be closed primarily with sutures. High recurrence rates, infection, and rather prolonged hospitalizations have been common with the open procedure.

In the present case, we present a patient with a large complicated incisional hernia who underwent a laparoscopic components’ separation which was facilitated by the use of a Dissecting Balloon. The space created for the separation between the rectus abdominus muscle and overlying anterior rectus fascia was then maintained using a Structural Balloon. These devices are commonly used in laparoscopic inguinal hernia repairs, but not in components’ separation. Viewing the undersurface of the anterior rectus fascia, the most lateral aspect of that fascia is then cut under direct vision from the pubic bone to  just above the lowermost rib. This allows for the mobilization of approximately 8-10 cms. of abdominal wall musculature.  Sutures are then placed and tied intracorporeally to primarily repair the fascial defect. Reinforcement of the suture repaired hernia defect is then accomplished with a large composite mesh held in place by several concentric rows of tacks .No drains were placed. The patient was hospitalized overnight and discharged the following day. She is making an uneventful recovery.

Although preliminary, this case demonstrates that components’ separation with primary suture repair of large incisional hernias followed by mesh reinforcement can be accomplished laparoscopically. By avoiding large abdominal wall incisions, recovery time and infection rates should decrease significantly. This will allow for the more liberal use of synthetic meshs in these cases.

Session: Emerging Technology Poster
Program Number: ETP027
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