Outcomes of Laparoscopic Ventral Hernia Repair with Routine Defect Closure Using “shoelacing” Technique

Laparoscopic approach has become standard to most ventral hernia repairs. The benefits of minimal access include reduced wound complications, improved cosmesis, and faster functional recovery, among others. However, “bridging” of hernia defects during traditional laparoscopic ventral hernia repair (LVHR) often leads to seromas, bulging and, importantly, does not restore a functional abdominal wall. We have modified our approach to LVHR to routinely utilize trans-abdominal defect closure (“Shoelacing technique”) prior to mesh placement. Herein, we aimed to analyze outcomes of LVHR with “Shoelacing”.

Consecutive patients undergoing LVHR with “Shoelacing” were reviewed retrospectively. Main outcome measures included patient demographics, previous surgical history, intraoperative time, mesh type and size, post-operative complications, length of hospitalization, and hernia recurrence.

Between February 2008 and August 2009, 45 consecutive patients underwent LVHR with defect closure. There were 22 females, average age was 55 years (range, 30-81) and the average BMI was 32 kg/m2 (range, 22-50). Sixteen (35%) patients had an average of 1.7 previous repairs (range, 1-4). Intra-operatively, the mean defect size was 82 cm2 (range, 120-600), requiring a median of 3 (range, 2-7) trans-abdominal stitches for “Shoelacing.” Two patients required endoscopic component separation to facilitate defect closure. The mean mesh size used was 278 cm2 (range, 120-600). The mean operative time was 128 min (range, 40-280). There were no intra-operative complications. The average length of hospitalization was 2.8 days (range, 1-10). There were two major postoperative complications (pulmonary embolism-1, stroke-1), however there was no wound related morbidity or significant seromas. At a mean follow-up of 8 months, there have been no recurrences. Postoperative Computed Tomography (available in 9 patients [20%]) revealed complete medialization of rectus muscles.

LVHR with defect closure confers a strong advantage in hernia repair, shifting the paradigm towards more physiologic abdominal wall reconstructions. In this series, we found our approach to be safe and comparable to historic controls in operative times and duration of hospitalization. While providing a reliable hernia repair, the addition of defect closure in our patients essentially eliminated post-operative seromas. We advocate routine use of the “Shoelace” technique during laparoscopic ventral hernia repair.

Session: Podium Presentation

Program Number: S025

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