Completely Intra- Peritoneal Technique of Augmentation During Laparoscopic Ventral Hernia Repair

Jagpreet S Deed, MS, DNB, MRCS, Gen, Surg1, Parveen Bhatia, MS, FRCS, FICS, FIAGES, FMAS, FAIS, FALS2, Vinay Sabharwal, Medical, Director, amp, Chief, MS, Gene, Surg3, Vivek Bindal, MRCS, Fellowship, , MAS, Endoscopy, FNB4. 1Zulekha hospital, Sharjah, UAE, 2SIr Ganga Ram Hospital and Bhatia Global hospital and Endosurgery Institute, 3Jeewan Mala Hospital, 4Sir Ganga Ram Hospital

Background: Augmentation or closure of hernial defect is an important step, while performing laparoscopic ventral hernia repair. It reduce the hernia defect to zero size, eliminates bulging and simulates physiological condition more closely. It reduces the seroma formation, allows greater overlap of mesh and more surface contact between mesh and abdominal wall. It may also result in reduced pain probably due to reduced stretch at the edges of defect.

  • Utilizing intraperitoneal technique for augmentation completely avoids the risk of contamination by skin organisms which may occur due to percutaneous introduction of suture.

Objective: To evaluate the utility of completely intra- peritoneal technique of augmentation during laparoscopic ventral hernia repair

Methodology: We utilize intracorporeal suturing with non-absorbable suture to close the defect completely. Suturing on ‘roof’ is made simpler by manual pressure from external skin aspect which achieves the desired orientation and angulation of the abdominal wall. After closure of defect IPOM (Intra-peritoneal onlay Mesh) placement is done by a combination of transfacial sutures and tacks.

Results: Since 2008, 63 patients underwent laparoscopic ventral hernia repair by the described method. 4 patients (6.3%) developed seroma, which resolved with conservative management. There were no other major or minor complications and no recurrence. The pain & quality of life scoring were acceptable.

Conclusions: The technique is easy, inexpensive and reproducible. It can be routinely utilized during surgery of laparoscopic ventral hernia repair.

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