Andrew C McCoy, MD, James Rifenbery, MD, Michael Higgins, MD. Franciscan Health System.
Introduction: Laparoscopic ventral hernia repair has become widely used, however one of the more frustrating aspect of the repair is the inability to correctly place trans-abdominal sutures and still maintain the correct tension and placement in the peritoneal surface. This is especially true in patients with a high BMI. This is due to the fact that the curvature of the skin is not identical to the curvature of the peritoneum. It is common for surgeons to place the trans-abdominal sutures perpendicularly with a suture passer from the skin to the mesh. This method will only work on thin patients. In larger patients this technique usually causes the mesh to be loose and have wrinkles
Methods: In an effort to standardize the correct placement of trans-abdominal sutures, several abdominal CT scans of patients with varying BMIs were evaluated. The curvature of the skin and the underlying peritoneum were measured to find the correct distance a trans-abdominal suture should be placed with relation to the patient’s BMI.
Results: In patients with a BMI of 25 to 50, the distance “X” that needs to be added to account for the extra circumference of the skin is subject to the formula: X cm = (BMI – 10)/10.
Conclusion: Any formula trying to judge the variables of distance is subject to error and interpretation. Manipulation and adjustment is occasionally necessary. However, we have found that this formula for suture placement to be correct in a majority of patients with a BMI ranging from 25 to 50. We have named this formula the Higgins Formula after Dr. Higgins who derived the formula.