Eiichi Hirai, MD, Hideto Oishi, MD, Fumi Maeda, MD, Takeshi Ishita, MD, Masayuki Ishii, MD, Takuya Satou, MD, Takayuki Iino, MD, Hidekazu Kuramochi, MD, Shunsuke Onizawa, MD, Mie Hamano, MD, Tutomu Nakamura, MD, Tatsuo Araida, MD. Division of Gastroenterological Surgery,Department of Surgery,Yachiyo Medical Center,Tokyo Women’s Medical University.
We have begun to perform laparoscopic abdominal incisional hernia repair strictly with anchor sutures rather than tacks when fixation of a large mesh is required. We do this to prevent the hernia repair from splitting open should the patient awake from anesthesia bucking and to prevent hernia recurrence during the early postoperative period, both of which are potential, unacceptable complications. Our suture-only strategy arose out of three background experiences: (1) our regular application of hernia orifice reefing performed with needle forceps to close the fascia with a few thick absorbable sutures in patients with a large hernia, (2) our switch to anchor suturing rather than suturing and tacking for fixation of the mesh, and (3) our chance observation that, after 3 years, no adhesions involving the mesh were found in a patient treated for a large hernia by orifice reefing and then mesh fixation with sutures rather than tacks. We describe our new procedure as well as outcomes in five cases.
With the patient under general anesthesia with deep muscle relaxation, we close the hernial orifice with PCO mesh that we attach with anchor sutures of 3-0 absorbable material placed every 4-5 cm. The mesh is firmly secured by this method. It lies flat against the abdominal wall; there are no wrinkles.
We have used this mesh repair technique in five patients with a large abdominal incisional hernia. The repair was good in all cases. The patients experienced some pain due to the reefing of the hernia orifice, but the pain was alleviated with NSAIDs, which were administered for a few days. There were no complications or recurrences, and all patients were satisfied with the procedure.
It is our belief that hernia orifice reefing and strict anchor suturing rather than tacking of the mesh will both simplify the mesh repair procedure and resolve the problems associated with it.