Anil Kumar T, Post, Graduate, Manash Ranjan Sahoo
SCB MEDICAL COLLEGE, CUTTACK, ODISHA, INDIA
OBJECTIVES: Laparoscopic ventral hernia repair has gained popularity over open conventional surgery as it offers many benefits to patients mainly in terms of low recurrence rate and better cosmesis. Although this is a costly procedure as the patient has to purchase costly mesh, patients coming to government hospitals asking for it especially recurrence after open repair. We are sharing our experience of laparoscopic ventral hernia repair (LVHR) using spinal needle as a transfascial suture fixation device, in referral government hospital.
MATERIALS AND METHODS: From July 2007 to July 2012, we retrospectively collected data of 72 consecutive LVHR with sutured closure of the defect. 32 patients had recurrent incisional hernia following open hernioplasty, 15 had recurrent incisional hernia following sutured repair, 3 patients had recurrent incisional hernia following pfannenstiel incision and 22 had primary ventral hernias. The defect was closed by continuous suturing with 1-0 monofilament suture. In all the cases, the defect closure was reinforced by intraperitoneal onlay mesh (IPOM) placement. The mesh used was tissue separating multilayered mesh. Mesh was fixed to anterior abdominal wall by midline transfascial suture and edges of the mesh are fixed by intracorporeal suturing and transfascial suture fixation using a spinal needle & the mesh was centralised by taking an atraumatic cutting polyamide needle from outside through 10 mm port & fixing into the centre of the mesh & taking the mesh inside through the 10mm port under 4 mm telescopic vision.
RESULTS: The mean hernia defect was 6.4 cms. The mean operative time was 131 minutes and there were no intra operative complications. The mean hospital stay was 3 days. At mean follow-up of 18.2 months, there have been no recurrences. There were no intra-operative and post-operative complications
To all patients we asked why they opted for this procedure even though it is costlier, the primary reason was decreased recurrence rate and the second was better cosmesis.
CONCLUSION: Laparoscopic ventral hernia repair in government sector hospital is feasible. Most of the patients come with recurrent hernia after open repair. Cost of the procedure can be reduced by intracorporeal suturing and transfascial suture fixation using a spinal needle for mesh fixation but cost of the tissue separating mesh worries for many patients. Despite, patients are demanding for this procedure; main reason was high recurrence with open repair, not the cosmetic reasons.
Session: Poster Presentation
Program Number: P270