Michael W Cook, MD, FACS, Jude Barber. Louisiana State University Health Science Center
There has been a lot of recent discussion regarding the optimal material for reinforcement of ventral hernia defects. Tissue repairs were commonplace prior to the advent of synthetic meshes. Synthetic meshes are cost effective and cut down on recurrence rates. However, when mesh becomes infected, the cost to treat the infection, including mesh explantation and reoperations for recurrence, can be high. Further complications including bowel erosion can lead to catastrophic results. Patient concerns related to mesh are more commonplace and have led to the use of biologic meshes. Biologics can be very expensive and are difficult to work with, particularly in laparoscopic repairs. Biologics theoretically perform well in infected fields, but occasionally inexplicably completely resorb, leading to recurrence. Bioabsorbable meshes are more cost effective, but are designed to reabsorb at some point, which may lead to recurrence. We present a novel use of a previously described substrate for tissue repair, that of autologous dermal graft.
The video shows the steps involved in the harvest of the skin graft from the inguinal crease, preparation of the graft for use as mesh, implantation in an intraperitoneal onlay position via the laparoscopic approach, and fixation via traditional methods. This approach is surprisingly simple to apply and has the potential to drive down healthcare costs in the United States. It further adds a viable option for repair in countries with much more limited resources where even traditional synthetic meshes are not easily obtainable.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95794
Program Number: V091
Presentation Session: Inquinal and Ventral Hernia
Presentation Type: Video