Minimally Invasive Functional Abdominal Wall Reconstruction: A New Paradigm in Ventral Hernia Repair.

Laparoscopic ventral hernia repair has resulted in significant reduction of wound complications as compared to standard open techniques. However, the current laparoscopic approach requires bridging of an adynamic sheet of prosthetic material. This can result in paradoxical abdominal wall motion during straining. Abdominal wall bulging and a poor functional and cosmetic outcome can result in patient dissatisfaction. Endoscopic component separation has been described for reducing wound complications when accompanied with complex open abdominal wall reconstructions. We hypothesize that the combination of an endoscopic component separation at the time of a purely laparoscopic ventral hernia repair with primary fascial reapproximation and mesh augmentation might be the ideal abdominal wall reconstruction.
We present a case of an incisional hernia repaired with the use of an endoscopic component separation. After the myofascial advancement flaps are created, the laparoscopic ports are then placed intraperitoneally. The fascial defect is closed with transfascial sutures using a laparoscopic suture passer. After primarily closing the fascial defect a synthetic mesh is placed intraperitoneally and secured with transfascial fixation sutures.
A minimally invasive functional dynamic abdominal wall reconstruction with medialization of the rectus muscle and mesh augmentation might be the ideal hernia repair.

Session: Podium Video Presentation

Program Number: V020

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