Device Objective:
Laparoscopic ventral hernia repair (VHR) is a well-accepted method for addressing abdominal wall hernia. The BARD ECHO mesh positioning system is a newly marketed device used to facilitate mesh placement and improve the efficiency of laparoscopic VHR.
Description:
The BARD ECHO device consists of a pre-attached inflatable balloon packaged with Ventralight ST polypropylene mesh and custom mesh rolling tines. Once rolled and introduced into the abdominal cavity, the inflation hose is delivered through a stab incision in the abdominal wall and subsequently used to inflate the balloon, thereby unrolling the mesh. Gentle traction on the hose apposes the mesh to the abdominal wall, facilitating orientation and fixation with tacks. Once fixation is complete, the device is deflated and removed through an existing port.
Results:
Our recent experience of 11 cases using the ECHO device was compared with a group of 15 previous Laparoscopic VHRs using Ventralight ST mesh. Both cohorts were matched with respect to age, gender, body mass index (BMI), and size of hernia defect. Mean BMIs were 31.4 (ECHO) and 33.9 (Non-ECHO). Mean defect sizes were 65 cm sq. and 52.5 cm sq. (unpaired t test, p-value= 0.55) in the ECHO and control groups, respectively. There was no significant difference in mean operative time between the ECHO (95.5 minutes) and control groups (97.6 minutes), p-value= 0.872. In the ECHO group, trans-fascial sutures were selectively employed in addition to tack placement in 5 of 11 patients (45%). Operative time in this subset of patients was significantly longer than when tack placement alone was utilized (122.4 vs. 76.8 minutes, p-value= 0.0043). Mean operative time using the ECHO device with tacks alone for mesh fixation was less than for the control group (76.8 vs. 97.6 minutes), though this did not reach statistical significance (p-value= 0.2061).
Conclusions:
Use of the BARD ECHO device with tack placement alone as a means of securing the mesh is associated with decreased operative time. However, our early experience with this novel mesh deployment device fails to demonstrate a statistically significant improvement in operative time when compared to a matched control group. As experience with this device accumulates, we anticipate that its use will confer unique advantages and decrease operative time compared to the traditional method. Further evaluation with a more adequately powered study is warranted.
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