Open or endoscopic circular intra abdominal VH: A new technique in VHR

Sarkis Yeretsian, MD. Clinique Medic-Aide

1) Objective of the technology or device:

Description of a new technique in ventral hernia repair from the peritoneal cavity (Circular Herniorrhaphy) without large raising/dissecting myocutaneous flaps without bilateral external oblique fasciotomy.

2) Description of the technology and method of the use or application:

The old scar is not excised. The abdomen is entered via a midline laparotomy. The incision is extended at either end to give adequate access to all the margins of the defect. The peritoneum is entered and the sac contents reduced. The hernia sac excised. All intra-abdominal adhesions are lysed past the lateral border of the rectus muscle. A circular heavy weight Auto-Graft Bio-Synthetic mesh (polypropylene) is used for ventral hernia repair. The mesh is tailored upon the size of the hernia. The main objective of this technique involves the application of two or three row of circular sutures on the mesh separated from each other by 3.5-4.0 cm. The first row of polypropylene 2-0 continuous suture is passed from the edge of the circular mesh taking full thickness of the wall including the parietal peritoneal and the posterior rectus sheath. The first row of suture is used for anchoring the mesh, as well as, partial approximation of the lateral displaced rectus abdominis muscle towards the midline.The second row of suture delineated by tinted circle to ease the surgeon task is passed 3.5-4.0 cm from the first row of suture will apply, as the first row of sutures, centripetal forces on the floppy anterior abdominal wall leading an approximation of the rectus muscle to its normal anatomical and physiologic position and will re-establish the linea Alba. An overlapping condition of both edges of the skin and subcutaneous tissue created by this method will necessitate an excision of both edges of the skin for cosmetic wound closure. A third row of suture could be done if necessary. Bleeding could be avoided by meticulous placement of the sutures only on the posterior rectus sheath thus avoiding the vasculature of the rectus muscle. This technique could be an alternative to component separation, bulging and diastasis cases in moderate size hernias (10-15cm) located above the arcuate line.

3) preliminary results.

5 cases were performed during my residency in general surgery using this novel technique. One wound infection was treated successfully with I-V antibiotic. A bulging case produced after open cholecystectomy was treated successfully using Circular Herniorrhaphy.

4) Conclusion/future direction.

Open or Endoscopic Circular Intra-Abdominal Ventral Herniorrhaphy (Circular Herniorrhaphy) could be an alternative to Component Separation, Dastasis and Bulging cases without extensive dissection in moderate size hernias located above the arcuate line and could reduce the rate of hernia recurrence.

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