LAPAROSCOPIC VENTRAL HERNIA REPAIR: A SINGLE SURGEON STUDY USING A CIRCUMFERENTIAL TRANSFASCIAL SUTURE TECHNIQUE.

BACKGROUND: The ideal technique for ventral primary and incisional hernia repair is unclear. There is a paucity of literature from South African authors. In this report, a standardised technique of intraperitoneal mesh placement and fixation is described.

METHOD: A retrospective study of 152 patient records. Each patient underwent laparoscopic ventral hernia repair between 2007 and 2016 by a single surgeon. A standardised technique was used in every operation. In each case a circumferential mesh overlap of 5 centimetres from the defect was achieved. The same composite mesh was used in every operation. The mesh was secured with transfascial Tycron sutures placed around the circumference at 2 centimetre intervals. The correct position of the mesh was confirmed with skin markings from a template, prior to pulling the sutures through the abdominal wall with an Endoclose.

RESULTS: 152 patients underwent a total of 154 operations. They were followed up at 2 and 6 weeks postoperatively and longer in many patients. The average follow up time was 327 days.Seromas occurred in 16 patients, one persisting beyond 6 weeks, which resolved after aspiration. Three patients developed abscesses, requiring mesh removal in 2. Hernia recurrences occurred in 3 patients (1.97%). More than one mesh was used in 6 patients. Few patients had any residual pain at 2 weeks and none at 6 weeks. The average hospital stay was 2 days.

CONCLUSION: The described standardised technique of laparoscopic ventral hernia repair results in a very secure mesh fixation with evenly distributed load on the mesh. The potential complications associated with tacks, inadequate fixation and cost of tacks are avoided.