Laparoscopic transcutaneous closure of central defects in laparoscopic incisional hernia repair
Mike K Liang1, Anuradha Subramanian, Samir S Awad
1Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Michael E. DeBakey Veteran's Affairs Medical Center, Houston, TX, USA. ml3@bcm.edu
Purpose:
The aim of this technical report is to investigate the safety, efficacy, and outcome of transcutaneous closure of central defects (TCCD) for laparoscopic incisional hernia repair (LIHR).
Methods:
Twenty-two patients with incisional hernias underwent a LIHR-TCCD repair. After clearance of the abdominal wall from adhesions, laparoscopic central closures were performed transcutaneously with 0-polypropelene sutures placed every 1 cm of the defect starting at the cranial-most edge of the hernia and ending at the caudal-most edge of the hernia. A standard LIHR was performed with coated polyester mesh placed with at least 6 cm of overlap with mesh on all borders. Transfascial sutures with 0-polypropelene sutures were placed every 4 cm circumferentially, and titanium tacks were used to secure the mesh to the peritoneum every 1 cm.
Results:
The mean age was 52 years and the mean body mass index was 35 kg/m. The mean hernia defect was 4.7 cm×7.2 cm with a mean area of 37 cm. There were no mortalities and no major perioperative morbidities. Minor complications included 2 (9%) cases of pneumonia/pneumonitis. There were no clinically significant seromas, no radiographic or clinical eventrations, and no hernia recurrences with a mean follow-up of 21 months.
Conclusions:
LIHR-TCCD is safe and technically feasible in incisional hernias of width <10 cm. By closing the central defect, seromas and eventrations can be reduced.
