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Application of a New Mesh Fixation Method in Laparoscopic Incisional Hernia Repair
Published on: December 23, 2022
Mesh shift following laparoscopic ventral hernia repair
Mike K Liang1, Marissa L Clapp, Andrea Garcia
1Department of Surgery, Michael E. DeBakey VAMC, Baylor College of Medicine, Houston, Texas 77006, USA. ml3@bcm.edu
The Journal of Surgical Research
|April 24, 2012
Summary
Mesh shift is common after laparoscopic ventral hernia repair (LVHR), with nearly half of patients experiencing it. This mesh migration, often away from the surgical site, may precede hernia recurrence.
Area of Science:
- Surgical innovation
- Medical imaging
- Hernia repair techniques
Background:
- Laparoscopic ventral hernia repair (LVHR) traditionally involves trocar placement on one side, potentially complicating mesh fixation.
- Mesh shift, defined as displacement from the hernia defect's center, is hypothesized to occur with this approach.
Purpose of the Study:
- To evaluate the incidence of mesh shift after LVHR.
- To develop a grading system for mesh shift.
- To investigate the relationship between mesh shift and hernia recurrence.
Main Methods:
- Retrospective review of 201 patients undergoing LVHR from 2000-2010.
- Analysis of 78 postoperative CT scans to measure mesh overlap.
- Development of a four-grade system (I-IV) to classify mesh shift based on overlap ratios.
Main Results:
- Mesh shift occurred in 48% of patients (Grade II: 23%, Grade III: 10%, Grade IV: 17%).
- In most cases (92%), mesh shifted away from the port placement site, reducing fascial overlap.
- A trend toward increasing mesh shift over time was observed, and recurrences (Grade IV) were associated with mesh shift.
Conclusions:
- Mesh migration is a significant issue following LVHR, often occurring towards the non-operative side.
- Mesh shift may be an early indicator of potential hernia recurrence.
- Strategies to improve mesh fixation, such as increasing overlap and optimizing tack placement, are suggested.
