Novel Technique for Full-Thickness Abdominal Wall Closure in Laparoscopic Ventral Hernia Repair

Laparoscopic ventral hernia repair incorporating a prosthetic mesh underlay, first described in 1993, has demonstrated a lower long-term recurrence rate versus open non-mesh repair. However, over the past 25 years, the laparoscopic approach to ventral/incisional hernias is utilized in only approximately 30% of cases. One of the reasons that prevents it from being utilized more often is the inability to readily, reliably, and easily close the fascial defect. A novel technique has been developed for full-thickness abdominal wall closure in laparoscopic ventral hernioplasty, utilizing puncture sites to place multiple self-locking ligature straps. Introduction of the straps into the abdominal cavity in orthogonal orientation to the skin surface, followed by subcutaneous retrieval of the contralateral tip of the strap, achieves incorporation of full-thickness abdominal wall on either side of the defect. The self-locking property of each strap allows tension to be applied in sequential fashion. Incremental tension application facilitates re-apposition of the borders in large defects. The increased width of the strap compared with conventional suture serves to resolve the force exerted upon tissue during the acute phase of defect closure. The instrumentation was tested in six ventral hernias created in resected porcine belly walls. Subsequent tests were conducted in three swine with large congenital umbilical hernias. One of the test animals was re-examined laparoscopically 30 days post repair, with full healing and no recurrence exhibited upon re-examination. We anticipate that the simplicity and functionality of this technique will translate to clinical utility in the significant cohort of human ventral hernia patients.