Sutureless "Slim-Mesh" Technique for the Repair of Abdominal-Wall Hernias in the Obese Population

In 2009, we designed the sutureless "Slim-Mesh" laparoscopic technique to facilitate and promote repair of ventral hernias in the obese/superobese populations, including cases with large-giant/massive and multiple widely-spaced hernias. We also aimed to reduce surgical time and intra- and postoperative complications.

Cases were divided into Class I (body mass index [BMI] 30.0-34.9 kg/m²), II (35.0-39.9 kg/m²), III (40.0-49.9 kg/m²), and superobese (50.0-59.9 kg/m²). A ventral hernia was small-medium (∅ 2-9.9 cm), or large (∅ 10-14.9 cm)-giant (∅ 15-19.9 cm)/massive (∅ ≥ 20 cm). Between September 2009 and May 2023, 64 obese/superobese ventral-hernia patients were enrolled prospectively (81%)-retrospectively and treated with the Slim-Mesh technique.

We operated on 35 males and 29 females. Mean age and BMI were 60 years old and 33 kg/m², respectively. Class I cases numbered 48, II 13, III 2, with 1 superobese case. Small-medium, large-giant, and massive ventral hernias were found intraoperatively in 40, 21, and 3 cases, respectively. Mean surgical time for all cases was 104 minutes. Mean length of hospital stay was 2 days and mean follow-up time was 5 years. We had 1 case of chronic abdominal-wall pain and 6 late postoperative-complications: 4 (6%) hernia recurrences, and 2 trocar-site hernias.

The sutureless "Slim-Mesh" technique implements the laparoscopic approach to repair ventral hernias in the obese/superobese populations rather than open surgery or traditional transfixation suture-based laparoscopy, including cases with large-giant/massive and multiple widely-spaced hernias. This study proves that "Slim-Mesh" is safe, straightforward, quick, easy-to-reproduce, and economical.