Page 29 - Journal of WALS

Bharati Vishwanath Hiremath et al

did not look infected. These sinus tracks along with the bit
of mesh were excised (Fig. 1). The other two sinus tracts
contained the prolene sutures used for transfacial fixation
of the mesh (Fig. 2). All these sinues extended from the
skin upto external oblique aponeurosis only.
After excising the tracts, defects in the external oblique
aponeurosis were closed with 1-0 prolene (Fig. 3). Since,
the mesh did not look infected and all cultures were negative,
a decision was made not to remove the mesh. A primary
closure of skin and subcutaneous tissue was done. Patient
did well postoperatively. All wounds healed well and now
patient is 5 months postoperative and doing well.

DISCUSSION
Fig. 3: After sinus excision
Laparoscopic repair of ventral hernia was introduced in the
9
early 1990s. Since, then newer and newer methods of mesh sutures in 1996. In recent times different types of fixation
fixation are being introduced. Majority of the published devices are available for reinforcing the fixation of the mesh.
reports advocate the mandatory use of transfacial sutures 8 A few types of such tacks available are compared in the
and further fixation may be achieved by various fixation table below:
devices available. Park et al first popularized the use of LVHR involves using a mesh and fixing it to the anterior
abdominal wall using sutures and fixation devices.
Transabdominal prolene nonabsorbable sutures are used to
fix the mesh. However, the chief disadvantage is that the
knots of these sutures can be felt in the subcutaneous plane
and can cause significant discomfort to the patient.
Moreover, application of these sutures is a tedious process.
With different types of fixation devices e.g. tacks being
available over the recent years and the ease of their
application has made their use more appealing. The list of
these fixation devices is as shown in the Table 1. Of these
the most commonly used ones are tacks. Nonabsorbable
titanium helical tacks are deployed through the mesh to fix
it to the anterior abdominal wall (peritoneum to
preperitoneum). They are compatible with magnetic
Fig. 1: Contents of sinus tracts resonance imaging and inert in tissue. However, the use of

Table 1: Few of the types of tacks available
Type Composition Degradation
Absorbable Blend of polydioxanone Hydrolysis by
ethicon dyed with D and C violet 12 to 18 months
SecureStrap TM #2 and an L lactide/
5 mm strap glycolide copolymer
device
Absorbable 5 mm Synthetic polyester Hydrolysis by
spiral tapered copolymer derived from 1 year
construct lactic and glycolic acid
AbsorbaTack TM
Absorbable 5 mm Poly (D, L)–Lactide Degrades by
spiral construct (PLA) 1 year post-
Sorbafix TM implantation
Nonabsorbable Titanium
titanium helical
fastners protack
Fig. 2: Sinuses with sutures and tacks
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JAYPEE