Page 55 - World Journal of Laparoscopic Surgery
P. 55

Laparoscopic Ventral Hernia Repair























            Fig. 1: Fixation of mesh by transfascial suture    Fig. 4: The mesh placement after retromuscular flap creation
























            Fig. 2: Double crowning technique for mesh fixation  Fig. 5: Closure of peritoneum over the mesh

                                                                  We imitated the technique of the previous studies. 20,21  The
                                                               first row was put right at the defect or the hernia and the second
                                                               one was placed at the mesh, 5 cm from the defect edge. To avoid
                                                               adhesions between the mesh and the abdominal organs, created
                                                               peritoneal flaps, or greater omentum were interfaced. Closure of the
                                                               skin was completed using 3–0 sutures or skin stapler. A gauze ball
                                                               was put over the area of the defect, with a gentle pressure dressing
                                                               applied and kept for 2 weeks allowing its support, obliteration of
                                                               any space between the mesh and parietal wall, and creation of
                                                               adhesion in between.
                                                               Transabdominal Retromuscular Repair
                                                               The same steps were followed as IPOM and the same technique
                                                               of the previous studies was performed. 20,21  The measurement of
                                                               the defect was done by the use of a paper ruler (Fig. 3). Then start
                                                               to create a retromuscular flaps through the preperitoneal plane all
                                                               around the defect, 5-cm distance from the defect edge to create
            Fig. 3: Measurement of defect size by a paper ruler  roomy space for mesh placement (Fig. 4). After securing good
                                                               hemostasis and closure of the fascial defect using non-absorbable
            the defect margins and anchored to the anterior parietal wall after   suture, the polypropylene mesh placement in retromuscular space
            lowering the pressure down to 6–8 mm Hg. Fixation was performed   was done and fixed using some absorbable tacks with the closure
            using transfascial sutures and double crown technique using   of the peritoneal flaps over the mesh by interrupted sutures using
            absorbable tacks (Figs 1 and 2).                   Vicryl 3/0 (Fig. 5).

                                                        World Journal of Laparoscopic Surgery, Volume 15 Issue 2 (May–August 2022)  151
   50   51   52   53   54   55   56   57   58   59   60