Prof. Dr. R. K. Mishra. MRCS,M.MAS (U.K).
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Patient should be under general anaesthesia, Nasogastric tube is introduced and there should not be any Organomegaly if surgeon is planning two port laparoscopic repair of ventral hernia.
Access is performed through Palmers Point.
Veress Needle or Open technique both can be used for access from the palmers point.
All the safety indicators should be used and checked at the time of access
10 mm port should be introduced carefully through palmers point. It should be introduced perpendicular not oblique towards anus to avoid injury of splenic flexor of colon.
Telescope should be introduced and the size extent and content of hernia is assessed.
After initial assessment of ventral hernia one more port is introduced according to Base Ball Diamond concept.
Content of hernia is reduced and adhesiolysis should be performed for any possible omental or bowel adhesion.
Size of the Mesh is selected in such a way that, at least it should cover 4 cm all around beyond the healthy margin of defect.
1mm only skin deep stab incision should be given at all the four corner of mesh.
6 cm long PDS is tied around three corner of the mesh and one of the remaining corner should be tied through the needle and thread introduced through one of the stab wound of skin.
The thread which was introduced percutaneously will help to stablize the mesh and it will act as the third port.
Both the end of mesh is pulled out through the same skin puncture side but keeping rectus and peritoneum in between.
The end of both the thread should be ligated using tumble square knot and it should be slipped inside before locking to avoid loosening.
This two port technique can be accomplished with the help of Anchor or Protack or Tacker if patient can afford. Two port technique using PDS is safe and economical method of performing laparoscopic repair of ventral hernia. Although using strategically placed knot we have performed one port repair of ventral hernia also with the help of suture passer but if adhesions are present one port technique is not possible. Two port technique should be included in the practice of repair of ventral hernia surgery laparoscopically because in case of any difficulty the third port can be introduced any time without any difficulty.
