Hybrid technique for laparoscopic incisional ventral hernia repair combining laparoscopic primary closure and mesh repair

Abstract

Introduction: Incisional ventral hernia is one of the most common surgical complications after laparotomy. Laparoscopic repair of incisional ventral hernia has been conducted recently, and the advantages of this procedure have been reported. However, in large orifice cases, the recurrence rate is increased. To improve recurrence rates in large cases, a hybrid method combining laparoscopic primary closure and mesh repair can be applied. Materials and Surgical Technique: Monofilament thread was inserted into the abdominal cavity for hernia closure and pulled from the other side of the orifice. The same procedure was performed from the upper side to the lower side without closure, and all thread was placed in line. Both sides of the thread were then introduced to the midline of the incision through a subcutaneous route. This procedure was conducted with an introducer. All threads were tied, and then a mesh was placed. Discussion: Hybrid techniques already combine mini-laparotomy for hernia closure and subsequent laparoscopic intraoperative onlay mesh for reinforcement, but such techniques require laparotomy. In our technique, closure of the linea alba does not require laparotomy. All procedures were performed laparoscopically. This procedure is very easy and safe, and does not require the abdominal cavity to be opened. Thus, hybrid methods are effective for treating cases of incisional hernia involving a large orifice.

Hybrid: Evolving techniques in laparoscopic ventral hernia mesh repair

“…[ 4 ] Its been reported that hybrid methods are effective for treating cases of ventral hernias involving a large orifice. [ 5 ]…”

Laparoscopic and percutaneous repair of a large midline incisional hernia extending to the bilateral subcostal region: A case report

“…The advantage of our technique is the minimal effect on the scar in the midline incision. The surgical technique we used was comparable to that in a previous report, with some modifications [14] . In the previous report, the subcutaneous threads for closing the defect were tied in the midline where some scar tissue may persist [14] , whereas that of ours were tied in the left lateral side ( Fig.…”

“…Regardless of the surgical techniques, we should keep in mind that the recurrence rate is higher for larger hernias measuring 10–15 cm [14] , [17] , [18] . In this case, a favorable surgical outcome was achieved only in a short-term.…”

“…After lysis of adhesions, percutaneous defect closure was performed with a modified technique described in previous report [14] . The schematic presentation of this percutaneous defect closure is shown in Fig.…”

Outcomes and Complications of Open, Laparoscopic, and Hybrid Giant Ventral Hernia Repair

“…Sharma et al subsequently argued that a limited-conversion technique offered a safe and viable alternative in laparoscopic incisional hernia repair for patients with a bowel incarcerated hernia sac, or requiring extensive adhesiolysis [12]. Other studies have shown that a hybrid technique (laparoscopy with an additional open procedure using only a small incision) reduced the incidence of postoperative complications in patients with giant ventral hernias [13,14]. Griniatsos et al reported a hybrid technique for recurrent incisional hernia repair [15], while Stoikes et al showed that the hybrid approach could be used in obese patients requiring open adhesiolysis during incisional hernia repair [16].…”