The "Slim-Mesh": Single Operation with Multiple Slim-Meshes for Multiple Widely-Spaced Ventral Hernias in the Same Patient

Abstract

Purpose: Test the technical feasibility of the "Slim-Mesh" technique using multiple "Slim-Meshes" during an operation for multiple widely-spaced ventral hernias in the same patient; verify the results of a 12-year followup.Methods: From September 2009 to December 2019, 8 patients with the above hernias were treated exclusively with the "Slim-Mesh" technique at our Department. This was a prospective (63%)-retrospective study.Results: This study comprised 6 males and 2 females. Mean age was 57 years. Three of the 8 cases had a triple spaced ventral hernia (Group 1): 2 of the 3 were treated with 2 "Slim-Meshes" each, and the remaining patient with 3. The remaining 5 cases had one double spaced ventral hernia each (Group 2); each case was operated on with 2 "Slim-Meshes". During operation, the author also found and repaired associated diastasis recti in 38% of cases, doing so without using additional "Slim-Meshes". Mean operation time for all 8 cases, Group 1 and Group 2 was 153, 220 and 112 minutes respectively. Composite mesh, non-composite mesh, titanium tacks and absorbable straps for mesh fixations were used in 87.5%, 12.5%, 25% and 75% of cases respectively. Mean length of hospital stay was 3 days. Mean follow-up time was 6 years. No early or long-term postoperative complications occurred. Conclusion:This study revealed the existence of a new patient-type, namely one with multiple widely-spaced ventral hernias (7%). My technique facilitates intra-abdominal introduction and fixation of successive multiple meshes during the same operation, proving to be safe, fast and economical.

“Slim-Mesh” Technique for Diastasis Recti Abdominis, Including Obesity-Related Cases

“…The mesh used is called a "Slim Mesh" because of its thickness, becoming "slim cigarette like", 10,[19][20][21][22][23][24][25][26][27][28][29] and not because of its composition, weight or size, even when large pieces of mesh are placed.…”

“…DRA can cause discomfort in the abdomen 8,9 and a great loss of function of the AW muscles with abdominal and back pain, as well as respiratory disorders, 10 fecal and urinary incontinence, and a gynecological complaint called pelvic organ prolapse. 9 In DRA patients, back pain is due to the occurrence of spinal troubles because of a dynamic imbalance of the forces generated by the front and rear muscles of the trunk.…”

“…9 In DRA patients, back pain is due to the occurrence of spinal troubles because of a dynamic imbalance of the forces generated by the front and rear muscles of the trunk. Consequently, this AW dysfunction may contribute to restricting a patient's everyday physical activity, such as standing, walking, running, working, lifting weights, [8][9][10] especially in cases of mothers when they are caring for their newborns, e.g., picking them up, or jogging.…”

“…However, the low number of cases studied with the above techniques in literature and their unproven scientific and methodological quality do not provide an adequate degree of scientific evidence. 1,18 I treated DRA patients with the "Slim-Mesh" ("SM") technique 10,[19][20][21][22][23][24][25][26][27][28][29] to repair/reinforce the diastasis and LA/recti muscles of the AW without plicating and traumatizing them, which does not occur with "SM" (Figures 3, 4, and 5, see "SM" YouTube video: https://www.youtube. com/watch?v5w6Ywy7KHJNg&t54s).…”

“…27 My primary goal was to empirically test the technical feasibility/reliability of the "SM" sutureless technique for patients with DRA, mostly obese, by exploiting the well-known advantageous qualities of laparoscopy combined with the "SM" technique's benefits in reducing intra-and postoperative complications and operation time. 10,[19][20][21][22][23][24][25][26][27][28][29] My secondary goal was to verify the "SM" technique's outcomes in DRA patients, including obese ones, with a 13year follow-up study.…”