Laparoscopic ventral hernia meshplasty with "double-breasted" fascial closure of hernial defect: a new technique

BACKGROUND: Absence of recurrence, seroma, and pain eludes the laparoscopic surgeon managing ventral and incisional hernias. Multifactorial etiology (i.e., obesity, comorbidity, and dyscollagenemia) is a challenge. Surgeons have risen to this challenge by providing laparoscopic ventral hernia repair (LVHR). Stability of mesh in a standard LVHR is attributed to Pascal's Principle (PP). PP, based upon concentration of forces at the point of least resistance, has been classically applied in hydraulic jacks to move large masses. Application of PP in LVHR is thus misplaced where the hernial defect becomes a point of concentration of intra-abdominal forces. This makes the mesh inherently unstable. For a stable mesh aided by PP, benefits of defect closure needed to be explored. METHODS: Between January 2000 and December 2004, 30 nonsmoker patients with incisional, primary ventral, and recurrent ventral hernias were operated on. Laparoscopic closure of the defect augmented with intraperitoneal onlay mesh (IPOM), as done in standard LVHR, was preformed. RESULTS: Thirty patients with 34 defects of a mean "closed defect" length of 5.7 cm (range, 3-10) were operated on. Mean operative time was 90 minutes (range, 75-110). There were no conversions, visceral injury, postoperative visible bulge, or seroma. No painkiller except Paracetamol was required. There was no recurrence in a mean follow-up of 58 months (range, 26-84). Restored abdominal contour was achieved by all the patients. CONCLUSION: Closure of hernial defect augmented with IPOM is a safe, patient friendly, and scientific way of doing LVHR.