Title Totally Extraperitoneal Laparoscopic Ventral Hernia Repair
Author(s) Jagpreet S. Deed, MBBS, MS, DNB, MRCS, FACS
Runtime 9:23
Year 2018
Description Background: Placing mesh in extraperitoneal plane is important during ventral hernia repair to avoid its complications by direct contact with abdominal viscera. Currently available techniques have few limitations: Division of important fascial layers like posterior sheath/ linea alba in retromuscular/ recto-rectus repair. Peritoneal flap creation challenges: Close proximity of trocars to peritoneal incision Tangential working along parietal wall makes task difficult. Inadequate covering of mesh and hole formation in peritoneal flap. Aim: To demonstrate novel technique of extraperitoneal placement of mesh in laparoscopic ventral hernia repair. Material methods: 43 year old male with symptomatic umbilical fatty hernia of linea alba and was taken up for surgery after routine pre-operative work-up. The port positions were left-sided, similar to usual laparoscopic ventral hernia repair. Under vision and guidance of intraperitoneal 10 mm Palmer's point camera, two 5mm trocars were placed extraperitoneally. By a combination of traction-countertraction, blunt dissection and later re-directing 10mm trocar into extraperitoneal space, the space between peritoneum and fascia was created till midline with complete reduction of hernial sac, progressing further to contralateral side, for adequate placement of 15x15cm mesh without crevices. The peritoneum intact in continuity, sprung back, completely covering the mesh upon stopping insufflation. Results: Uneventful recovery with notable reduction of pain score and discharge on first postoperative day. Conclusion: Novel technique is feasible, simple to perform, without violation of important fascial layers with lesser postoperative pain and quicker recovery. Reproducibility and routine application in ventral hernias needs to be established by larger sample size and randomized trial.

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