Laparoscopic intraperitoneal onlay mesh repair of incisional hernia

Surgicallnparoscopy& Endoscopy Vol. 8, No. 5, pp.360 362 O 1998LippincouWilliams & Wilkins, Philadelphia

LaparoscopicIntraperitonealOnlay Mesh Repairof IncisionalHernia EvangelosC. Tsimoyiannis,M.D., F.A.B.I., AndreasTassis,M.D., GeorgeGlantzounis,M.D., MohammedJabarin,M.D., Philipos Siakas,M.D., and Helen Tzourou,M.D.

Summary: Improvements in Iaparoscopictechniquesand equipment have engendered many new intraabdominal procedures. Laparoscopic hernioplasty was used in 11 patients with 12 incisional abdominal hernias. All repairs were made with an intraperitoneal onlay patch of expanded polytef Gore-Tex DualMesh Biomaterial. The patch was securedby whole-thickness sutures,tied subcutaneouslythrough stab holes, and staples between the sutures to cover the hernia defect without excision of the hernia sac. There were three postoperative complications: one seroma, one hematoma, and one infection. These complications successfully healed without reoperation. No recurrence was observed during a follow-up of 8-21 months (average 15 months). It is concluded that laparoscopicincisional hernioplasty using the new Gore-Tex DualMesh Biomaterial, which is securely sutured and stapled on the abdominal wa1l, is a promising minimally invasive procedure.Continued follow-up is necessaryto determine the long-term results. Key Words: Expanded polytef-Hernioplasty-LaparoscopyProsthetic material-Ventral hernia.

Incisional hemias of the abdominal wall may develop in any abdominal incision, but most are found in midline or paramedianincisions (1). Successfulrepair of an abdominal wall hernia requires closure of the defect without undue tension on the sutured tissue (2). In repairing hernias without tension, surgeons have used prosthetic materials of different structure and composition. The expanded polytetrafluoroethylene (ePTF'E)patch has been used since 1985 (3) by many with excellent results (4-6). Recently the ePTFE patch has been used by the laparoscopicroute to repair inguinal (7) or incisional hernias(8,9). Gore-Tex DualMesh Biomaterial (W.L. Gore and Associates,Flagstaff,AZ, U.S.A.), composedof ePTFE, is indicated for laparoscopic procedures with the intraperitoneal onlay mesh (IPOM) technique becauseone side of the patch has a pore size of