Laparoscopic incisional hernia surgery: different approaches
Sharma, Anil (2002) Laparoscopic incisional hernia surgery: different approaches. In: Congress of Endoscopic and Laparoscopic Surgeons of Asia, 2002 [ELSA 2002], 19-21 Sep 2002, Tokyo, Japan.
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Laparoscopic repair of incisional hernia has gradually gained acceptance and has shown results which compare favourably to open hernia repair. Pure tissue repairs are known to have unacceptably high recurrence rates. These patients with recurrences have been found to have some element of intrinsic tissue weakness which make them ideal candidate for a laparoscopic hernia repair. This surgical approach is well away from the previous surgery site, is tensionless and uses prosthetic materials for closing the defect and reinforcing the local tissues. There are several approaches for fixing the mesh securely over the area of defect. These include railroading the mesh into place with the help of a suture passed from without through the centre of the hernial defect and fixed to the centre of the mesh after bringing it out through the 10mm trocar. The mesh may be placed either inlay over the defect (intraperitoneal) or within a flap of peritoneum and sheath lifted around the defect (extraperitoneal). Mesh fixation is done by spiral tacks, staplers, or sutures with subcutaneously placed, knots or intra corporeal suturing. The merits and demerits of both approaches will be discussed. In our experience careful selection of cases, adhesiolysis avoiding the likelihood of an accidental enterotomy and a well placed mesh, covering the entire weakened area, fixed with appropriately placed spiral tacks ensure a successful outcome of the surgical procedure.
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