Laparoscopic ventral hernia mesh repair without the use of transfascial sutures: our experience

Wasim M. D., Uday Muddebihal, U. V. Rao, Praveen J.


Background: Repair of the abdominal wall defects can be quite challenging even for most experienced surgeon under best of conditions. In the laparoscopic method there have been many modifications with regard to the type of mesh and methods of fixation. The aim of this study was to identify immediate post-operative pain and the long-term outcomes of laparoscopic ventral hernia mesh repair without the use of transfascial sutures to fix the mesh.

Methods: A total of hundred (n=100) patients underwent Laparoscopic Ventral Hernia Mesh Repair by our surgical unit between January 2011 and December 2015. All patients underwent standardized Laparoscopic mesh repair with light weight composite meshes and without the use of transfascial sutures. Only absorbable tackers were used to anchor the mesh. Analgesics stopped after 24 hours or given only on demand. Mesh fixation time, post-operative pain score (visual analogue score), and follow up for pain and recurrence (at 6 months, 12 months and 24 months) were recorded and analyzed.

Results: Out of 100 patients (42 men and 58 women), the mean age was 48 years and BMI of the patients was 20-35. Types of hernias operated were 63 para umbilical hernias, 32 incisional and 5 recurrent hernias. The median defect size was 5 cm (Range 3-8 cm) and the mesh sizes used were15 x 15 cm circular (87) and 15 x 20 rectangular (13). The median mesh fixation time with only absorbable tackers was 15 mins (range 15-20 mins). Visual analog scale for pain (VAS) was of median 1 (Range 0-2) at 24 hours. Five patients required analgesics for 48 hours. No patients complained of pain at follow ups (1 month, 6 months, 12 months and 24 months). Mean hospital stay post operatively was 2-3 days. Only one patient had recurrence of hernia within 6 months

Conclusions: Laparoscopic Ventral Hernia Mesh Repair without the use of transfascial sutures is an easy and feasible approach. The use of only absorbable tacks to fix the mesh is time saving and gives less post-operative pain. However, randomized controlled trials are required to compare transfascial sutures with absorbable tacks for fixing the mesh in separate cases to reach a standardized method.


Absorbable tackers, Laparoscopic ventral hernia mesh repair, Transfascial sutures

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LeBlanc KA, Booth WV. Laparoscopic repair of incisional hernias using ePTFE: preliminary findings. Surg Laparosc Endosc. 1993;3(1):39-41.

Grubnik VV, Grubnik AV, Vorotyntseva KOV. Laparoscopic repair of incisional and ventral hernias with the new type of meshes: randomized control trial. Videosurgery Miniinv Tech. 2014;9(2):145-51.

Beldi G, Wagner M, Bruegger LE, Kurmann A, Candinas D. Mesh shrinkage and pain in laparoscopic ventral hernia repair: a randomized clinical trial comparing suture versus tack mesh fixation. Surg Endosc. 2011;25(3):749-55.

Dąbrowiecki S, Pierściński S, Wojciech S. The Glubran 2 glue for mesh fixation in Lichtenstein's hernia repair: a double-blind randomized study. Videosurgery Miniinv. 2012;7(2):96-104.

Pielaciński K, Szczepanik AB, Misiak A, Wróblewski T. Randomized clinical trial comparing inguinal hernia repair with Lichtenstein technique using non-absorbable or partially absorbable mesh. Preliminary report. Videosurgery Miniinv. 2011;6(4):190-206.

Gillian GK, Geis WP, Grover G. Laparoscopic incisional and ventral hernia repair (LIVH): an evolving outpatient technique. J Soc Laproendo Surg. 2002;6(4):315-22.

Perrone JM, Soper NJ, Eagon LC. Perioperative outcomes and complications of laparoscopic ventral hernia repairs. Surgery. 2005;138(4):715-6.

Sroka G, Feldman LS, Vassiliou MC, Kaneva PA, Fayez R, Fried GM. Fundamentals of laparoscopic surgery simulator training to proficiency improves laparoscopic performance in the operating room: a randomized controlled trial. Am J Surg. 2010;199(1):115-20.

Rea R, Falco P, Izzo D, Leongito M, Amato B. Laparocopic ventral hernia repair with primary transparietal closure of the hernial defect. BMC Surg. 2012;12(1):S33.

Orenstein SB, Dumeer JL, Monteagudo J, Poi MJ, Novitsky YW. Outcomes of laparoscopic ventral hernia repair with routine defect closure using "shoelacing" technique. Surg Endosc. 2011;25(5):1452-7.

Melvin WS, Renton D. Laparoscopic ventral hernia repair. World J Surg. 2011;35(7):1496-9.

Elazary R, Abu-Gazala M, Schlager A, Khalaileh A, Shussman N, Rivkind AI, Mintz Y. Trans-fascial laparoscopic mesh fixation: a procedural comparison using the standard suture passer versus iMESH stitcher™ device. Hernia. 2011;15(3):321-4.

Nguyen SQ, Divino CM, Buch KE, Schnur J, Weber KJ, Katz LB, et al. Postoperative pain after laparoscopic ventral hernia repair: a prospective comparison of sutures versus tacks. J Soc Laparoendoscop Surg. 2008;12(2):113.

Palmer R. Safety in laparoscopy. J Reprod Med. 1974;13(1):1-5.

Carbajo MA, Blanco JI, Toledano M, Cuesta C, Ferreras C, Vaquero C. Laparoscopic approach to incisional hernia. Surg Endo Oth Intervention Tech. 2003;17(1):118-22.

Raftopoulos I., Courcoulas A.P. Outcome of laparoscopic ventral hernia repair in morbidly obese patients with a body mass indexes exceeding 35 kg/m2. Surg Endosc. 2007;21(12):2293-97.

Uranues S, Salehi B, Bergamaschi R. Adverse events, quality of life and recurrence rates after laparoscopic adhesiolysis and recurrent incisional hernia mesh repair in patients with previous failed repairs. J Am Coll Surg. 2008;207(5):663-9.

Rea R, Falco P, Izzo D, Leongito M, Amato B. Laparocopic ventral hernia repair with primary transparietal closure of the hernial defect. BMC Surgery. 2012;12(1):S33.

Matthews BD, Mostafa G, Carbonell AM, Joels CS, Kercher KW, Austin C, et al. Evaluation of adhesion formation and host tissue response to intra-abdominal polytetrafluoroethylene mesh and composite prosthetic mesh1. J Surg Res. 2005;123(2):227-34.

Kirshtein B, Lantsberg L, Avinoach E, Bayme M, Mizrahi S. Laparoscopic repair of large incisional hernias. Surgical Endoscopy and Other Interventional Techniques. 2002;16(12):1717-9.

Cobb WS, Kercher KW, Heniford BT. Laparoscopic repair of incisional hernias. Surg Clin N Am. 2005;85(1):91-103.