Percutaneous Mesh Expansion and Fixation at the Retro-Rectus Plane without Stabs by Using Redirecting Suture Hook in Midline Hernias Repair

Abstract

Background: Mesh expansion and fixation at retro-rectus plane through multiples stabs produces good results. But these stabs cause cosmetic disorders for the patients and doctors. So, we find some modification to do this procedure without these stabbing wounds in midline hernial repair. Patients and methods: This technique was used to fix the mesh at retro-rectus plane in 50 patients suffering from midline hernias, from January 2008 through January 2010 at Zagazig university Hospital, Egypt. Laparotomy incision was done over the hernial sac or at old incision; the contents were then released and reduced into peritoneal cavity without much subcutaneous dissection. The suitable sheet of polypropylene mesh to cover the hernial defect and any weak area was prepared and fixed at retro-rectus plane percutaneously without stabbing wounds by using redirecting suture hook. The mean period of follow up was 26 months. Results: There was no recurrence during the period of follow up. Five patients developed subcutaneous bluish discoloration at the site of some stitches, which disappear within two weeks with conservative treatment. Conclusion: Percutaneous mesh expansion and fixation at retro-rectus plane by using redirecting suture hook procedure has good results in recurrence rate and cosmetic appearance.