Short-Term Outcome of “Double Crown” Tackers Mesh Fixation in Laparoscopic Ventral Hernia Repair

Abstract

Background: Many ventral hernia repair methods have been described among surgeons. The traditional primary repair entails a laparotomy with suture approximation of strong fascial tissue on each side of the defect. However, recurrence rates after this procedure range from 12% to 24% during long-term follow-up. Laparoscopic ventral hernia repair (LVHR) is a well recognized minimally invasive surgical technique for repair of different types of abdominal wall ventral hernias. However, the best method of mesh fixation during LVHR is still a subject of debate. Patients & Methods: In the present study, 50 patients were presented with ventral hernia between June 2012 and October 2013. Demographics of the patients were recorded. All patients were submitted to LVHR with mesh fixation by "Double Crown" of tackers. The first crown was placed on the mesh periphery with 1 cm between each 2 successive tackers and the second crown around the edges of the defect. Operative complications, VAS scale, post-operative complications, and length of hospital stay were reported. Results: The mean age was 40.08 years. Female to male ratio was 3:2. The mean BMI was 32.3. The diameter of the hernial defect was <5 cm in 64%, while, the defects larger than 15 cm were excluded. LVHR was successfully completed in all the patients with no conversion. Only 1 patient had intra-operative bleeding from omental vessels that was successfully controlled. The mean operative time was 79 minutes. Post-operatively, the mean VAS was 3.96, 2.12, and 0.24 at 24 hours, 2 weeks, and 4 weeks, respectively. Two patients developed post-operative ileus that was treated conservatively and 1 patient developed persistent seroma that was treated by repeated aspiration. The mean length of hospital stay was 3.08 days. Conclusion: "Double Crown" tackers mesh fixation in LVHR seems to be a safe and effective surgical technique with favorable outcome. However, further randomized studies are needed on larger numbers of patients to validate these results.

“Slim-Mesh” Technique for Giant Ventral Hernia

“…In addition, the increased intrabdominal visibility and operating space make it simpler to calculate the size of the SM overlap 9 , 27 , 28 during fixing maneuvers to reduce recurrence rate (4.6%). Grande documented a recurrence rate of 5.7% and a mean follow-up time of 24 months.…”

The Impact of the “Slim-Mesh” Technique on Operation Time and Short/Midterm Outcomes in 67 Overweight, Obese and Superobese Patients from a 10-year Follow-up Study

“…Briefly, we considered 3–5 cm (preferably 5 cm) beyond the edges of the hernia defect to be an adequate SM overlap for small (3–5 cm) [ 12 ] VH repair and more than 5 cm for medium (5–10 cm) [ 12 ], L/G [ 12 ] and M VH repair (during Phase 1, and before the marking of 4 peritoneal axial points (PAP, [ 6 7 9 ], Figs. 1 , 2 , 3 , 4 )), as per Leblanc's advice for larger meshes [ 13 ].…”