“Slim-Mesh” Technique for Giant Ventral Hernia

The "Slim-Mesh": Single Operation with Multiple Slim-Meshes for Multiple Widely-Spaced Ventral Hernias in the Same Patient

“…• A SM's adhesion force is a complex physical and chemical phenomenon of an electrostatic nature slowly released and the mesh remembers its rolled shape when the surgeon cuts the stitches and the SM gently unrolls. The same force is generated when we spread our fingers, releasing the spring (Figure 1) [18,24].…”

“…The mesh used is called a 'Slim Mesh' because of its thickness, becoming "slim cigarette like" [17][18][19][20][21][22][23][24][25], and not because of its composition or weight. The SM technique is divided into 4 surgical phases: phase 1 or first laparoscopic step, phase 2: Marking the skin axial points (SAP), and the skin measurement of the SM application area (SMAA), which is the same as the peritoneal SMAA; phase 3: Preparation SM as per the SM technique, for introduction into the abdomen; phase 4 or last laparoscopic step [17][18][19][20][21][22][23][24][25]. S.A.C used successive multiple SMs (MSM) during an operation for the repair of MWSH located in the same patient.…”

“…The MWSH were "noncontralateral" when they were located in the same half-part (left or right) of the abdominal-wall (AW) and/or at its center; and "contralateral" when located in both half-parts of the AW (see YouTube videos); one or more widely-spaced VH may also be present at the center of the AW. Other variables were VH type (incisional or primary); preoperative size of fascial defect at physical examination (PE); VH neck-size according to AW ultrasound (US) and/or CT-scan; VH operative necksize and type (small/medium [S/Me] and large [L]) -according to Korenkov, et al's Classification and surgical treatment of incisional hernia [27]; the author considered a VH to be giant (G) or massive (M) when its diameter was 15-19.9 cm or ≥ 20 cm respectively, both without loss of domain, when the VH was oval, he measured the major axis [24]; massive (M) without loss of domain (≥ 20 cm); satellite VH; DR, which were considered a widening of the line a alba exceeding 2 cm [13]; mesh-type employed (composite or non-composite); type of fixation device employed; operation time; estimated blood loss at suction; operative complications; possible conversion to open surgery; early postoperative complications (within 30 days after operation); readmission to hospital; reoperation; postoperative day when patient returns to regular diet; length of hospital stay; chronic AW pain when it lasted > 3 months [28]; and the final outcome at follow-up (F.U.). The results were expressed as a mean ± SEM (SD) and as a percentage (%).…”

“…• A SM's tension force is the physical and chemical phenomenon that enables the SM to self-sustain when is unfolded, stretched and fixed to the two opposite edges of the AW defect. In a similar example, tension force is generated when a bridge is built over a river and its tie rods are stretched and fixed between the two opposite banks (Figure 1) [18,24].…”

“…This AW dysfunction may lead to restricted everyday physical activity, respiratory and digestive disorders, abdominal-wall pain, back pain [16] due to spinal trouble, as well as urinary and obvious possible mood disorders. Consequently, MWSH could be considered a systemic disease.Firstly and empirically, the author wanted to test the technical feasibility and reliability of the "Slim-Mesh" (SM) technique with successive multiple SMs during an operation for the repair of MWSH located in the same patient, exploiting the well-known benefits of LAP combined with the SM technique's technical qualities [17][18][19][20][21][22][23][24][25]. Secondly, he expected to verify its outcomes in the MWSH patients with a 12-year follow-up study.…”