New mesh shape and improved implantation procedure to simplify and standardize open ventral hernia repair: a preliminary report

• Published in: Hernia : the journal of hernias and abdominal wall surgery 2011-12, Vol.15 (6), p.659-665
• Main Authors: Amato, G., Romano, G., Goetze, T., Salamone, G., Agrusa, A., Gulotta, G., Paolucci, V.
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Abdominal Wall - surgery; Adult; Aged; Female; Follow-Up Studies; Hernia, Ventral - surgery; Herniorrhaphy - adverse effects; Herniorrhaphy - instrumentation; Herniorrhaphy - methods; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Prosthesis Implantation - adverse effects; Prosthesis Implantation - methods; Seroma - etiology; Surgical Mesh - adverse effects; Surgical Wound Infection - etiology
• ISSN: 1265-4906; 1248-9204
• DOI: 10.1007/s10029-011-0842-9

Introduction Issues in ventral hernia repair are represented by the need for mesh fixation and how to assure a sufficient mesh overlap of the defect. Aiming to resolve these problems, this study describes a modified technique for ventral and incisional hernia repair based upon a newly developed mesh with a special design. This new type of implant allows broader coverage of the abdominal wall and results in tension- and fixation-free repair. Materials and methods A unique geometrically shaped mesh consisting of a large central body and radiating arms was used to repair ventral or incisional hernia. The mesh was intended not to be point-fixated. The friction of the straps passing through the tissues was hypothesized to be adequate to maintain the mesh firmly fastened in the abdominal wall, ensuring a wide coverage far from the hernia border. The newly designed mesh was placed in the preperitoneal sublay in 22 patients with ventral or incisional hernia. All straps were passed laterally through the transverse and oblique muscles. In all patients, a defect overlap of at least 8–12 cm was achieved. Results In a midterm follow-up of 18–24 (mean 22) months, three seromas and one infection occurred, which were successfully managed without mesh removal. No hematoma, chronic pain, or recurrence has been reported to date. Conclusions The described arm system of the implant allowed for a much smaller incision and eliminated the complicated maneuvers associated with suturing the mesh. The fixation arms seemed to have ensured the mesh stayed orientated in all patients. A very wide lateral mesh placement was accomplished, assuring sufficient defect overlap when shrinkage occurs.