"Slim-Mesh" Technique for Giant Ventral Hernia

Abstract

Background and objective: We devised a sutureless "Slim-Mesh" technique to treat ventral hernias, including large-giant/massive ones, reduce intra- and postoperative complications, and lower operation time.

Methods: Between September 1, 2009 and October 31, 2020, 43 patients with large (10 - 14.9 cm)-giant (15 - 19.9 cm) and massive (≥ 20 cm) ventral hernia were operated at our Department with the above technique. This was a prospective (79%)-retrospective study.

Results: This study comprised 22 males and 21 females. Mean age was 63 years. Large-giant and massive hernias were found intraoperatively in 37 and 6 cases respectively. Mean operation time for all hernias was 116 minutes, 104 for large-giant hernias, and 190 for massive. In 53.4% of cases, hernia-neck operative measurement was larger than preoperative size. In 25.5% of cases, laparoscopy found satellite hernias previously undetected by ultrasound- and/or computed tomography scan. A composite mesh and a noncomposite mesh were used in 95% and 5% of cases respectively. For mesh fixation, titanium tacks and absorbable straps were used in 14% and 86% of cases respectively. Mean length of hospital stay was 2.3 days. Mean follow-up time was 3 years and 4 months. In our study, there were 5 early postoperative complications: 3 seromas, 1 trocar-site hernia, and 1 case of cystitis. We found 2 late small symptomless recurrences (4.6%).

Conclusion: The sutureless "Slim-Mesh" technique facilitates intra-abdominal introduction, as well as the handling and fixation of giant and monster (36 × 26 cm) meshes. In our experience, "Slim-Mesh" is safe, simple, and fast, and economical even for large-giant/massive ventral hernia repair.

Keywords: Giant ventral hernia repair; Massive ventral hernia; Operation time; Postoperative pain; Slim-Mesh technique.

Figure 1.

External view of the first set of 3 ports introduced into the right abdominal wall region in a class I obese patient with massive ventral hernia measuring 20 × 10 centimeters. The hasson port is center, a 12 millimeter port is placed in the right hypochondria, and a 5.5 millimeter port at the right iliac fossa. Blue North, West, and South skin axial points are noted.

Figure 2.

Laparoscopic view of the first set of 3 ports from the left-hand Side with the monster “Slim-Mesh” completely fixed. A part of the massive hernia defect can be viewed through the prosthesis. The Blue West peritoneal axial point is noted.

Figure 3.

External view of the first set of 3 ports with the monster “Slim Mesh” before its intra-abdominal introduction through the 12 millimeter port in the right hypochondria.

Figure 4.

External view of the 6 ports. The 12 millimeter port of the second set is in the iliac fossa of the left abdominal region, along with two 5.5 millimeter ports located higher up the left-side of the abdomen. The Blue East and South skin axial points are noted.

Figure 5.

External views of the second set of 3 ports located on the left-hand side.

Figure 6.

Laparoscopic view of the second set of 3 ports with the fixed monster “Slim Mesh” (33 × 24 centimeters). The ports are several centimeters away from the first edge to be fixed. The monster “Slim Mesh” is shown from the right-hand side with its 7 centimeter overlap, which extends from the massive ventral hernia’s edges to the four peritoneal axial points. The Blue East peritoneal axial point can be noted between the two 5.5 millimeter ports above mentioned in Figure 4. A part of the massive hernia defect can be viewed through the prosthesis in this case.

Figure 7.

Pre-operative photo of class I obese patient with massive ventral hernia while tensing his abdomen.

Figure 8.

Scout computed tomography image of the patient before “Slim Mesh” operation.

Figure 9.

Postoperative photo of patient one year after operation while tensing his abdomen.