Fixation free incisional hernia repair with a newly designed mesh with integrated bands

Abstract

Introdution: Implant fixation and how to ensure adequate mesh overlap are key issues in abdominal hernia repair. A newly developed technique for ventral and incisional hernia repair using a proprietary implant with incorporated straps makes fixation unnecessary through tissue friction. This new implant allows for a broader coverage of the abdominal wall and results in simplified repair. Midterm follow- up in a cohort of patients indicates a decrease in postoperative com- plications and no recurrences to date. Matcrial and methods: A lightweight, large porous polypropylene mesh with a central body and eight radiating arms was used to repair ventral or incisional hernia. The implant was placed in open preperi- toneal or retromuscular sublay in 30 patients. The straps were deliv- ered by means of a proprietary needle, tunneled laterally through the abdominal wall muscles. Results: There were no significant intraoperative complications to report. An overlap of the defect of at least 3O7o was achieved in all patients. In a follow up from 30 to 36 months, 3 seromas and 1 infection occurred, successfully managed without mesh removal. Postoperative ultrasound detection showed that all straps were well integrated within the abdominal wall. No mesh dislocation, hematoma, chronic pain or recurences have been reported to date. Conclusions: The described prosthetic straps system allowed for much smaller incisions and eliminated challenging mateuvers asso- ciated to mesh f,xation. The straps showed to ensure a firm, correctly orientated mesh positioning. A very wide lateral mesh placement with broad defect overlap was accomplished. Friction and straps elonga- tion helped to absorb forces impacting the implant during early recovery avoiding mesh dislodgement. In our belief these advantages are clearly demonstrated and result in: fixation-free mesh placement, simplified procedure, broader coverage of the abdominal wall, short- ening of the operative time. Additional advantages are decreased postoperative complications and absence of recurrences.