Laparoscopic Intraperitoneal Ventral Hernia Repair with Sutures

Abstract

With the resounding success of the laparoscopic cholecystectomy, a similar panacea for the difficult problem of ventral/incisional hernia was sought beginning in the early 1990s. The stimulus for success in this area occurred when the laparoscopic investigators adopted the retrorectus repair using a prosthetic mesh, as described by Rives/Stoppa. The senior author’s first attempt at laparoscopic repair of a ventral/incisional hernia involved a Spigelian hernia. This was prior to the development of automatic hernia staplers and a reloadable hernia stapler was used to affix a piece of mesh to the abdominal wall. While aesthetically pleasing, the hernia soon recurred. When evaluated laparoscopically it could be seen that the prosthetic mesh had simply migrated with the peritoneum into the hernia defect. We thus realized that suture fixation as in the Rives/Stoppa approach would be critical to long term success in these often times large patients. During the following decade, our technique has been modified by our and other surgeons’ growing experience, along with new improved tacking devices and prosthetic material. In this chapter, we present the current technique we use for the laparoscopic repair of ventral hernia.