Endoscopic totally preperitoneal ventral hernia repair

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Abstract
Background: In order to combine the advantages of a minimal invasive approach with a retromuscular mesh implantation, we developed an endoscopic totally preperitoneal approach for the treatment of ventral hernias. Methods: The surgical technique is described with the accent on preoperative marking of mesh surface, the retromuscular insertion of the first trocar, the extraperitoneal dissection, the reduction of the hernia sac, and the choice and insertion of the mesh. Results: Fifteen patients have been operated. Complete reduction of the hernia sac could be accomplished in five. In eight, the peritoneum was incised at the hernia neck. A polypropylene mesh was used in six cases. In the others, ePTFE or a composite mesh was used. Circumferential fixation with a tacker was performed. No major complications were seen. No mesh needed to be removed. One recurrence was seen 5.5 months postoperatively with a median follow-up period of 126 days. Conclusions: This new endoscopic technique takes advantage of immediate mesh fixation by the peritoneal sac and may avoid the potential complications related to the transabdominal approach and intraabdominal position of the mesh. A further long-term evaluation is necessary.

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