This protocol provides a new method to effectively solve the problem of mesh fixation in laparoscopic incisional hernia repair. The advantages of this method include accurate mesh positioning, firm fixation, and easy learning, especially for beginners. After mastering this method, the time of mesh fixation during operation can be significantly reduced.
Text and picture demonstration cannot effectively show the whole process of this mesh fixing method, hence, visual demonstration enables understanding all of the details of this method. Begin by selecting an appropriate size anti-adhesion mesh, measure and mark the approximate range of the incisional hernia on the abdominal wall surface with a sterile ruler and marking pen. The size of the hernia ring defect can also be measured by a pre-operative CT examination.
Place the ruler parallel to the longitudinal axis of the hernia defect and measure the maximum longitudinal length of the defect. Select an appropriately sized anti-adhesion mesh according to the size of the hernia ring defect. Ensure that the coverage of the mesh exceeds the edge of the defect by at least five centimeters.
Mark the longitudinal length of the defect on the mesh and mark the nail gun fixation points at intervals of five centimeters on the longitudinal axis. Then extend the fixation points more than five centimeters along the marked line to the edge of the mesh which pertains to the alignment. Mark the nail gun fixation points evenly every two to three centimeters along the edge of the mesh which pertains to the contraposition.
Ensure that the fixing points of the nail gun are uniformly marked two centimeters from the longitudinal axis of the defect on both sides with an interval of three centimeters. Roll the mesh such that the anti-adhesion surface will face the abdominal wall and place the rolled mesh into the abdominal cavity through the 12-millimeter puncture hole. Then unfold the mesh under laparoscopic guidance.
Ensure that the marked line of the unrolled mesh overlaps the longitudinal axis of the hernia ring defect. Fix the marked points on the longitudinal axis of the mesh to the abdominal wall with non-absorbable nails using a nail gun. Fix the edge of the mesh to the abdominal wall along the marked points on the edge of the mesh with non-absorbable nails using a nail gun.
Fix the mesh on the abdominal wall along the marked points on both sides of the longitudinal axis of the mesh with absorbable nails using a nail gun. The contraposition and alignment mesh fixation or traditional double-loop hernia nail fixation was performed in the experimental and control groups respectively with 42 patients in each group. The mean mesh placement time for the experimental group was approximately 32.5 minutes which was notably lower than the control group, having a mesh placement time of about 44.7 minutes.
There were only two cases of chronic pain in the experimental group, significantly lower than the eight cases observed in the control group. However, there were no significant differences between the two groups in terms of seroma formation, mesh infection, recurrence of incisional hernia, the length of the post-operative hospital stay, and hospitalization expenses. Ensure that the mesh placement is accurate with adequate coverage and that precise fixation methods have been used.
The application of the contraposition and alignment mesh fixation method is not limited to incisional hernia repair, but can also be used for laparoscopic parastomal hernia mesh repair and laparoscopic esophageal hiatal hernia mesh repair.
