XXXX repair with extraperitoneal mesh: surgical technique and early results.

@entity1 @entity7502 @entity4036 @entity547 @entity4037
Laparoscopic repair of ventral abdominal wall hernias involves intraperitoneal placement of a mesh, which may lead to adhesion formation and bowel fistulation. The first series of selected @entity1 with ventral abdominal wall hernias treated laparoscopically by extraperitoneal placement of a @entity7502 mesh is presented. Thirty-four @entity1 (24 @entity1 and 10 @entity1 ; median age, 52 years [range, 34-70]) were selected from among 122 @entity1 undergoing @entity4037 repair. Of these @entity1 , 18 had a primary ventral @entity4036 and 16 had an incisional @entity547 . After reduction of sac contents and adhesiolysis intraperitoneally, a large flap of peritoneum (with extraperitoneal fat, fascia, and posterior rectus sheath where present) was raised to accommodate a suitably sized @entity7502 mesh, which was then covered again with the peritoneal flap at the end of the procedure. Intraoperatively, apart from circumcision of the hernial sac at the neck, a total of 24 iatrogenic peritoneal tears occurred in 20 @entity1 , mainly at the site of the previous scar. In two @entity1 , it was observed that greater than 25% of the mesh was exposed after the procedure. The median (+/-SD) duration of hospitalization postoperatively was 1 day (+/-0.56). One @entity1 's @entity547 recurred 4 months after surgery, and one @entity1 's infected mesh was removed 8 months after surgery. Laparoscopic extraperitoneal placement of a mesh is feasible and appears to be an advance over laparoscopic intraperitoneal mesh placement for ventral abdominal wall hernias in selected @entity1 . However, longer follow-up and controlled clinical trials will be necessary before any firm conclusions can be drawn.
