New mesh shape and improved implantation procedure to simplifyand standardize open ventral hernia repair: a preliminary report

Introduction Issues in ventral hernia repair are representedby the need for mesh fixation and how to assure asufficient mesh overlap of the defect. Aiming to resolvethese problems, this study describes a modified techniquefor ventral and incisional hernia repair based upon a newlydeveloped mesh with a special design. This new type ofimplant allows broader coverage of the abdominal wall andresults in tension- and fixation-free repair.Materials and methods A unique geometrically shapedmesh consisting of a large central body and radiating armswas used to repair ventral or incisional hernia. The meshwas intended not to be point-fixated. The friction of thestraps passing through the tissues was hypothesized to beadequate to maintain the mesh firmly fastened in theabdominal wall, ensuring a wide coverage far from thehernia border. The newly designed mesh was placed inthe preperitoneal sublay in 22 patients with ventral orincisional hernia. All straps were passed laterally throughthe transverse and oblique muscles. In all patients, a defectoverlap of at least 8–12 cm was achieved.Results In a midterm follow-up of 18–24 (mean22) months, three seromas and one infection occurred,which were successfully managed without mesh removal.No hematoma, chronic pain, or recurrence has beenreported to date.Conclusions The described arm system of the implantallowed for a much smaller incision and eliminated thecomplicated maneuvers associated with suturing the mesh.The fixation arms seemed to have ensured the mesh stayedorientated in all patients. A very wide lateral mesh placementwas accomplished, assuring sufficient defect overlapwhen shrinkage occurs.