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KMID : 1035920170200030084
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Journal of Minimally Invasive Surgery
2017 Volume.20 No. 3 p.84 ~ p.92
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Minimally Invasive Approach to Supra-pubic and Non-Midline Lower Abdominal Ventral Hernia ? An Extended Indication of TAPE Technique
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Fan Joe King Man
YIP Jeremy
Fung Matrix
LO Oswens Siu Hung
Liu Jianwen
Yang Xuefei
Chen Kejin
Law Wai Lun
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Abstract
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Repair of lower abdominal incisional hernia is always a surgical challenge. TAPE technique has been described for the repair of supra-pubic midline incisional hernia with satisfactory outcome. Its indication can be extended for treatment of non-midline lower abdominal hernia. Peritoneal incision is created just below the hernia defect with pre-peritoneal dissection to expose supra-pubic preperitoneal space with Cooper’s ligament exposed. Non-adhesive mesh then placed over pre-peritoneal space and partially intra-peritoneally, and cover the whole extra-peritoneal space prepared to ensure enough overlapping. Mesh is fixed by tackers for intra-peritoneal part, most inferior fixation points were at peritoneal incision line. Extra-peritoneal part of meshes is fixed at the safety zone and covered up by the peritoneal flap to avoid mesh migration. Fixation of the meshes at the lateral aspects were facilitated by the peritoneal flap and subsequent fibrosis and adhesion to the extra-peritoneal structures in cases of lateral lower abdominal hernia. Repair of midline and lateral lower abdominal incisional hernia with this novel modified technique with prosthetic mesh is safe and effective. A larger case series and longer follow-up is required for validation of this technique.
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KEYWORD
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Supra-pubic, Non-midline Ventral Hernia, Ventral Hernia, TAPE, Laparoscopic
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