Name: Application of a New Mesh Fixation Method in Laparoscopic Incisional Hernia Repair (Video) | JoVE Journal
Uploaded: 2022-12-23T15:00:00.000+00:00
Duration: 5 min 15 s
Description: Learn a new mesh fixation method for laparoscopic incisional hernia repair that enables accurate positioning and firm fixation. This technique reduces operative time and is easy for beginners to master.

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5 minutes

This research was supported by the Guangdong Science and Technology Plan Project (grant number: 2021A1515410004) and the National Key Clinical Discipline (grant number: [2012]649).

The protocol was carried out in accordance with the tenets of the Declaration of Helsinki and approved by the Ethics Review Committee of the Sixth Affiliated Hospital of Sun Yat-sen University.
The patients and families were informed of the purpose of shooting and making the surgical video, and informed consent was obtained.
1. Patient data and grouping
NOTE: From January 2018 to June 2020, laparoscopic incisional hernia repair using the IPOM method was performed during gastrointestinal, hernia, and abdominal surgery at the Sixth Affiliated Hospital of Sun Yat-sen University. After obtaining informed consent, a total of 84 patients with incisional hernias were included in the study.
<ol>
	<li>Enroll patients based on the inclusion criteria (adult patients diagnosed with incisional hernias) and exclusion criteria (age &#8804;18 years or &#8805;80 years; emergency operation; strangulated incisional hernia; recurrent incisional hernia; the presence of severe organ dysfunction). 
	NOTE: The characteristics of the two groups, including the patient&#39;s age, sex, and body mass index (BMI), the length of time the hernia was present, and the maximum size of the hernia ring defect, are shown in Table 1. There were no significant differences in characteristics between the two groups (all P &#62; 0.05).</li>
	<li>All the operations were performed by the same group of surgeons, who received standardized training and had rich experience in laparoscopic surgery.</li>
</ol>
2. Necessary preparation and examination before the operation
<ol>
	<li>Carry out preoperative examinations, including routine blood tests, blood biochemistry tests, routine urine tests, a routine stool test, a chest X-ray, an electrocardiogram, and an abdominal CT.</li>
	<li>For a giant incisional hernia, use preoperative botulinum toxin A (BTA) and preoperative progressive pneumoperitoneum (PPP) for the surgical preparation11.</li>
	<li>Administer fentanyl at 4 &#181;g/kg using another pump at a rate of 250 &#181;g/min simultaneously with propofol administration. Intravenously inject cisatracurium (0.2 mg/kg) after the patient is anesthetized.
	<ol>
		<li>Subsequently, intubate the patient with the help of an experienced anesthesiologist 4 min after the muscle relaxant injection. Next, mechanically ventilate the patient with sevoflurane 1% inhalation with the following respiratory parameters: tidal volume, 8 mL/kg; respiratory rate, 12 breaths per minute. 
		NOTE: The anesthetic maintenance drugs were sevoflurane 1%-3%, propofol 1-3 mg/kg/h, remifentanil 0.05-0.3 &#181;g/kg/min, cisatracurium 0.15-0.2 mg/kg, and 1/5-1/3 of the additional induction amount every 0.5-1 h12.</li>
	</ol>
	</li>
	<li>Use 0.5% PVP-I disinfectant to disinfect the surgical area. The upper part of the disinfection range should reach the nipple line on both sides, the lower part should reach the pubic symphysis, and both sides should reach the midaxillary line.</li>
	<li>After endotracheal intubation, place the trocars using the method of &#65279;modelized trocar arrangement. Determine the locations of the trocar placement based on the preoperative computed tomography (CT) images and the assessment of the abdominal adhesions13. 
	NOTE: For example, the case in this video is a lower abdominal incision hernia, which requires a total of five puncture tubes. A 12 mm puncture device is placed 10 cm above the belly button, 12 mm and 5 mm puncture tubes are placed at the left and right clavicular midlines, and 5 mm puncture tubes are placed at the left and right axillary midlines.</li>
	<li>Establish carbon dioxide pneumoperitoneum, and maintain the pneumoperitoneum pressure at 13 mmHg.</li>
	<li>Explore the whole abdominal cavity, evaluate the degree of abdominal adhesion around the hernia ring, and separate the adhesion.</li>
	<li>Close the defect of the hernia ring by continuous suture with a 1-0 barbed suture.</li>
</ol>
3. Measurement of the size of the hernia ring defect and anti-adhesion mesh marking
<ol>
	<li>Select an appropriate size anti-adhesion mesh (see Table of Materials) according to the size of the hernia ring defect, and then mark the mesh with a sterile marking pen as described below. 
	NOTE: A commercially available anti-adhesion mesh was used here, which contains a polypropylene mesh on the anterior side with an absorbable hydrogel barrier on the posterior side for laparoscopic hernia repair. The hydrogel barrier on the mesh prevents adhesion, and the mesh on this side should face the viscera.
	<ol>
		<li>Measure and mark the approximate range of the incisional hernia on the abdominal wall surface with a sterile ruler and marking pen (Figure 1A).The size of the hernia ring defect can also be measured by a preoperative CT examination.</li>
		<li>Place the ruler parallel to the longitudinal axis of the hernia defect, and measure the maximum longitudinal length of the defect (Figure 1B).</li>
		<li>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 5 cm. For example, for an incisional hernia defect of size 7 cm x 5 cm, use a mesh approximately 20 cm x 15 cm in size (Figure 1C).</li>
		<li>Mark the longitudinal length of the defect on the mesh, and mark the nail gun fixation points at intervals of 5 cm on the longitudinal axis. Then, extend the fixation points more than 5 cm along the marked line to the edge of the mesh, which pertains to the &#34;alignment&#34; (Figure 1D).</li>
		<li>Mark the nail gun fixation points evenly every 2-3 cm along the edge of the mesh, which pertains to the &#34;contraposition&#34; (Figure 1E).</li>
		<li>Finally, ensure that the fixing points of the nail gun are uniformly marked 2 cm from the longitudinal axis of the defect on both sides, with an interval of 3 cm (Figure 1F).</li>
	</ol>
	</li>
</ol>
4. Mesh placement method
<ol>
	<li>Roll the mesh such that the anti-adhesion surface will face the abdominal wall. Place the rolled mesh into the abdominal cavity through the 12 mm puncture hole, and then unfold the mesh under laparoscopic guidance (see Table of Materials, (Figure 2B).</li>
	<li>Reduce the pneumoperitoneum pressure to 8-10 mmHg.</li>
	<li>Ensure that the marked line of the unrolled mesh overlaps the longitudinal axis of the hernia ring defect (Figure 2C).</li>
	<li>Fix the marked points on the longitudinal axis of the mesh to the abdominal wall with non-absorbable nails using a nail gun (see Table of Materials; (Figure 2D).</li>
	<li>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 (Figure 2E).</li>
	<li>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 (Figure 2F).</li>
	<li>For the control group, flatten the mesh to cover the abdominal wall defect and fix the mesh using the double-loop mesh fixation method9,14.</li>
	<li>For the double-ring fixing method, do not mark the mesh.
	<ol>
		<li>First, place the fixing nails along the edge of the mesh to ensure that the distance between the nails and the edge of the mesh is about 2-4 mm and that the distance between the nails is about 2-3 cm.</li>
		<li>Then, fix the mesh along the outer edge of the hernia ring defect about 2 cm away from it, with a distance between the nails of 3-5 cm 
		&#8203;NOTE: See Figure 3A-D for this method.</li>
	</ol>
	</li>
</ol>
5. Follow-up
<ol>
	<li>Perform postoperative follow-up, including outpatient visits and telephone consultations, for 3 months to 24 months. 
	NOTE: In this study, the median follow-up time was 12 months. A physical examination and abdominal wall color ultrasound were performed in the first month after the operation, and an abdominal CT was performed at 3 months, 12 months, and 24 months after the operation.The follow-up time was 24 months after the operation.After all the follow-ups, the case data were collected and compared.</li>
	<li>Record the occurrence of seromas, hernia recurrence, chronic pain, and mesh infection. 
	Seroma can be diagnosed by an abdominal wall color ultrasound, hernia recurrence and mesh infection by an abdominal CT, and chronic pain by a pain rating scale.In particular, carry out an abdominal CT examination with patients 3 months after surgery, and then compare the results with the preoperative abdominal CT images to evaluate the surgical treatment effects and whether there is a recurrence of the incisional hernia (Figure 4A-F).</li>
</ol>
6. Statistical analysis
<ol>
	<li>Compare the time required for mesh placement, seroma formation, mesh infection, hernia recurrence, chronic pain, the length of hospital stay, and the hospital costs between the two groups. 
	NOTE: In this study, the measurement data (age, BMI, disease time, mesh placement time, length of hospital stay, and hospitalization costs) were expressed as mean &#177; standard deviation, and the count data (gender, maximum defect of the hernia ring, seroma, mesh infection, hernia recurrence, and chronic pain) were expressed as a count and percentage.</li>
	<li>Compare the measurement data between the groups using a t-test, and compare the count data using a chi-square test. A value of P &#60; 0.05 was considered to indicate a statistically significant difference in this study.</li>
</ol>

<ol><li>Misiakos, E., Patapis, P., Zavras, N., Tzanetis, P., Machairas, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Current+trends+in+laparoscopic+ventral+hernia+repair%5BTitle%5D)+AND+%22Journal+of+the+Society+of+Laparoscopic+%26+Robotic+Surgeons%22%5BJournal%5D)">Current trends in laparoscopic ventral hernia repair.</a> Journal of the Society of Laparoscopic & Robotic Surgeons. 19 (3), 2015(2015).</li>
<li>Raakow, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((A+comparison+of+laparoscopic+and+open+repair+of+subxiphoid+incisional+hernias%5BTitle%5D)+AND+%22Hernia%22%5BJournal%5D)">A comparison of laparoscopic and open repair of subxiphoid incisional hernias.</a> Hernia. 22 (6), 1083-1088 (2018).</li>
<li>Warren, J., Love, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Incisional+hernia+repair%3A+Minimally+invasive+approaches%5BTitle%5D)+AND+%22The+Surgical+Clinics+of+North+America%22%5BJournal%5D)">Incisional hernia repair: Minimally invasive approaches.</a> The Surgical Clinics of North America. 98 (3), 537-559 (2018).</li>
<li>Judy, J., Michael, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Laparoscopic+versus+open+ventral+hernia+repair%5BTitle%5D)+AND+%22The+Surgical+Clinics+of+North+America%22%5BJournal%5D)">Laparoscopic versus open ventral hernia repair.</a> The Surgical Clinics of North America. 88 (5), 1083-1100 (2008).</li>
<li>Muysoms, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((IPOM%3A+History+of+an+acronym%5BTitle%5D)+AND+%22Hernia%22%5BJournal%5D)">IPOM: History of an acronym.</a> Hernia. 22 (5), 743-746 (2018).</li>
<li>Tim, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Prospective+analysis+of+ventral+hernia+repair+using+the+Ventralight%E2%84%A2+ST+hernia+patch%5BTitle%5D)+AND+%22Surgical+Technology+International%22%5BJournal%5D)">Prospective analysis of ventral hernia repair using the Ventralight™ ST hernia patch.</a> Surgical Technology International. 23, 113-116 (2013).</li>
<li>Henriksen, N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Open+versus+laparoscopic+incisional+hernia+repair%3A+Nationwide+database+study%5BTitle%5D)+AND+%22BJS+Open%22%5BJournal%5D)">Open versus laparoscopic incisional hernia repair: Nationwide database study.</a> BJS Open. 5 (1), (2021).</li>
<li>Köckerling, F., Schug-Pass, C., Bittner, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((A+word+of+caution%3A+Never+use+tacks+for+mesh+fixation+to+the+diaphragm%5BTitle%5D)+AND+%22Surgical+Endoscopy%22%5BJournal%5D)">A word of caution: Never use tacks for mesh fixation to the diaphragm.</a> Surgical Endoscopy. 32 (7), 3295-3302 (2018).</li>
<li>Olmi, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Prospective+clinical+study+of+laparoscopic+treatment+of+incisional+and+ventral+hernia+using+a+composite+mesh%3A+Indications%2C+complications+and+results%5BTitle%5D)+AND+%22Hernia%22%5BJournal%5D)">Prospective clinical study of laparoscopic treatment of incisional and ventral hernia using a composite mesh: Indications, complications and results.</a> Hernia. 10 (3), 243-247 (2006).</li>
<li>Ning, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Application+of+%26%2334%3Bcontraposition+and+alignment%26%2334%3B+mesh+fixation+in+laparoscopic+incisional+hernia+repair%5BTitle%5D)+AND+%22Chinese+Journal+of+General+Surgery%22%5BJournal%5D)">Application of &#34;contraposition and alignment&#34; mesh fixation in laparoscopic incisional hernia repair.</a> Chinese Journal of General Surgery. 31 (4), 474-480 (2022).</li>
<li>Fu-Xin, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Botulinum+toxin+A+facilitated+laparoscopic+repair+of+complex+ventral+hernia%5BTitle%5D)+AND+%22Frontiers+in+Surgery%22%5BJournal%5D)">Botulinum toxin A facilitated laparoscopic repair of complex ventral hernia.</a> Frontiers in Surgery. 8, 803023(2022).</li>
<li>Lihong, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Observer%27s+assessment+of+alertness%2Fsedation-based+titration+reduces+propofol+consumption+and+incidence+of+hypotension+during+general+anesthesia+induction%3A+A+randomized+controlled+trial%5BTitle%5D)+AND+%22Science+Progress%22%5BJournal%5D)">Observer's assessment of alertness/sedation-based titration reduces propofol consumption and incidence of hypotension during general anesthesia induction: A randomized controlled trial.</a> Science Progress. 104 (4), 368504211052354(2021).</li>
<li>Zhou, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Application+of+modelized+port+arrangement+based+on+data+analysis+and+calculation+in+laparoscopic+repair+of+abdominal+wall+incisional+hernia%5BTitle%5D)+AND+%22Chinese+Journal+of+General+Surgery%22%5BJournal%5D)">Application of modelized port arrangement based on data analysis and calculation in laparoscopic repair of abdominal wall incisional hernia.</a> Chinese Journal of General Surgery. 31 (4), 449-456 (2022).</li>
<li>Bittner, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Update+of+Guidelines+for+laparoscopic+treatment+of+ventral+and+incisional+abdominal+wall+hernias+%28International+Endohernia+Society+%28IEHS%29%29+-+Part+A%5BTitle%5D)+AND+%22Surgical+Endoscopy%22%5BJournal%5D)">Update of Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS)) - Part A.</a> Surgical Endoscopy. 33 (10), 3069-3139 (2019).</li>
<li>Petersen, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Deep+prosthesis+infection+in+incisional+hernia+repair%3A+Predictive+factors+and+clinical+outcome%5BTitle%5D)+AND+%22The+European+Journal+of+Surgery%22%5BJournal%5D)">Deep prosthesis infection in incisional hernia repair: Predictive factors and clinical outcome.</a> The European Journal of Surgery. 167 (6), 453-457 (2001).</li>
<li>Montgomery, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Evidence+for+replacement+of+an+infected+synthetic+by+a+biological+mesh+in+abdominal+wall+hernia+repair%5BTitle%5D)+AND+%22Frontiers+in+Surgery%22%5BJournal%5D)">Evidence for replacement of an infected synthetic by a biological mesh in abdominal wall hernia repair.</a> Frontiers in Surgery. 2, 67(2015).</li>
<li>Mathes, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Mesh+fixation+techniques+in+primary+ventral+or+incisional+hernia+repair%5BTitle%5D)+AND+%22The+Cochrane+Database+of+Systematic+Reviews%22%5BJournal%5D)">Mesh fixation techniques in primary ventral or incisional hernia repair.</a> The Cochrane Database of Systematic Reviews. 5 (5), (2021).</li>
<li>Rieder, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Mesh+fixation+in+laparoscopic+incisional+hernia+repair%3A+Glue+fixation+provides+attachment+strength+similar+to+absorbable+tacks+but+differs+substantially+in+different+meshes%5BTitle%5D)+AND+%22Journal+of+the+American+College+of+Surgeons%22%5BJournal%5D)">Mesh fixation in laparoscopic incisional hernia repair: Glue fixation provides attachment strength similar to absorbable tacks but differs substantially in different meshes.</a> Journal of the American College of Surgeons. 212 (1), 80-86 (2011).</li>
<li>Stoikes, N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Biomechanical+evaluation+of+fixation+properties+of+fibrin+glue+for+ventral+incisional+hernia+repair%5BTitle%5D)+AND+%22Hernia%22%5BJournal%5D)">Biomechanical evaluation of fixation properties of fibrin glue for ventral incisional hernia repair.</a> Hernia. 19 (1), 161-166 (2015).</li>
<li>Bansal, V., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((A+prospective+randomized+study+comparing+suture+mesh+fixation+versus+tacker+mesh+fixation+for+laparoscopic+repair+of+incisional+and+ventral+hernias%5BTitle%5D)+AND+%22Surgical+Endoscopy%22%5BJournal%5D)">A prospective randomized study comparing suture mesh fixation versus tacker mesh fixation for laparoscopic repair of incisional and ventral hernias.</a> Surgical Endoscopy. 25 (5), 1431-1438 (2011).</li>
<li>Eriksen, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Pain%2C+quality+of+life+and+recovery+after+laparoscopic+ventral+hernia+repair%5BTitle%5D)+AND+%22Hernia%22%5BJournal%5D)">Pain, quality of life and recovery after laparoscopic ventral hernia repair.</a> Hernia. 13 (1), 13-21 (2009).</li>
<li>Bageacu, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Laparoscopic+repair+of+incisional+hernia%3A+A+retrospective+study+of+159+patients%5BTitle%5D)+AND+%22Surgical+Endoscopy%22%5BJournal%5D)">Laparoscopic repair of incisional hernia: A retrospective study of 159 patients.</a> Surgical Endoscopy. 16 (2), 345-348 (2002).</li>
<li>Taylor, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Laparoscopic+inguinal+hernia+repair+without+mesh+fixation%2C+early+results+of+a+large+randomised+clinical+trial%5BTitle%5D)+AND+%22Surgical+Endoscopy%22%5BJournal%5D)">Laparoscopic inguinal hernia repair without mesh fixation, early results of a large randomised clinical trial.</a> Surgical Endoscopy. 22 (3), 757-762 (2008).</li>
<li>Baker, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Decreased+re-operation+rate+for+recurrence+after+defect+closure+in+laparoscopic+ventral+hernia+repair+with+a+permanent+tack+fixated+mesh%3A+A+nationwide+cohort+study%5BTitle%5D)+AND+%22Hernia%22%5BJournal%5D)">Decreased re-operation rate for recurrence after defect closure in laparoscopic ventral hernia repair with a permanent tack fixated mesh: A nationwide cohort study.</a> Hernia. 22 (4), 577-584 (2018).</li>
<li>Beldi, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Mesh+shrinkage+and+pain+in+laparoscopic+ventral+hernia+repair%3A+A+randomized+clinical+trial+comparing+suture+versus+tack+mesh+fixation%5BTitle%5D)+AND+%22Surgical+Endoscopy%22%5BJournal%5D)">Mesh shrinkage and pain in laparoscopic ventral hernia repair: A randomized clinical trial comparing suture versus tack mesh fixation.</a> Surgical Endoscopy. 25 (3), 749-755 (2011).</li>
<li>Muysoms, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Randomized+clinical+trial+of+mesh+fixation+with+%26%2334%3Bdouble+crown%26%2334%3B+versus+%26%2334%3Bsutures+and+tackers%26%2334%3B+in+laparoscopic+ventral+hernia+repair%5BTitle%5D)+AND+%22Hernia%22%5BJournal%5D)">Randomized clinical trial of mesh fixation with &#34;double crown&#34; versus &#34;sutures and tackers&#34; in laparoscopic ventral hernia repair.</a> Hernia. 17 (5), 603-612 (2013).</li>
<li>Eriksen, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Fibrin+sealant+for+mesh+fixation+in+laparoscopic+umbilical+hernia+repair%3A+1-year+results+of+a+randomized+controlled+double-blinded+study%5BTitle%5D)+AND+%22Hernia%22%5BJournal%5D)">Fibrin sealant for mesh fixation in laparoscopic umbilical hernia repair: 1-year results of a randomized controlled double-blinded study.</a> Hernia. 17 (4), 511-514 (2013).</li>
<li>Erwin, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Mesh+fixation+in+laparoscopic+incisional+hernia+repair%3A+Glue+fixation+provides+attachment+strength+similar+to+absorbable+tacks+but+differs+substantially+in+different+meshes%5BTitle%5D)+AND+%22Journal+of+the+American+College+of+Surgeons%22%5BJournal%5D)">Mesh fixation in laparoscopic incisional hernia repair: Glue fixation provides attachment strength similar to absorbable tacks but differs substantially in different meshes.</a> Journal of the American College of Surgeons. 212 (1), 80-86 (2011).</li>
<li>Carbonell, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Local+injection+for+the+treatment+of+suture+site+pain+after+laparoscopic+ventral+hernia+repair%5BTitle%5D)+AND+%22The+American+Surgeon%22%5BJournal%5D)">Local injection for the treatment of suture site pain after laparoscopic ventral hernia repair.</a> The American Surgeon. 69 (8), 688-692 (2003).</li>
</ol>

The authors have no conflicts of interest to disclose.

Laparoscopic incisional hernia repair is primarily performed using the IPOM method5, for which the placement and fixation of the mesh are key to achieving good outcomes. If the placement and fixation of the mesh are improper, the mesh will not adhere tightly to the abdominal wall and may be wrinkled or displaced. Improper mesh fixation is associated with seroma formation, abdominal infection, chronic pain, and hernia recurrence. Specifically, the treatment for mesh infections involves puncture and...

Incisional hernia is a common complication after abdominal surgery and can be properly treated only with surgery1. Compared with traditional open incision herniorrhaphy, laparoscopic herniorrhaphy has the advantages of less surgical trauma, a lower infection rate, and faster postoperative recovery2,3. Currently, laparoscopic herniorrhaphy is the method of choice for the treatment of incisional hernia if there are no contraindications4.
However, laparoscopic herniorrhaphy is technically complex. Intraperitoneal onlay mesh (IPOM) is commonly used in laparoscopic incisional hernia repair, and this involves placing a mesh into the abdominal cavity laparoscopically to cover the hernia defect5. The mesh is a new type of medium-weight monofilament polypropylene mesh covered with a hydrogel barrier on the visceral side6. For laparoscopic incisional hernia repair using the IPOM method, it is necessary to master the placement of the trocars, the techniques to separate intra-abdominal adhesions, the techniques for suturing the incisional hernia, and the methods for placing and fixing the mesh in the abdominal cavity. In particular, if the mesh is not properly placed and fixed, this can result in the recurrence of the hernia, as well as potentially serious complications such as intestinal obstruction and mesh infection7,8. Therefore, mastering the correct mesh fixation technique is an important criterion for achieving a good surgical outcome. 
The traditional method of mesh fixation for incisional hernia is to fix the mesh with a double-ring hernia nail. After the mesh is placed into the abdominal cavity, the edge of the mesh is fixed with a nail gun first, and then the edge of the hernia ring is fixed9. However, this method has poor spatial positioning, and the mesh is prone to displacement, leading to hernia recurrence. By reviewing and analyzing the various mesh fixation methods, a new "contraposition and alignment" method for mesh fixation is proposed and presented in this protocol10. In this method, the size and scope of the incisional hernia are measured in advance, after which the mesh fixation points can be marked in advance. When the mesh is placed into the abdominal cavity during the operation, nail gun fixation and suture fixation can be performed according to the previously marked locations. This method can reduce the difficulty of the operation, the operation time, the medical cost, and the occurrence of complications. In this study, this new method is compared with the conventionally used double-loop hernia nail fixation method for mesh fixation during laparoscopic incisional hernia repair surgery.

<table><tbody><tr><td>1-0 Stratafix Symmetric PDS Plus Violet 45cm PS-1&amp;nbsp;</td><td>ETHICON</td><td>sxpp1a401</td><td>STRATAFIX Symmetric PDS Plus</td></tr><tr><td>3-0 VICRYL suture</td><td>ETHICON</td><td>VCP316</td><td>absorbable suture</td></tr><tr><td>AbsorbaTack Fixation</td><td>Covidien llc</td><td>ABSTACK15</td><td>absorbable nail gun</td></tr><tr><td>Laparoscopic needle holder</td><td>KARL-STORZ</td><td>26173KL</td><td>needle holder</td></tr><tr><td>Laparoscopic separating forceps</td><td>KARL-STORZ</td><td>38651ON</td><td>separating forceps</td></tr><tr><td>Laparoscopic system (OTV-S400)</td><td>Olympus</td><td>CLV-S400_WA4KL530</td><td>4K HD image large screen surgical laparoscope</td></tr><tr><td>ProTack Fixation</td><td>Covidien llc</td><td>174005</td><td>Non absorbable nail gun</td></tr><tr><td>VENTRALIGHT ST</td><td>BARD</td><td>5954810</td><td>Biological anti-adhesion mesh</td></tr></tbody></table>

application of a new mesh fixation method in laparoscopic incisional hernia repair

Application of a New Mesh Fixation Method in Laparoscopic Incisional Hernia Repair

Laparoscopic incisional hernia repair using intraperitoneal onlay mesh (IPOM) is one of the most widely used minimally invasive methods for repairing incisional hernias. The laparoscopic IPOM involves implanting the mesh into the abdominal cavity through laparoscopy to repair an abdominal wall hernia. In the IPOM surgery, after the closure of the hernia ring, an anti-adhesion mesh is placed laparoscopically. The correct placement of this mesh is critical to the success of the method, and surgical skills are required to achieve perfect placement. If the mesh placement is not mastered properly, the operation and anesthesia time will be prolonged. In addition, improper placement of the mesh can lead to serious consequences, such as intestinal obstruction and mesh infection. A "contraposition and alignment" mesh fixation method is described in this study, which involves pre-marking the fixation position of the mesh to reduce the difficulty of mesh placement. A properly placed mesh is completely flat on the peritoneum, the edges are not curled or wrapped, and the mesh is adhered firmly such that there is no displacement after removing the pneumoperitoneum pressure. The "contraposition and alignment" mesh fixation technique offers the advantages of reliable placement of the mesh and fewer complications than other techniques, and it is easy to learn and master. It also allows for positioning the nail gun in advance based on the anatomy of the incisional hernia. This enables the use of the minimum number of nails possible while still ensuring good fixation, which can reduce the occurrence of complications and reduce the cost of surgery. Thus, the mesh fixation method described here is highly suitable for clinical applications based on the aforementioned advantages.

Either "contraposition and alignment" mesh fixation (experimental group) or traditional double-loop hernia nail fixation (control group) was performed for the patients in the study, with 42 patients in each group.
During the hernia repair surgery performed in this study, the anti-adhesion mesh was placed after the hernia ring was sutured. In the experimental group, the "contraposition and alignment" method was used to place the mesh, while the traditional double-loop fixation method was used t...

Presented here is a method for improving the mesh placement in laparoscopic incisional hernia repair, which can shorten the time required for mesh fixation and reduce the occurrence of postoperative chronic pain.

Laparoscopic incisional hernia repair using intraperitoneal onlay mesh (IPOM) is one of the most widely used minimally invasive methods for repairing ...

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Research

JoVE Journal

Medicine

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Learn a new mesh fixation method for laparoscopic incisional hernia repair that enables accurate positioning and firm fixation. This technique reduces operative time and is easy for beginners to master.

Application of a New Mesh Fixation Method in Laparoscopic Incisional Hernia Repair

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