Laparoendoscopic stapled rives stoppa sublay technique for extraperitoneal ventral hernia repair

Laparoscopic and robotic extraperitoneal ventral hernia repair techniques have developed with the goal of combining the benefits of traditional open sublay repair with those of minimally invasive surgery. We describe the use of a laparoendoscopic extraperitoneal sublay repair employing a linear stapler for plication and division of the linea alba with subsequent mesh augmentation.

Between January 2016 and February 2017, 21 patients with midline ventral and incisional hernias underwent repair using a laparoendoscopic extraperitoneal stapled sublay mesh repair. Six of the cases included simultaneous laparoscopic bilateral posterior component separation with division of the posterior lamella of the internal oblique muscle. Three of these had additional myofascial release of the transversus abdominis muscle to facilitate midline approximation. Intraoperative and perioperative complications, recurrence, pain, and narcotic usage were measured.

Defect width ranged from 3 to 9 cm. No significant intraoperative complications or conversions to open surgery occurred. Patients were discharged at 0.9 days on average. Early postoperative complications included hernia site seroma in two patients. There were no early postoperative infections of recurrences. One patient underwent local exploration at 6 months to remove a palpable suprafascial retained hernia sac. Compared with traditional laparoscopic intraperitoneal onlay mesh repair, less acute pain was reported.

Laparoendoscopic extraperitoneal stapled sublay is a safe and effective method for small to medium-sized ventral and incisional hernias and adds another option to achieve minimally invasive extraperitoneal ventral hernia repair.