Skip to main content
SpringerLink
Log in

Outcomes of laparoscopic ventral hernia repair with routine defect closure using “shoelacing” technique

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Introduction

Laparoscopic approach has become standard for many ventral hernia repairs. The benefits of minimal access include reduced wound complications, faster functional recovery, and improved cosmesis, among others. However, “bridging” of hernia defects during traditional laparoscopic ventral hernia repair (LVHR) often leads to seromas or bulging and, importantly, does not restore a functional abdominal wall. We have modified our approach to LVHR to routinely utilize transabdominal defect closure (“shoelacing” technique) prior to mesh placement. Herein, we aim to analyze outcomes of LVHR with shoelacing.

Methods

Consecutive patients undergoing LVHR with shoelacing were reviewed retrospectively. Main outcome measures included patient demographics, previous surgical history, intraoperative time, mesh type and size, postoperative complications, length of hospitalization, and hernia recurrence.

Results

Forty-seven consecutive patients underwent LVHR with defect closure. Average body mass index (BMI) was 32 kg/m2 (range 22–50 kg/m2). Eighteen (38%) patients had an average of 1.5 previous repairs (range 1–3). Mean defect size was 82 cm2 (range 16–300 cm2), requiring a median of 4 (range 2–7) transabdominal stitches for shoelacing. Two patients required endoscopic component separation to facilitate defect closure. Mean mesh size used was 279 cm2 (range 120–600 cm2). Mean operative time was 134 min (range 40–280 min). There were no intraoperative complications. Average length of hospitalization was 2.9 days (range 1–10 days). There were two major postoperative complications [one pulmonary embolism (PE), one stroke]; however, there was no wound-related morbidity or significant seromas. At mean follow-up of 16.2 months, there have been no recurrences.

Conclusions

LVHR with defect closure confers a strong advantage in hernia repair, shifting the paradigm towards more physiologic abdominal wall reconstruction. In this series, we found our approach to be safe and comparable to historic controls. While providing reliable hernia repair, the addition of defect closure in our patients essentially eliminated postoperative seroma. We advocate routine use of the shoelace technique during laparoscopic ventral hernia repair.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Rosen MJ, Jin J, McGee MF, Williams C, Marks J, Ponsky JL (2007) Laparoscopic component separation in the single-stage treatment of infected abdominal wall prosthetic removal. Hernia 11:435–440

    Article  PubMed  CAS  Google Scholar 

  2. Burger JW, Luijendijk RW, Hop WC, Halm JA, Verdaasdonk EG, Jeekel J (2004) Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 240:578–583; discussion 583–575

    PubMed  Google Scholar 

  3. Sauerland S, Schmedt CG, Lein S, Leibl BJ, Bittner R (2005) Primary incisional hernia repair with or without polypropylene mesh: a report on 384 patients with 5-year follow-up. Langenbecks Arch Surg 390:408–412

    Article  PubMed  Google Scholar 

  4. Luijendijk RW, Hop WC, van den Tol MP, de Lange DC, Braaksma MMJNIJ, Boelhouwer RU, de Vries BC, Salu MK, Wereldsma JC, Bruijninckx CM, Jeekel J (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 343:392–398

    Article  PubMed  CAS  Google Scholar 

  5. Lomanto D, Iyer SG, Shabbir A, Cheah WK (2006) Laparoscopic versus open ventral hernia mesh repair: a prospective study. Surg Endosc 20:1030–1035

    Article  PubMed  CAS  Google Scholar 

  6. White TJ, Santos MC, Thompson JS (1998) Factors affecting wound complications in repair of ventral hernias. Am Surg 64:276–280

    PubMed  CAS  Google Scholar 

  7. Finan KR, Vick CC, Kiefe CI, Neumayer L, Hawn MT (2005) Predictors of wound infection in ventral hernia repair. Am J Surg 190:676–681

    Article  PubMed  Google Scholar 

  8. Breuing K, Butler CE, Ferzoco S, Franz M, Hultman CS, Kilbridge JF, Rosen MJ, Silverman RP, Vargo D (2010) Incisional ventral hernias: Review of the literature and recommendations regarding the grading and technique of repair. Surgery 148(3):544–558

    Article  PubMed  Google Scholar 

  9. Bencini L, Sanchez LJ, Boffi B, Farsi M, Scatizzi M, Moretti R (2003) Incisional hernia: repair retrospective comparison of laparoscopic and open techniques. Surg Endosc 17:1546–1551

    Article  PubMed  CAS  Google Scholar 

  10. DeMaria EJ, Moss JM, Sugerman HJ (2000) Laparoscopic intraperitoneal polytetrafluoroethylene (PTFE) prosthetic patch repair of ventral hernia. Prospective comparison to open prefascial polypropylene mesh repair. Surg Endosc 14:326–329

    Article  PubMed  CAS  Google Scholar 

  11. Heniford BT, Park A, Ramshaw BJ, Voeller G (2003) Laparoscopic repair of ventral hernias: nine years’ experience with 850 consecutive hernias. Ann Surg 238:391–399; discussion 399–400

    PubMed  Google Scholar 

  12. Park A, Birch DW, Lovrics P (1998) Laparoscopic and open incisional hernia repair: a comparison study. Surgery 124:816–821; discussion 821–812

    Article  PubMed  CAS  Google Scholar 

  13. Ramshaw BJ, Esartia P, Schwab J, Mason EM, Wilson RA, Duncan TD, Miller J, Lucas GW, Promes J (1999) Comparison of laparoscopic and open ventral herniorrhaphy. Am Surg 65:827–831; discussion 831–822

    PubMed  CAS  Google Scholar 

  14. Novitsky YW, Cobb WS, Kercher KW, Matthews BD, Sing RF, Heniford BT (2006) Laparoscopic ventral hernia repair in obese patients: a new standard of care. Arch Surg 141:57–61

    Article  PubMed  Google Scholar 

  15. Agarwal BB, Agarwal S, Mahajan KC (2009) Laparoscopic ventral hernia repair: innovative anatomical closure, mesh insertion without 10-mm transmyofascial port, and atraumatic mesh fixation: a preliminary experience of a new technique. Surg Endosc 23:900–905

    Article  PubMed  Google Scholar 

  16. Agarwal BB, Agarwal S, Gupta MK, Mishra A, Mahajan KC (2008) Laparoscopic ventral hernia meshplasty with “double-breasted” fascial closure of hernial defect: a new technique. J Laparoendosc Adv Surg Tech A 18:222–229

    Article  PubMed  Google Scholar 

  17. Carbajo MA, Martin del Olmo JC, Blanco JI, de la Cuesta C, Toledano M, Martin F, Vaquero C, Inglada L (1999) Laparoscopic treatment vs. open surgery in the solution of major incisional and abdominal wall hernias with mesh. Surg Endosc 13:250–252

    Article  PubMed  CAS  Google Scholar 

  18. Sajid MS, Bokhari SA, Mallick AS, Cheek E, Baig MK (2009) Laparoscopic versus open repair of incisional/ventral hernia: a meta-analysis. Am J Surg 197:64–72

    Article  PubMed  Google Scholar 

  19. Giancoli DC (1995) Physics: principles with applications, 4th edn. Prentice Hall, Englewood Cliffs, NJ

    Google Scholar 

  20. Sabiston DC, Townsend CM (2008) Sabiston textbook of surgery: the biological basis of modern surgical practice, 18th edn. Saunders/Elsevier, Philadelphia

    Google Scholar 

  21. Abrahamson J, Eldar S (1988) “Shoelace” repair of large postoperative abdominal hernias: a simple extraperitoneal technique. Contemp Surg 32:24–34

    Google Scholar 

  22. Palanivelu C, Jani KV, Senthilnathan P, Parthasarathi R, Madhankumar MV, Malladi VK (2007) Laparoscopic sutured closure with mesh reinforcement of incisional hernias. Hernia 11:223–228

    Article  PubMed  CAS  Google Scholar 

  23. Franklin ME Jr, Gonzalez JJ Jr, Glass JL, Manjarrez A (2004) Laparoscopic ventral and incisional hernia repair: an 11-year experience. Hernia 8:23–27

    Article  PubMed  Google Scholar 

Download references

Disclosures

S. Orenstein, J. Dumeer, J. Monteagudo, M. J. Poi, and Y. Novitsky have no conflicts of interest or financial ties to disclose for this study.

Author information

Authors and Affiliations

  1. Department of Surgery, Connecticut Comprehensive Center for Hernia Repair, University of Connecticut Health Center, 263 Farmington Avenue—MC 3955, Farmington, CT, 06030, USA

    Sean B. Orenstein, Mun Jye Poi & Yuri W. Novitsky

  2. University of Connecticut School of Medicine, Farmington, CT, USA

    Jillian L. Dumeer, Julie Monteagudo & Yuri W. Novitsky

Authors
  1. Sean B. Orenstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jillian L. Dumeer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Julie Monteagudo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mun Jye Poi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yuri W. Novitsky
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yuri W. Novitsky.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Orenstein, S.B., Dumeer, J.L., Monteagudo, J. et al. Outcomes of laparoscopic ventral hernia repair with routine defect closure using “shoelacing” technique. Surg Endosc 25, 1452–1457 (2011). https://doi.org/10.1007/s00464-010-1413-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-010-1413-3

Keywords

Search

Navigation