Laparoscopic Transcutaneous Closure of Central Defects in Laparoscopic Incisional Hernia Repair

Purpose: The aim of this technical report is to investigate the safety, efficacy, and outcome of transcutaneous closure of central defects (TCCD) for laparoscopic incisional hernia repair (LIHR). Methods: Twenty-two patients with incisional hernias underwent a LIHR-TCCD repair. After clearance of the abdominal wall from adhesions, laparoscopic central closures were performed trans-cutaneously with 0-polypropelene sutures placed every 1 cm of the defect starting at the cranial-most edge of the hernia and ending at the caudal-most edge of the hernia. A standard LIHR was performed with coated polyester mesh placed with at least 6 cm of overlap with mesh on all borders. Transfascial sutures with 0-polypropelene sutures were placed every 4 cm circumferentially, and titanium tacks were used to secure the mesh to the peritoneum every 1cm. Results: The mean age was 52 years and the mean body mass index was 35 kg/m(2). The mean hernia defect was 4.7cm x 7.2 cm with a mean area of 37 cm(2). There were no mortalities and no major peri-operative morbidities. Minor complications included 2 (9%) cases of pneumonia/pneumonitis. There were no clinically significant seromas, no radiographic or clinical eventrations, and no hernia recurrences with a mean follow-up of 21 months. Conclusions: LIHR-TCCD is safe and technically feasible in incisional hernias of width < 10 cm. By closing the central defect, seromas and eventrations can be reduced.