New technique for midline hernia repair

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Midline hernias comprise of epigastric,umbilical, paraumbilical and periumbilical port site hernias.
Though these hernias appear to be small, yet they have a very high chance of developing complications. Surgical treatment may appear to be very easy but the recurrence rate with these methods is very high. Laparoscopic methods too have ahigh recurrence rate.
Hence the need to develop a new method which envisages good anatomical repair accompanied by mesh reinforcement.

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New technique for midline hernia repair

  1. 1. New technique for midline hernia repair.(A combination of anatomical and mesh repair) By Dr. Ketan Vagholkar MS, DNB, MRCS, FACS Consultant General Surgeon & Professor of Surgery
  2. 2. Salient features of the new repair.l Repair of midline hernias is a challenging problem.l Midline hernias include epigastric, paraumbilical , umbilical and periumbilical port site hernias.l Traditional anatomical repairs have a high recurrence rate.l Traditional mesh repair involves placement of the mesh by onlay technique which has a high chance of infection and sinus formation.l Laparoscopic approach has a high failure rate.l A combination of anatomical and mesh repair has therefore been devised to overcome the shortcomings in the various repairs.l This involves creation of a new linea alba followed by placement of the mesh on it but below the rectus muscle.l The anterior rectus sheath is then closed over the rectus muscles ,thus covering the mesh completely.
  3. 3. l Hernial sac dissected upto the neck and thereafter opened
  4. 4. l Sac closed with 2-0 vicryll Cuts made on the anterior rectus sheath parallel to the defect on either side about 1 inch longer than the size of the defectl Rectus muscle dissected free and retracted laterally.
  5. 5. l Flaps of anterior rectus sheath thus created approximated in the midline by continuous 1-0 prolene suture
  6. 6. l Prolene mesh placed on the newly created linea alba and made to extend beyond the midline on either side and vertically about an inch above and below the defect.l The mesh fixed with interrupted 2-0 prolene stitches to prvent migration.
  7. 7. l Negative suction drain kept at the level of the mesh and brought out through a separate openingl The lateral edges of the anterior rectus sheath approximated with 1-0 ethilon.
  8. 8. Resultsl Paraumbilical & l Epigastric hernias umbilical herniasN= 52 N= 24Recurrence rate nil (Mean follow up Recurrence rate nil (Mean follow up period 12 months) period 12 months)l Periumbilical Port site incisional herniasN= 24Recurrence rate nil (mean follow up period 10 months)

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