Laparoscopic ventral hernia repair without sutures--double crown technique: our experience after 140 cases with a mean follow-up of 40 months.

It has been reported that avoidance of recurrences after laparoscopic ventral hernia repair (LVHR) depends on using sutures to secure the mesh. We developed a successful suture-less LVHR. The Double Crown LVHR using ePTFE mesh (overlap, ≥3 cm) was done in 140 cases. Tacks were placed 1 cm apart at the edge of the mesh. A second crown of tacks was placed at the edge of the defect. Three conversions (2.14%) and five bowel perforations occurred intraoperatively (3.57%). Postoperative complications were prolonged ileus (two cases), hematoma (two cases), seroma requiring drainage (three cases), and reoperation in one case for mesh intolerance, three cases for bowel perforation, and one case for small bowel ischemia. The recurrence rate (mean follow-up of 40 months) was 2.14%. The Double Crown LVHR is a safe alternative to LVHR using sutures, with a similar recurrence rate, less pain, fewer incisions and infections, and a shorter operating time.