The assessment of modification of prosthesis fixation method on visceral interposition during laparoscopic abdominal hernia reconstruction

UNLABELLED: During laparoscopic abdominal hernia repair (LAHR) there is a discrepancy in relative position of mesh and fixation points during the procedure (while abdominal cavity is distended with gas) and afterwards. Therefore, after the surgery the prosthesis becomes corrugated, and tension develops in suture anchoring points. One of the proposed solutions of this problem is to place stabilizing sutures outside the mesh edges and to tie them after emptying the abdominal cavity of CO2. However, due to lack of visualization, viscera entrapment between the mesh and integuments may occur during this stage of surgery. The aim of the study was to assess the effect of fixation technique modification on the risk of visceral interposition between the mesh and integuments and deformation of prostheses fixated this way. MATERIAL AND METHODS: The study was performed in an experimental animal model (12 pigs) by implanting laparoscopically two 6.6x6 cm mesh fragments per animals and tying fixation sutures after emptying the abdominal cavity of CO2. After 6 weeks, visceral interposition between mesh and integuments and such fixated fragments corrugation were assessed. RESULTS: Visceral dislocation between parietal and visceral surface was absent in all 24 assessed meshes, despite fixation under no visual guidance. There were no mesh deformities between anchoring points. CONCLUSIONS: The analysed modification of laparoscopic abdominal hernia repair does not create risk of internal organ interposition between the prosthesis and integuments and prevents mesh from being corrugated.