Over the past few years, the laparoscopic repair of Spigelian hernias or incisional hernias has become increasingly popular. The two techniques are similar. However, in the laparoscopic repair of incisional hernias, a difficult and time consuming enterolysis is usually performed prior to the repair. Nonetheless, these procedures can now  be performed with relative ease and improved recovery.

 

TROCAR PLACEMENT

The placement of the trocars varies with the size and location of the hernia defect. Usually, these repairs are performed using three trocars.

INSTRUMENTS AND HARDWARE

• 1 VERSAPORT* 10-5 MM
• 2 VERSAPORT* 5 MM
• 1 ENDOSHEAR* INSTRUMENT
• 1 ATRAUMATIC GRASPER 5 mm
• 1 PROTACK* INSTRUMENT
• 1 SURGIPRO* MESH
• A 30 Deg. 10 or 5 mm Straight Forward Telescope

THE TECHNIQUE

The intra-abdominal cavity is well visualized. The facial defect and the peritoneal sac are identified. Any adhesions should be lysed using the ENDOSHEARS INSTRUMENT*.

A peritoneal incision is made using the ENDOSHEARS INSTRUMENT*, one centimeter from the edges of the facial defect. A peritoneal flap is raised while mobilizing the hernia sac. The dissection is continued beyond the hernia defect. This peritoneal flap will be eventually used to cover the completed repair.

The size of the defect is now assessed. The SURGIPRO* Mesh is cut to be larger than the defect. The custom-size Mesh is inserted into the intra-abdominal cavity via the 10-5 mm VERSAPORT*.  The Mesh is then deployed over the facial defect (overlapping the fascial defect on each side). Using a PROTAC* INSTRUMENT,  the Mesh is meticulously stapled to the abdominal facia around the defect. The attachments of the Mesh should be checked by placing pressure at the center of the Mesh with an atraumatic grasper to verify the Mesh is properly anchored.

The peritoneal flap is deployed over the Mesh and repair. It is stapled to the abdominal wall using the PROTACK* INSTRUMENT. The entire peritoneal flap (including the hernia sac) should cover the defect and the entire Mesh.

The procedure is completed and the abdomen deflated.