Is there a Keyhole repair for Incisional HERNIA ?
This is a newer technique and has become available largely because of new development of special meshes which have two sides, one that adheres to the muscle layer and the other, which is exposed to the intestines, is smooth and non-adherent to avoid bowel sticking to it. Briefly, the procedure is performed by inflating the abdomen with CO2 gas and placing 3-4 laparoscopic ports to one side of the abdominal wall. The hernial contents will be reduced back into the abdominal cavity. In case of adhesions or if the contents are stuck, these will be dissected away from the hernial sac prior to repairing the defect. If for any reason, the above was not possible, then the procedure may have to be converted to an open conventional repair.
Once the defect is fully exposed, a piece of mesh is placed in the abdomen. This is rolled up initially like a Cigar after marking it according to the size and shape of the defect. A number of pre-tied sutures can be placed around its edges to facilitate accurate positioning of the mesh. Once inside the abdomen, it is unrolled and the pre-tied sutures will be picked up and the mesh tied up to the abdominal wall. This covers the hernial defect. Further fixation with metal tacks is used to keep the mesh in position. The laparoscopic ports are removed, after a thorough inspection for any bleeding or any bowel injury. The wounds are closed with absorbable sutures. The mesh is usually incorporated within the abdominal wall over the next six weeks, thus repairing the hernia.
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