Mesh fixation: transfascial sutures, absorbable and non-absorbable peritoneal fixation, glues

In this key lecture, Dr. Adrian Park presents an overview of abdominal wall anatomy, function, defects and their management.

The laparoscopic repair of incarcerated incisional hernias is still debated in the literature. The recent EAES/EHS guidelines state that laparoscopic surgery is not contraindicated and may be considered in selected patients with incarcerated hernia. This video shows the case of an 83-year-old woman with an incarcerated incisional hernia in the left iliac fossa (L2 zone – W2) successfully managed laparoscopically with an intraperitoneal onlay mesh reinforcement (IPOM-plus).

In this video, we present the technique of a TEP approach for the management of an inguinal hernia in a male patient. The technique is meticulously explained, emphasizing on the main anatomical landmarks, the key steps of the procedure and the potential injuries to be avoided.

Background: Laparoscopic inguinal hernia repair offers various advantages both to the patient and the surgeon. Transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP) repairs represent the two laparoscopic options. A personal technique of single incision laparoscopic TEP has already been published on WebSurg (Link: http://www.websurg.com/MEDIA/?noheader=1&doi=vd01en4054).
Video: This video demonstrates the single incision laparoscopic treatment of a peritoneal hole, which occurred accidentally during a right TEP procedure.
Results: The TEP procedure lasted 41 minutes and the peritoneal repair 8 minutes. The final umbilical scar length was 10mm and the patient was discharged within 24 hours.
Conclusions: Peroperative complications can occur during single incision laparoscopy, as well as during conventional laparoscopy and open surgery. The procedure can be performed without conversion or additional trocars, depending on the complications which occurred.

In this authoritative lecture, Dr. Morales-Conde focuses on mesh fixation for laparoscopic ventral hernia repair.

Guidelines are increasingly impacting the decision-making process in daily clinical work. Guidelines can be valuable in helping particularly the young surgeon in his/her daily work to find the best decision for the patient when confronted with a wide and confusing range of options. In this key lecture, Dr. Bonjer presents the recent guidelines for the laparoscopic treatment of ventral and incisional hernia repair.

In this video, Dr. Morales Conde highlights different techniques for mesh fixation in laparoscopic ventral hernia repair. Factors influencing pain, recurrence and adhesions are also demonstrated. Different techniques and materials to decrease pain and adhesions are outlined. The ideal laparoscopic ventral hernia repair can be achieved by decreasing mechanical fixation and increasing biological fixation to reduce pain and adhesions while preventing recurrence.

The transabdominal preperitoneal (TAPP) approach is the most frequently used laparoscopic technique for inguinal hernia repair. In this video, key steps of the procedures are demonstrated. Patient and port positioning, anatomical landmarks, and subtle technical tricks are provided by J Leroy, MD, FRCS, one of the pioneers of the technique. Interaction with the audience during this live demonstration addresses important issues of the technique.