Umbilical hernia is a common pathology treated by General Surgeons in worldwide hospitals. Due to the risk of incarceration and strangulation, surgical repair is always indicated, even in asymptomatic cases.
The use of prosthesis can prevent / decrease recurrences. Where to place it? "Sublay" application of prosthesis (behind hernia defect) seems to be the ideal. For ventral hernias there are two main techniques where the prosthesis is placed in a "sublay" fashion:
Retrorectus repair (Rives-Stoppa-Wanz): between the rectus muscle and the posterior rectus sheath - behind the defect, with no contact with viscera
Intraperitoneal Rives-Type repair: intraperitoneal in contact with viscera (double layer prosthesis)
Laparoscopic approach to ventral hernia repair was first described in early 1990's. Since then, laparoscopic technique has gained acceptance in surgical community. In fact, laparoscopic ventral hernia repair is one of the fastest growing minimally invasive techniques due to the excellent results reported.
Hernia repair principles in laparoscopic technique are the same as in open surgery. Prosthesis should be placed in a "sublay" position behind the hernia defect, and overlapping normal aponeurosis for 4-5 cm beyond hernia defect. In laparoscopy, mesh is placed intraperitoneal and in contact with viscera. For this, a double layer prosthesis is needed.
The video now published, summarizes the laparoscopic umbilical hernia repair using three ports and a double layer prosthesis. Fixation was achieved with four transfascial sutures followed by two rows of tackers. Patient was discharge home the day after surgery.
Link to watch the video in Surgical Videos:
Link to watch the video in YouSurg (YouTube):
Hope you enjoy the video. Place your comments bellow.
Dr. Carlos Eduardo Costa Almeida
General Surgeon