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Primary Fascial Closure During Laparoscopic Incisional Hernia Repair

Most laparoscopic ventral hernia repairs are taught as bridged repairs, where surgical mesh spans an unclosed fascial defect, but bridged repair can result in poor abdominal wall function and reduced quality of life. This procedure video demonstrates a surgical technique for closing fascial defects up to 10 to 12 cm in width that underlie ventral hernias prior to mesh placement using a percutaneous technique. First, adhesions are lysed and the hernia is reduced, then small stab incisions are created along the midline atop the hernia defect through which a disposable suture passer device is inserted. After traversing the subcutaneous tissue, the device is oriented laterally to pierce through the edge of the fascia on 1 side; the suture is transferred intra-abdominally to a grasper, and then the suture passer is reinserted through the same puncture incision and passed through the fascia on the opposite side. Sutures are then placed 1 cm apart, and following placement of every 4 sutures, the abdomen is desufflated and the 4 sutures are tied extracorporeally approximating the fascial edges in the midline. These steps are repeated until reaching slightly beyond the cephalad and caudal ends of the hernia. The mesh is then secured using 0-PDS positioning sutures in 4 corners and tacked with a double crown of permanent tacks. Click the article link for a video illustrating a robotic technique of primary fascial closure repair and for a complete description of the surgical approach.

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