Primary Fascial Closure During Robotic 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 underlying ventral hernias prior to mesh placement using a robotic approach. First, adhesions are lysed, the hernia is reduced, and abdominal pressure is reduced to 6 to 8 mm Hg. Smaller defects (patient 1) can be closed along the long axis using 0-barbed slowly absorbable suture run in a continuous manner along the whole length of the defect, then run back in the opposite direction to create overlap. For larger defects (patient 2, recurrent hernia), a second suture is used, usually in a caudal-to-cranial direction. Click the article link for a video illustrating a percutaneous technique and for a complete description of the surgical approach.