By Dr. J. Gnanaraj and Mr. Joshua W.J.
Incisional/ventral hernias are defects of the abdominal wall that appear after a prior surgery, at the site of the incision. They represent a significant drawback to invasive abdominal surgery and can develop in up to 20% of patients who have abdominal surgeries (1). In addition to the poor cosmesis, there could be social embarrassment and impaired quality of life. While it is no longer necessary to debate the use of suture vs. mesh repairs, there are still varying opinions on whether laparoscopic surgery is a reasonable alternative to open surgery for mesh repairs. There are benefits to laparoscopic incisional hernia repair, such as lower post-op pain, shorter hospital stays, and higher patient satisfaction. Meta-analysis shows the advantage of laparoscopic hernia repair (2). However, due to the high cost of the mesh, the cost of laparoscopic repair is very high, with the direct costs quoted as equivalent to INR 2,00,000 (3). We describe a low-cost technique for doing the smaller incisional hernia or epigastric or paraumbilical hernia, using the low-cost Prolene mesh (INR 2000).
Technique
Surgery is performed under general anesthesia with Foley’s catheter and a nasogastric tube in place, and with the patient cleaned and draped in the supine position. The 10 mm port for the camera is placed at an appropriate place, about six inches away from the hernia. A blunt trocar is placed using the open placement technique, so that there is no injury to the intra-abdominal organs. Two 5 mm ports are placed on either side, in an arc with the hernia at focal point. A 10 mm 30-degree telescope is used, facing upwards to the hernia. It is important to hold the camera the 12 o’clock position correctly, to have proper orientation.
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