Muhammad Farooq Afzal, Wasim Hayat, Muhammad Waris Farooka, Imran Khokar, Amir Zaheer, Mahmood Ayyaz.
Laparoscopic ventral hernia repair using intraperitoneal onlay polyester mesh alone.
Pak J Med Health Sci Jan ;4(4):362-5.

Background: Although the standard practice in laparoscopic ventral hernia repair is placing a dual mesh so as to prevent visceral adhesions to the mesh but majority of the patients cannot afford the cost of these meshes. We propose simple polyester mesh with omentum as a cheap and effective alternative to the dual mesh. Methods: This is a retrospective review of a prospectively maintained database and is conducted at one private and one teaching hospital of Lahore. The case records of all patients presenting with ventral hernia with a defect size of more than 4cm were eligible. Those unfit for GA or with a defect size of 15 cm or more with or without skin ulceration or bowel fistulation or loss of domain were excluded. All patients received standard preop prophylaxis for wound infection and DVT. Results: From the period March 2007 to Sep 15, 2008; 18 patients underwent Laparoscopic intraperitoneal onlay mesh repair (IOM). Male to female ratio was 3:2. Mean age was 35 with age range of 19 to 73. There were 5 Primary paraumbilical hernias and 4 incisional hernias. All the rest were primary midline hernias with multiple defects. Two patients underwent Dual polyester mesh (Parietex composite) whereas all other patients underwent simple polyester mesh with omentum sandwiched between abdominal wall and viscera. Average operating time was 75 minutes. Seroma formation was the commonest complication whereas port site infection happened in 10% patients. There are two recurrences; both in the simple polyester mesh group, with a minimum follow up of 6 months but were not statistically significant. No mesh infection happened in this period of time. One case had prolonged ileus but it resolved with conservative management. Conclusion: Laparoscopic hernia repair is a useful technique especially in obese patients with hidden defects or multiple previous operations. Simple polyester mesh with omental barrier is a safe and cheap alternative to the dual mesh technique.

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