Journal of Surgery Current Trends & Innovations Category: Clinical Type: Research Article
Massive Ventral Hernia Repair: A Novel Technique with an Innovative Device
- Luo Y1*, Raj MT 2, Zhang WJ3, Lim J2, Xu Y2, Wright F3
- 1 Department Of Surgery, College Of Medicine, Saskatoon, Canada
- 2 Department Of Surgery, College Of Medicine, University Of Saskatchewan, Canada
- 3 Department Of Surgery, College Of Engineering, University Of Saskatchewan, Canada
*Corresponding Author:Luo Y
Department Of Surgery, College Of Medicine, Saskatoon, Canada
Received Date: Nov 27, 2017 Accepted Date: May 26, 2017 Published Date: Dec 29, 2017
We hypothesized that during mesh application in the massive ventral hernia repair, a novel easily applicable retractor that is flexible, foldable and puncture-proof can better facilitate the surgery as compared to the currently available spatula device (Figure 1). This study has been approved by the University of Saskatchewan Ethical Board (#20170063).
MATERIALS AND METHODS
Design and production of the device
Abdominal surgery on pigs
Simple and innovative retractor design for use in abdominal hernia repairs
A time-saving and protective retractor for abdominal surgery on pig model
The removal process on the other hand was quick and the compact size of the folded retractor proved beneficial (Figure 8). Only 26-28 minutes were needed to suture the mesh inside the abdomen. Roughly half the time was needed to do the same repair with currently available equipment (spatula) in the operating room.
CLINICAL CASE RESULT
She recovered very well after the surgery. The follow-up 3 months showed that she was doing well, back to work, with no complications or recurrence (Figures 2 and 9).
Over the last 20 years, tension-free repair of massive ventral hernia with mesh, especially by laparoscopy, becomes gradually popular with much better outcomes, such as less postoperative abdominal pain and a decreased recurrence rate close to 15% [2,3,5-10]. However, most research on massive ventral hernia repair is about modification of the existing approaches or surgical methods, including abdominal wall reconstruction. There was little research on surgical instruments or devices for this purpose, in particular, design of a retractor to facilitate this type of surgery.
Inlay mesh repair is one choice of surgical techniques, where the mesh is inserted and attached to inside surface of abdominal wall. Although the laparoscopic approach is to facilitate inlay mesh placement with less likelihood of infection, seroma or hematoma, it carries high rate of incidental enterotomy and usually takes longer surgical time . In addition, very large ventral hernia, recurrent ventral hernia, incarcerated hernia and hernia with multiple past surgeries might be relative contraindicative for laparoscopic surgery . On the other hand, open hernia repair usually needs to free the fascia muscular layer to facilitate the anchoring an inlay mesh and, thus creates a potential dead space between subcutaneous layer and fascia muscular layer. This approach leads to the shortcomings of open surgery: more postoperative pain, high rate of seroma, hematoma and mesh infection as well as longer patient stays in the hospital .
Our approach is to use an open technique but a laparoscopic instrument to speed up the surgery by not freeing the fascia muscular layer to omit the complications caused by the above mentioned dead space. After freeing the adhesions inside the abdomen, we repair the hernia by anchoring the inlay mesh with sutures across the whole abdominal wall with the help of laparoscopic suture passer. This technique has been used in clinical cases with good results. The patient hospital stay is shorter with little wound complications. However, incidental bowel perforation is a potential complication and although rare its consequence are devastating . In order to prevent incidental injury to the intestines and other intra-abdominal organs intra-operatively, we usually have to use a spatula, which is relatively small, narrow and inadequate in providing complete protection to the intra-abdominal organs, including the intestines. We need to move and ensure the spatula stay precisely in place of every suture passer puncture, which not only slows down the surgery but is also less reliable. Therefore, we invented a new abdominal retractor, which is designed as being foldable and fan-shaped. It can protect all the intra-abdominal organs including the intestines from incidental suture passer injury.
A novel retractor device for mesh application
Our results demonstrated adequate protection, foldable design and easy application. There is evidence for further development of this simple useful device. It is important to note that our device does not require extra personnel to hold it in place, whereas the currently available spatula requires at least a two-person team. Reducing manpower, speeding up the surgery and prevention of complications will save taxpayers’ money on the health system and save patients from suffering.
Our study was still preliminary. Further investigations are warranted. Comparative studies with currently available spatula device on live animal are necessary for further evaluation of our novel retractor for safety, efficiency and biocompatibility [11,12]. Our concept design was still not thin and flexible enough making its application slightly cumbersome. A gear mechanism that turns the leaflets spreading to a pre-set perfect overlap would be ideal. Reusability of the device might be another consideration in our future study. Engineering optimization of leaflet shape, thickness, flexibility, number and biocompatibility is now undertaken.
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Citation:Luo Y, Raj MT, Zhang WJ, Lim J, Xu Y, et al. (2017) Massive Ventral Hernia Repair: A Novel Technique with an Innovative Device. J Surg Curr Trend Innov 1: 003.
Copyright: © 2017 Luo Y, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.