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Bone Anchor Mesh Fixation for Complex Laparoscopic Ventral Hernia Repair

Department of General Surgery, Mayo Clinic Arizona, Scottsdale, Arizona

K.L. Harold, MD

Department of General Surgery, Mayo Clinic Arizona, Scottsdale, Arizona

W.S. Cobb, MD

Division of Minimal Access and Bariatric Surgery, Department of Academic Surgery, Greenville Hospital System University Medical Center, Greenville, South Carolina

A.M. Carbonell, DO

Division of Minimal Access and Bariatric Surgery, Department of Academic Surgery, Greenville Hospital System University Medical Center, Greenville, South Carolina, alfcarbonell{at}mac.com

Background: Laparoscopic ventral hernia repair (LVHR) has gained wide acceptance by both surgeons and patients, but hernias that approach a bony prominence are more complex due to the difficulty of proper fixation. This study was conducted to evaluate the use of bone anchor mesh fixation for complex LVHR. Methods: A prospective study of patients having complex LVHR with bone anchors was conducted using patients from 2 academic institutions between July 2003 and December 2007. Patient demographic data, characteristics of the hernia, operative details, and postoperative outcomes were recorded. Results: A total of 30 patients who had LVHR using bone anchors were evaluated (20 women, 10 men; mean age 60.9 years, range 41-83 years). In all, 17 suprapubic and 13 lateral hernias were included, requiring a mean of 2.8 and 3.2 bone anchors, respectively. The average hernia defect was 263 cm² (range 35-690 cm²), and the average mesh size was 663 cm² (range 255-1360 cm²). Mean operative time was 218 minutes (range 98-420 minutes), with an estimated blood loss of 46 mL (range 10-100 mL). The average length of stay was 5.2 days (range 1-26 days). Seven patients (23.3%) developed postoperative complications, and 1 patient in this study died (mortality 3.3%). During follow-up of 13.2 months (range 1-26 months), 2 patients (6.7%) developed a recurrent hernia. Conclusions: Bone anchors can be used successfully in the laparoscopic repair of complex ventral hernias, particularly with suprapubic and lateral hernias that approach a bony prominence. The complication rate is acceptable, with a short hospital stay and low recurrence rate.

Key Words: hernia • laparoscopic ventral hernia repair • suprapubic and parapubic hernia • incisional hernia • bone anchor

This version was published on December 1, 2008

Surgical Innovation, Vol. 15, No. 4, 292-296 (2008)
DOI: 10.1177/1553350608325231


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