Ventral Hernia Repair - Medium Hernia with Mesh by George Crawford, MD

Operative Steps

Access is generally obtained through an incision in the left upper quadrant. Usually, a 5 mm trocar is used to enter the abdomen if laparoscopic assistance is needed.
Once visualized and safe, a left lower quadrant 12 mm trocar and a right lower quadrant 5 mm trocar are placed under visualization.
All abdominal wall adhesions are taken down using blunt dissection, sharp dissection, or an energy device. This is done to remove adhesions to visualize the ventral hernia defect.
Any intra-abdominal content, such as small bowel, is reduced from the hernia.
An incision is made over the ventral hernia. The subcutaneous tissue is dissected to expose the hernia sack.

The hernia sac is dissected out bluntly and exposed.
Once completely exposed, the hernia sac is excised at the base of the fascial defect. The fascia is exposed circumferentially around the defect.
A mesh, such as the PROCEED™Ventral Patch is placed through the fascia
It is secured to the facia in all four quadrants, commonly using a size 0-Prolene suture and a suture passer. Any gaps in the repair from the fascia to the abdominal wall are closed using an absorbable laparoscopic fixation device such as ETHICON SECURESTRAP™.
A suture, such as Coated Vicryl™Plus Antibacterial suture, Prolene™Polypropylene, or Ethibond EXCEL™Polyester can be used to re-approximate the facia over the mesh if possible.
If this is an umbilical hernia, and the umbilicus has been mobilized away from the facia, it may be reapproximated, using synthetic absorbable suture, such as a size 0-Coated Vicryl™Plus Antibacterial suture.

The trocars are removed. The wounds are closed using synthetic absorbable suture, such as Monocryl™ Plus Antibacterial suture, and a topical skin adhesive such as DERMABOND™ PRINEO™Skin Closure System or any appropriate dressing.