Quick Tip

The Novel "Roll and Bind" Technique to Aid the Insertion of Biological Meshes through Laparoscopic Ports

CJ Walter, DL Beral, PJ Drew

Background

The development of synthetic and biological onlay meshes, suitable for direct contact with bowel, has facilitated the introduction of laparoscopic incisional hernia repair to surgical practice in Britain. This approach claims enhanced recovery and reduced infection rates. The ongoing Lapsis Trial is using factorial randomisation to examine both; laparoscopic versus open approaches, and synthetic versus biological meshes, in incisional hernia repair.[1]

Surgeons have noticed that fitting larger meshes down laparoscopic ports can be difficult. Techniques described to aid mesh insertion are based around rolling the mesh which is then either lubricated, sutured and tied, or protected in a sterile sheath whilst introduced through the port incision (with trocar removed).[2-5]

We examined techniques to improve insertion of larger meshes via laparoscopic ports.

Method

Sample synthetic (Gortex® 34cm x 26cm x 1mm DualMesh®) and biological meshes (TSL Plc. 10cm x 10cm x 1.5mm PermacolTM and Cook® Ltd. 22cm x 13cm x0.76mm Surgisis® GoldTM) were inserted using 5mm laparoscopic graspers and forceps through ports (Ethicon Inc. Endopath® 18mm, 12mm, 11mm) placed within a sham abdomen. Different insertion techniques were assessed and developed.

Discussion

Rolling the mesh along its longest edge (length) gave optimal insertion. (Figure 1)

Figure 1 Rolling the biological mesh along its length so that the mesh width determines roll diameter

The biological meshes were noted to lose the tightness of their roll. This is overcome by using the novel "roll and bind" insertion technique which permits greater areas of biological mesh to fit down any given port size than when rolled alone, and furthermore, does not involve port removal or mesh sutures as used in other insertion techniques. [3,5] (Figure 2)

Figure 2 The "Roll and Bind" Insertion Technique for biological meshes. A Vicryl tie holds the roll during insertion through the laparoscopic port.

References

1. www.kksk.de/pdfs/02_veranstaltungen/kolloquium_040719_handout_grass.pdf
2. Carbajo M, Martin del Olmo J, Blanco J, et al. Laparoscopic Approach to Incisional Hernia. Surg Endosc 2003; 17: 118-2.
3. Himpens J, Leman G, Deloose k. Technique for Introducing Large Composite Mesh While Performing Laparoscopic Incisional Hernioplasty. Surg Endosc 2002; 16: 1244-6.
4. Phillips E, Dardano A, Saxe A. Laparoscopic Repair of Abdominal Hernias Using an ePTFE Patch - A Modification of a Previously Described Technique. J Soc Laparoend Surg 1997; 1: 277-9.
5. Saber A. Simple Technique For Mesh Placement During Laparoscopic Ventral Hernia Repair. Surg Endosc 2003; 18: 162-4.