“Slim-Mesh” Technique for Giant Ventral Hernia

BACKGROUND AND OBJECTIVE: We devised a sutureless “Slim-Mesh” technique to treat ventral hernias, including large-giant/massive ones, reduce intra- and postoperative complications, and lower operation time. METHODS: Between September 1, 2009 and October 31, 2020, 43 patients with large (10 – 14.9 cm)-giant (15 – 19.9 cm) and massive (≥ 20 cm) ventral hernia were operated at our Department with the above technique. This was a prospective (79%)-retrospective study. RESULTS: This study comprised 22 males and 21 females. Mean age was 63 years. Large-giant and massive hernias were found intraoperatively in 37 and 6 cases respectively. Mean operation time for all hernias was 116 minutes, 104 for large-giant hernias, and 190 for massive. In 53.4% of cases, hernia-neck operative measurement was larger than preoperative size. In 25.5% of cases, laparoscopy found satellite hernias previously undetected by ultrasound- and/or computed tomography scan. A composite mesh and a noncomposite mesh were used in 95% and 5% of cases respectively. For mesh fixation, titanium tacks and absorbable straps were used in 14% and 86% of cases respectively. Mean length of hospital stay was 2.3 days. Mean follow-up time was 3 years and 4 months. In our study, there were 5 early postoperative complications: 3 seromas, 1 trocar-site hernia, and 1 case of cystitis. We found 2 late small symptomless recurrences (4.6%). CONCLUSION: The sutureless “Slim-Mesh” technique facilitates intra-abdominal introduction, as well as the handling and fixation of giant and monster (36 × 26 cm) meshes. In our experience, “Slim-Mesh” is safe, simple, and fast, and economical even for large-giant/massive ventral hernia repair.