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Minimally Invasive Primary Tissue Repair?
For people with a hernia complication they perceive as being related to mesh, remediating that problem with another mesh seems daunting. Two surgeons I’ve come to hold in exceedingly high regard have experience with removing preperitoneal mesh and then closing any remaining defects with a tissue repair all from the minimally invasive approach.
Dr. Towfigh has experience with robitic primary tissue repair using non-absorbable sutures.
Dr. Ramshaw has experience removing mesh laparoscopiclly followed by laparoscopic primary repair of defects (if present) with absorbable sutures.Pro’s seem to be sparing the patient a more invasive open traditional primary tissue repair (and its associated risks of nerve injury) while taking mesh out of the equation .
The most glaring con seems to be higher reoccurrence. The traditional open multilayer tissue repair’s seem to have a reoccurrence rate around 10% with most of the major players. I suspect the minimally invasive repair is a superficial one and potentially weaker but I have nothing to base this on. Another potential con seems to be entrapping a nerve darning everything together from the posterior approach but again I have nothing to base that on.
This type of repair seems to be emerging as an option for some patients. I’m curious if anyone out there has experience with or thoughts on it?
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2 Replies
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Thanks for this post, HerniaHelper.
I just submitted my longterm outcomes data after applying robotic non-mesh tissue repair for inguinal hernias. There are for sure risks to it (nerve entrapment being the main one), but no recurrences to date.
I was only offering this to persons with small hernias in patients with low risk for hernia recurrence. Now, I feel it is warranted to increase the inclusion criteria to a wider population. I now routinely offer this after any mesh removal surgery, especially if the mesh removal is due to mesh properties themselves.
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I had mesh removal about 4 weeks ago laparoscopically robotic assisted. The plan was if there were any hernias to repair them openly after the removal. However, there weren’t any. My direct hernia was filled in by scar tissue I’m guessing. Although there wasn’t a indirect hernia presence either there was some weakness and the surgeon did do a pure tissue repair-as far as I can tell after reading the operative report. He used absorbable sutures. So my plan is to take real slow as I know they lose more and more strength as the area heals. Hope this helps
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