Hybrid Technique for Incisional Hernias

Abstract

Hernia is one of the most common complications post any laparotomy. Various techniques are used for the repair of incisional hernias. Hernioplasty with synthetic materials is worldwide standard, and indications to the simple suture methods are rare. Miniinvasive techniques for hernia repair have become popular since 1990 and carry many advantages. Some incisional hernias have a very large hernia sac with large loss of fascia, which makes an exclusive laparoscopic approach challenging. Moreover, some patients are found to have very dense adhesions, which makes laparoscopic approach unsafe, and almost impossible necessitating conversion from laparoscopic to open surgery. Then, the process is carried on until the safe implantation of mesh into abdominal cavity becomes possible. This has led to the birth of what is known as the hybrid technique for incisional hernia repair (laparoscopy, conversion, laparotomy, laparoscopy). Patients with large, complicated, and recurrent incisional hernias should primarily be qualified to hernioplasty with the hybrid technique, which combines the conventional open repairs (safe adhesiolysis, safe placement of laparoscopic tools into the abdominal cavity, closing the defect) with laparoscopic repair (intraperitoneal mesh placing).