A Simplified Method of Primary Closure of the Defect in Laparoscopic Hernia Repair

Goals/Purpose: Incisional hernias are an important complication of abdominal surgeries and several methods of closure have been reported. Laparoscopic hernia repair uses the smallest possible incisions to access difficult to reach areas, shorter hospital stays and a significant cosmetic advantage. However, laparoscopic hernia repair can be technically challenging and time consuming. In this study, we report the use of non-absorbable suture with barbs placed along its length (Quill^TM, Angiotech), which allows the stitch to be pulled through tissue in only one direction. This method allows either primary closure of the hernia defect or reduction of size of the defect laparoscopically without need for intracoporeal knot tying.

Methods/Technique: A retrospective review of patients with ventral hernias repaired laparoscopically with Quill^TM sutures in addition to a mesh underlay was conducted. The procedure involved running the defect with a 2-0 non-absorbable prolene barbed suture and then placing Parietex mesh with tacks to underlay the closure.

Results/Complications: 7 patients were identified with hernias (mean age 56.4 years, 71.4% female, 42.9% male, 6 primary hernias, 1 recurrent hernia) closed primarily with quill sutures in addition to a mesh underlay. Size of the hernia in the longest dimension was an average of 7 cm and mean follow up was 1.5 months. Complications included 1 case of irritation around the incision site, which resolved and 1 case of seroma formation.

Conclusion: The Quill^TM knotless suture closure system can be used for rapid and effective primary closure in laparoscopic incisional hernia repair with additional mesh underlay. This method is both technically forgiving and the strength of primary closure in addition to reinforcement with mesh has been showed to be superior to mesh closure alone in some recent studies. Further evidence to support these findings and more long time follow up is warranted.