Laparoscopic incisional hernia repair - the problem of fixation

The laparoscopic repair of incisional hernias gains increasing popularity because the well-known advantages of laparoscopic techniques such as less tissue trauma should improve the results especially in these patients. Since the first description of the laparoscopic technique in 1993 some promising results have been published. The main question however concerns the fixation of the intraperitoneally placed mesh. The combination of sutures and the so-called spiral tacks is most often used. Up to now there are only 2 experimental studies dealing with different fixation techniques and leading to controversial results. No clinical study is available which clearly examines the fixation technique. Our own results in a prospective series of 266 unselected patients show that there may be no clinical difference between tack fixation and sutures if fatty tissue is completely dissected and the tacks are fixed in the fascia. Thus, the fatty tissue of the ligamentum falciforme or between the plicae mediales must be excised before setting the tacks. Tack-related complications such as intestinal erosion seem to be very rare, but the fixation of the meshes is the weak point of the whole procedure and needs to be improved in the future.