Step 1.

Access intra-abdominal cavity with your technique of preference. Place 3 or 4 ports (one port must be 10 mm, the others 5 mm). Examine all abdominal cavities. Assess adhesions.Take all adhesions down in order to see entire abdominal wall. Reduce all hernia contents. Revisit all reduced hernia contents to avoid missing an enterotomy.

Step 2.

Measure defect of the hernia to select appropriate size of mesh (abdomen can be deflated for better measurement).

Step 3.

Place sutures for transfascial fixation in corners of mesh, use as many as needed.¹

Step 4.

Roll the PROCEED mesh with either the blue side or the ORC side out and pass it through the trocar in either a 10 mm or 12 mm port into the abdomen. A grasper can help gently pull the mesh through the port site or trocar from the contralateral side.The blue side should face up towards the abdominal wall side (Figure 1).

Step 5.

Once the PROCEED mesh is situated in the abdomen, place the fixation sutures. Make small stab incisions where the suture will pass through on the abdominal side using a suture passer. Tie the transfascial suture securely but not too tightly.

Step 6.

With the sutures placed, ensure adequate tension on the mesh without stretching it.

Step 7.

Secure the mesh in place every 1 cm or so around its margin using tacks. Place sutures and tacks about 1 cm in from the edge of the PROCEED mesh to avoid herniation of the bowel (Figure 2).

Step 8.

Remove all trocars under direct vision and suture where appropriate. Close subcutaneous and deep dermal layers with Coated VICRYL* Plus (polyglactin 910) Antibacterial Suture and close the skin with DERMABOND* Topical Skin Adhesive.

Reference:

1.

Heniford BT, Park A, Ramshaw BJ, Voeller G. Laparoscopic repair of ventral hernias: Nine Years' Experience With 850 Consecutive Hernias. Ann Surg. 2003;238(3):391-400.

Step 1.

Identify the margins of the hernia defect. Make a midline incision across the entire length of the defect.

Step 2.

Identify the hernia defect and dissect away from the surrounding tissue.

Step 3.

Enter the peritoneal cavity and free up any viscera attached to the peritoneum by careful adhesiolysis.

Step 4.

Measure the size of the defect and determine the appropriate mesh size. Allow for 3-5 cm overlap of the outer margin.

Step 5.

Place the PROCEED mesh under the abdominal wall directly in contact with the viscera.

Step 6.

When placing the PROCEED mesh, make sure that the blue stripes face the peritoneal side.

Option One:

Step 7.

Cut PROCEED mesh to size and pre-place PROLENE suture into mesh coming out on the PROLENE Soft mesh side (Figure 1).

Step 8.

Parachute mesh into intra-abdominal space. Pull suture through abdominal wall and tie (Figure 2). Skip to Step 11.

Figure 1

Figure 2

Option Two:

Step 9.

Cut PROCEED mesh to size and pre-place PROLENE suture into mesh coming out on the ORC side. Space the sutures 1 cm apart. Suture at least 6.5 mm (1/4”) from the edge of the mesh to avoid dislodging, wrinkling, or curling the edges or herniation of the bowel between the sutures. Some surgeons take at least 1 cm (1/2”) from the edge (Figure 3).

Step 10.

Parachute the mesh into the intra-abdominal space using the suture to create a mesh lip. This will make it easier to place the tacks and sutures circumferentially (Figure 4).

Step 11.

Fixate the mesh with non-absorbable PROLENE suture size 1 or 2, according to preference (Figure 5).

Step 12.

The fascia on top of the mesh may be approximated or left open to avoid tension to the repair of the abdominal wall.

Step 13.

Close subcutaneous and deep dermal layers with Coated VICRYL* Plus (polyglactin 910) Antibacterial Suture and close the skin with DERMABOND* Topical Skin Adhesive.

Figure 3

Figure 4

Figure 5