Umbrella and roll-up techniques of mesh insertion for laparoscopic hernia repair: a comparative study.

Durai, Rajaraman; Mownah, Abdoolla; Ng, Philip C H

BACKGROUND Deploying a mesh during laparoscopic hernia repair can be difficult and possibly challenging for a trainee surgeon. METHODS A novel method of mesh insertion by folding the mesh like the fabric of an umbrella and loading it into the 10-mm cannula for delivery into the peritoneal cavity is described. This method uses the inherent ability of meshes to spring back into shape. In this study on 30 patients who underwent transabdominal preperitoneal hernia repair, the umbrella method of mesh insertion was compared with the traditional roll up type of mesh insertion in terms of easiness mesh deployment and operating time. In bilateral procedures, each side was considered as a separate operation. RESULTS The operative time for the mesh insertion was reduced slightly (6 min), from 18 min for the roll-up technique to 12 min for the umbrella technique. CONCLUSION The umbrella method has a distinct advantage over the roll-up technique, in which unrolling of the mesh is done in a plane parallel to the mesh. This may explain the time saved, as demonstrated in this pilot study.