Laparoscopic Repair of Low Abdominal Wall Hernias by Tack Fixation to the Cooper Ligament

Abstract

Laparoscopic repair of low abdominal wall hernias present a challenge in mesh fixation, especially in the obese patient. Few reports have suggested repair by tack fixation to the Cooper ligament. Thirteen women, mean age 54.7 years, range 27 to 93 years, presented with 14 low abdominal wall hernias. Body mass index averaged 31.5, range 21 to 50.6. Twelve hernias were diagnosed clinically. Twelve hernias were incisional (7 midline, 5 lateral); 1 recurrent spegelian; and 1 primary midline. All hernias were repaired using laparoscopic transabdominal preperitoneal dissection, mesh fixation to an exposed Cooper ligament using the Protack, inferior edge or total mesh coverage by peritoneal-bladder flap elevation and fixation. Five small midline and lateral hernias were repaired transabdominal preperitoneally with polypropylene mesh. Nine large lower abdominal wall hernias (6 midline, 3 lateral) were repaired with Bard Composix E/X mesh. Follow-up averaged 17.5 months (range 5 to 30 mo). No hernias recurred. In conclusion, although suture versus tack fixation of mesh with laparoscopic repair of ventral hernias remains controversial, tack fixation of mesh to an exposed Cooper ligament in midline and lateral low ventral hernias has proven to be a successful repair. This technique is also efficacious in the obese patient.