Laparoscopic fasciorrhaphy with the Carter-Thomason instruments

Objective

To describe an operative technique for securely closing the fascia of large laparoscopic incisions, umbilical hernias or small abdominal hernias under laparoscopic monitoring within the scope of minimally invasive surgery.

Study Design

Over a period of 8 months, the Carter-Thomason technique was used in 105 laparoscopic surgical procedures to close large trocar wound incisions (>=10 mm). This technique was also used to close 6 pre-existing umbilical hernias.

Results

In the postoperative period, no hernias or complications were observed in the patients who underwent fascial closure with the Carter-Thomason technique. Full-thickness trocar wound closure took about 2 minutes per incision site. Long-term results are pending. A controlled study is currently in progress.

Discussion

Hernias – bowel, omentum or Richter's – are a common complication of laparoscopic surgery. Secure closure of the peritoneum, the fascial and the muscle is a prophylaxis for hernia formation of laparoscopic incisions.

Conclusion

Laparoscopic fascial closure is simple to carry out taking approximately 2 minutes by an experienced practitioner. In contrast, conventional exposure and direct suturing is more involved and time consuming.