New York City
2001- 2009, New York City
TRABUCCO SUTURELESS INGUINAL HERNIOPLASTY
One of the potential shortcomings of the mesh- plug hernioplasty is a placement of the three dimensional plug placed in preperitoneal space. Such bulky plug has a potential to migration, may cause pressure and injury to the surrounding tissue- bladder, bowels, blood vessels.
Trabucco repair caught my attention as it offered a solution for that. Flat, pre-peritoneal, preshaped "plug" seemed to be more convenient and safe for inguinal hernia repair, whereas a three dimensional plug still remained a good option for "a tunnel like" femoral type of hernia.. The best part, for direct hernia, only one piece of onlay mesh was recommended..
Dr Ermanno Trabucco from Queens, NY was an Italian American surgeon who organized one of the first outpatient Hernia Clinic in early 90-ties.
He developed his technique sutureless tension-free mesh repair for uninsured Italian emigrants who could afford hospital stay so required early mobilization.
Living in NYC I had opportunity to meet with Dr Trabucco being invited on several occasions to his house and learn from him about his experience. I helped to put together his second edition of "Atlas of Trabucco sutureless hernioplasty" convinced that it should have been more popularized (download below)
without suturing on the posterior wall
being closed under spermatic cord
as long as apponerosis is strong enough
Survetta Hernia Experts Meeting in St Moritz, Switzerland, July 2008.
Later, I came across a report from several urological centers about injury and occlusion of the vas deference as a result of direct contact with the mesh in inguinal canal. I thought that Trabucco approach to separate the mesh from spermatic cord with the aponeurosis of external abdominal muscle closed below spermatic cord, would be a great solution to decrease risk of such injury.
My letter to editor was published in Annals of Surgery
After that, one day during my transplant clinical fellowship, I was invited for the Survetta Hernia Experts Meeting in St Moritz, Switzerland to discuss my idea with other experts in the hernia field. It was a very exciting experience! All presentations and discussions from the meeting were published in the book (below) and summary of the event in the conference report: Hernia 2008, 12, 671-673.
TRABUCCO SUTURELESS VENTRAL HERNIOPLASTY
For incisional hernia Dr Trabucco proposed the same sutureless concept: placing a polypropylene mesh with flat shape memory in preperitoneal or retromuscular space with closure of the fascia above should be sufficient repair with minimal suturing and injury to the tissue. Mesh placed in close space is integrated with connective tissue around within a couple of weeks and patch the defect. The sutures closing the fascia about the mesh should reassure the integrity of the the wound only for 2-3 weeks after the surgery.
I found this technique very effective for umbilical, periumbilical, and incisional hernia in midline as well as after kidney transplant. in the flank. For full description of the technique, please see Atlas and our article on our hernia publication website.
One day, I had to take my patient back to the OR and open the wound 3 weeks after incisional hernia repair and could not remove the mesh since it was so well adherent to the fascia it was placed on. It reassured me additionally that this technique works.
Technical tip: I leave a drain directly over the mesh to prevent fluid collection and enhance mesh into tissue integration. In case the defect is too big so I can't close a posterior fascia or peritoneum, I use biomaterial for bridging the gap suturing it around and place sutureless polypropylene mesh above as describe above.
in preperitoneal or retromuscular space
No sutures used to anchor the mesh
mesh not anchored to tissue