To my knowledge,older reviews stated laparoscopic ventral hernia repair with primarily transabdominal permanent sutures or tacks experience similar recurrence rates; sutures are usually placed 2 to 3 cm apart, while tacks are typically placed less than 1 to 2 cm apart, so possibly the technique details that operating teams employed are to be scrutinized; several parameters are important ( obesity,mean defect size, emergency settings with comorbidities, use of reabsorbable sutures and prosthesis,sites of intraparietal implants, infected sites, iatrogenic injuries,early abdominal trauma ...);also,self-fixating mesh was used in some trials - would this prove to be reliable?

I dont know if its described or not, but interrupted either nonabsorable or delayed absorable stitches, placed 2cms apart and tied excorporeally. Has anyone any idea?

I am sorry that my question was not clear.i meant hernias mimicking as recurrence at the site of Transfixation sutures placed to fix the mesh in lap incisional ventral hernia repair.

Sir, this is an interesting question you have raised. I've seen one case like your description. It is being described as a  'Pseudo-recurrence' because the new defect is present BEYOND the original hernial site. The transfixation suture compresses the muscle tissue included within it and causes localised ischemia, which eventually gives way to a hernia. Obviously, suture hernia can be avoided if any technique other than transfixation sutures is used.

I guess the only real issue in this situation is convincing the patient !!

'The transfixation suture compresses the muscle tissue included within it and causes localised ischemia' - this is also the reason why these patients experience moderate to severe postoperative pain. Other techniques of mesh fixation are associated with much less pain

Thanks Dr Rangarajan,please go through our article,

J Laparoendosc Adv Surg Tech A. 2010 Nov;20(9):753-5. doi: 10.1089/lap. 2010.0314. Epub 2010 Sep 28. Transfascial suture hernia: a rare form of recurrence ...

Suture hernia and tack hernias are "New Kids on the block". Appear at the mesh margin as a consequence of displacing force. To my knowledge being reported in cases of e-PTFE, due to known retraction tendency of this type of mesh. The shrinkage (up to 40%) causes a wall defect with consecutive possibility of hernia formation.

The purpose of transfacial sutures is not the local ischemia, but the "life insurrance" of secure fixation. The retention strenght of sutures is 4x higher than any tacking device.

The loose transfascial suture is a "air-knot" and as such it hardly ever causes chronic pain.

Karl LeBlanc described the tack hernia and Phillipe Muysom the suture hernia.

It has been my experience that on re-doing paraumbilical hernias, it is seldom through a re-opening in the original defect but rather through a new defect associated with the sutures.  My feeling is that this occurs when too much tissue as been gathered in the suture and it has then been tied too tight.   

Dear Jan

Thankyou,After Muysum we reported the secnd case.This was published in JLAST.

J Laparoendosc Adv Surg Tech A. 2010 Nov;20(9):753-5. doi: 10.1089/lap. 2010.0314. Epub 2010 Sep 28. Transfascial suture hernia: a rare form of recurrence

1. New or old entity?:

Tack and suture hernias (ie, hernias due to broadening of the original perforations caused by the respective material), are in fact analogous to “button-hole” hernias after abdominal wound closure with non-absorbable sutures in open surgery, as was described in the 1980s (Krukowski, Matheson. Br J Surg 1987;74:824-825 and Read, Yoder. Arch Surg 1989;124:485-488).

Since first Karl LeBlanc and then others described a similar type of hernia after laparoscopic ventral hernia repair, I have had more than the concern of chronic postoperative pain to make me a strong proponent of mesh fixation with either non-penetrating (Surg Endosc 2006;20:462–467) or long-term absorbable material (Arch Surg 2011;146:12-17), or a combination of the two.

2. “Pseudo-recurrence”

I strongly disagree with dr. Rangarajan´s terminology. A pseudo-hernia appears to be a recurrence when it is not, such as the transient swelling in the former medial groin hernia cavity after a TEP or TAPP. However, if a patient experiences a new hernia in the (even peripheral) area where he was once operated, especially when the recurrence is directly related to the hernia repair technique, I find it counterproductive not to name it for what it is; a true recurrence.

Point taken Dr. Novik

Never happened to me, nor heard of it before. May it be related with to much pressure when tying the knots?

"Suture hernia": identification of a new type of hernia presenting as a recurrence after laparoscopic ventral hernia repair.

Muysoms FE, Cathenis KK, Claeys DA.

Hernia. 2007 Apr;11(2):199-201. Epub 2006 Nov 21.

PMID:

17119854

[PubMed - indexed for MEDLINE]

Found another one:

Transfascial suture hernia: a rare form of recurrence after laparoscopic ventral hernia repair.

Khandelwal RG, Bibyan M, Reddy PK.

J Laparoendosc Adv Surg Tech A. 2010 Nov;20(9):753-5. doi: 10.1089/lap.2010.0314. Epub 2010 Sep 28.

PMID:

20874415

[PubMed - indexed for MEDLINE]

Thank you very much, Dr. Kukleta. I'll keep my research, for it is a very interesting matter