Extra Corporeal Knotting Approach Technique for Laparoscopic Hernia Repair: A Simple and Cost-Effective Method for Mesh and Structure Fixation.

Abstract

<h4>Background</h4>We describe a novel extracorporeal knotting approach (ECKA) that enables secure mesh fixation via extracorporeal suture manipulation, anchoring the mesh firmly within the abdominal cavity.<h4>Methods</h4>A retrospective analysis was conducted on 17 patients (14 males, 3 females) who underwent laparoscopic herniorrhaphy with mesh fixation using the ECKA technique. Key parameters included patient demographics, method of hernia repair (totally extraperitoneal [TEP] or transabdominal preperitoneal [TAPP]), laterality, and operative duration. Hernias were classified by procedure, with each side analyzed independently.<h4>Results</h4>From April 2024 to July 2025, a total of 21 hernia procedures were performed on 17 patients using the ECKA technique. The average patient age was 70.3 years (range: 47.1-88.5 years), with a mean body weight of 65.9 kg. Of the hernia types, 15 were direct, 3 were indirect, and 3 were mixed. Laterality distribution was as follows: right-sided (<i>n</i> = 6), left-sided (<i>n</i> = 7), and bilateral (<i>n</i> = 4). Nine procedures utilized the TAPP approach, while 12 were performed using the TEP approach. The average operative time was 88.4 minutes (range: 60.4-145.4 minutes). Postoperative analgesia consisted of diclofenac sodium administered three times daily for three days. No recurrences were observed during a mean follow-up period of 10.3 months (range: 2-17 months).<h4>Conclusions</h4>The ECKA technique provides a reproducible, minimally invasive solution for fixing mesh in direct, indirect, and combined hernias via either TEP or TAPP approaches. Its extracorporeal knotting system streamlines mesh fixation, ensures consistent clinical outcomes, and enhances operative efficiency across various hernia configurations.