Background: Many ventral hernia repair methods have been described among surgeons. The traditional primary repair entails a laparotomy with suture approximation of strong fascial tissue on each side of the defect. However, recurrence rates after this procedure range from 12% to 24% during long-term follow-up. Laparoscopic ventral hernia repair (LVHR) is a well recognized minimally invasive surgical technique for repair of different types of abdominal wall ventral hernias. However, the best method of mesh fixation during LVHR is still a subject ofdebate. Patients & Methods: In the present study, 50 patients were presented with ventral hernia between June 2012 and October 2013. Demographics of the patients were recorded. All patients were submitted to LVHR with mesh fixation by “Double Crown” of tackers. The first crown was placed on the mesh periphery with 1 cm between each 2 successive tackers and the second crown around the edges of the defect. Operative complications, VAS scale, post-operative complications, and length of hospital stay were reported. Results: The mean age was 40.08 years. Female to male ratio was 3:2. The mean BMI was 32.3. The diameter of the hernial defect was <5 cm in 64%, while, the defects larger than 15 cm were excluded. LVHR was successfully completed in all the patients with no conversion. Only 1 patient had intra-operative bleeding from omental vessels that was successfully controlled. The mean operative time was 79 minutes. Post-operatively, the mean VAS was 3.96, 2.12, and 0.24 at 24 hours, 2 weeks, and 4 weeks, respectively. Two patients developed post-operative ileus that was treated conservatively and 1 patient developed persistent seroma that was treated by repeated aspiration. The mean length of hospital stay was 3.08 days. Conclusion: “Double Crown” tackers mesh fixation in LVHR seems to be a safe and effective surgical technique with favorable outcome. However, further randomized studies are needed on larger numbers of patients to validate these results.
 Lomanto, S., Iyer, G., Shabbir, A. and Cheah, W.K. (2006) Laparoscopic versus Open Ventral Hernia Mesh Repair: A Prospective Study. Surgical Endoscopy, 20, 1030-1035.
 Hoer, J., Lawong, G. and Klinge, U. (2002) Factors Influencing the Development of Incisional Hernia: A Retrospective Study of 2983 Laparotomy Patients over a Period of 10 Years. Chirurgie, 73, 474-480.
 Forbes, S.S., Eskicioglu, C., Mcleod, R.S. and Okrainec, A. (2009) Meta-Analysis of Randomized Controlled Trials Comparing Open and Laparoscopic Ventral and Incisional Hernia Repair with Mesh. British Journal of Surgery, 96, 851-858.
 Sajid, M.S., Parampalli, U. and McFall, M.R. (2013) A Meta-Analysis Comparing Tacker Mesh Fixation with Suture Mesh Fixation in Laparoscopic Incisional and Ventral Hernia Repair. Hernia, 17, 159-166.
 Cobb, W.S., Kercher, K.W. and Heniford, B.T. (2005) The Argument of Light Weight Polypropylene Mesh in Hernia Repair. Surgical Innovation, 12, 63-71.
 LeBlanc, K.A., Whitaker, J.M., Bellanger, D.E. and Rhynes, V.K. (2003) Laparoscopic Incisional and Ventral Hernioplasty: Lessons Learned from 200 Patients. Hernia, 7, 118-122.
 van’t Riet, M., de Vos van Steenwijk, P.J., Kleinrensink, G.J., et al. (2002) Tensile Strength of Mesh Fixation Methods in Laparoscopic Incisional Hernia Repair. Surgical Endoscopy, 16, 1713-1716.
 Rudmik, L.R., Scheiman, C., Dixon, E., et al. (2006) Laparoscopic Incisional Hernia Repair: A Review of the Literature. Hernia, 10, 110-119.
 Carbajo, M.A., Martin Del Olmo, J.C., Blanco, J.I., Toledano, M., Cuesta, C., Ferreras, C. and Vaquero, C. (2003) Laparoscopic Approach to Incisional Hernia. Lessons Learned from 270 Patients over 8 Years. Surgical Endoscopy and Other Interventional Techniques, 17, 118-122.
 Baccari, P., Nifosi, J., Ghirardelli, L. and Staudacher, C. (2009) Laparoscopic Incisional and Ventral Hernia Repair without Sutures: A Single-Center Experience with 200 Cases. Journal of Laparoendoscopic & Advanced Surgical Techniques, 19, 175-179.
 Morales-Conde, S., Cadet, H., Cano, A., Bustos, M., Martín, J. and Morales-Mendez, S. (2005) Laparoscopic Ventral Hernia Repair without Sutures—Double Crown Technique: Our Experience after 140 Cases with a Mean Follow-Up of 40 Months. International Surgery, 90, S56-S62.
 LeBlanc, K.A. (2007) Laparoscopic Incisional Hernia Repair: Are Transfacial Sutures Necessary? A Review of the Literature. Surgical Endoscopy, 21, 508-513.
 Ujiki, M.B., Weinberger, J., Varghese, T.K., Murayama, K.M. and Joehl, R.J. (2004) One Hundred Consecutive Laparoscopic Ventral Hernia Repairs. American Journal of Surgery, 188, 593-597.
 Kapischke, M., Schulz, T., Schipper, T., Tensfeldt, J. and Caliebe, A. (2008) Open versus Laparoscopic Incisional Hernia Repair: Something Different from a Meta-Analysis. Surgical Endoscopy, 22, 2251-2260.
 Pham, C.T., Perera, C.L., Watkin, D.S. and Maddern, G.J. (2009) Laparoscopic Ventral Hernia Repair: A Systematic Review. Surgical Endoscopy, 23, 4-15.
 Muysoms, F., Vander Mijnsbrugge, G., Pletinckx, P., Boldo, E., Jacobs, I., Michiels, M. and Ceulemans, R. (2013) Randomized Clinical Trial of Mesh Fixation with “Double Crown” versus “Sutures and Tackers” in Laparoscopic Ventral Hernia Repair. Hernia, 17, 603-612.
 Wassenaar, E.B., Raymakers, J.T. and Rakic, S. (2008) Impact of Mesh Fixation Technique on Operation Time in Laparoscopic Repair of Ventral Hernias. Hernia, 12, 23-25.
 Carbonell, A.M., Harold, K.L., Mahmutovic, A.J., Hassan, R., Matthews, B.D., Kercher, K.W., et al. (2003) Local Injection for the Treatment of Suture Site Pain after Laparoscopic Ventral Hernia Repair. American Surgeon, 69, 688-691.
 Chevrel, J.P. and Rath, A.M. (2000) Classification of Incisional Hernias of the Abdominal Wall. Hernia, 4, 7-11.
 Kurmann, A., Visth, E., Candinas, D. and Beldi, G. (2011) Long-Term Follow-Up of Open and Laparoscopic Repair of Large Incisional Hernias. World Journal of Surgery, 35, 297-301.
 Baccari, P., Nifosi, J., Ghirardelli, L. and Staudacher, C. (2013) Short- and Mid-Term Outcome after Laparoscopic Repair of Large Incisional Hernia. Hernia, 17, 567-572.
 Leber, G.E., Garb, J.L., Alexander, A.I. and Reed, W.D. (1998) Long Term Complications Associated with Prosthetic Repair of Incisional Hernias. JAMA Surgery, 133, 378-382.
 Basoglu, M., Yildirgan, M.I., Yilmaz, I., Balik, A., Celebi, F., Atamanalp, S.S., Polat, K.Y. and Oren, D. (2004) Late Complications of Incisional Hernias Following Prosthetic Mesh Repair. Acta Chirurgica Belgica, 104, 425-428.
 Wassenaar, E., Schoenmaeckers, E., Raymakers, J., van der Palen, J. and Rakic, S. (2010) Mesh Fixation Method and Pain and Quality of Life after Laparoscopic Ventral or Incisional Hernia Repair: A Randomized Trial of Three Fixation Techniques. Surgical Endoscopy, 24, 1296-1302.
 Schoenmaeckers, E., de Haas, R.J., Stirler, V., Raymakers, J.T.F.J. and Rakic, S. (2012) Impact of the Number of Tacks on Post-Operative Pain in Laparoscopic Repair of Ventral Hernias: Do More Tacks Cause More Pain? Surgical Endoscopy, 26, 357-360.
 Sharma, A., Mehrota, M., Khullar, R., Soni, V., Baijal, M. and Chowbey, P.K. (2011) Laparoscopic Ventral/Incisional Hernia Repair: A Single Centre Experience of 1242 Patients over a Period of 13 Years. Hernia, 15, 131-139.
 Greenstein, A.J., Nguyen, S.Q., Buch, K.E., Chin, E.H., Weber, K.J. and Divino, C.M. (2008) Recurrence after Laparoscopic Ventral Hernia Repair: A Prospective Pilot Study of Suture versus Tack Fixation. American Surgeon, 74, 227-231.
 Eriksen, J.R., Bisgaard, T., Assaadzadeh, S., Nannestad Jorgensen, L. and Rosenberg, J. (2011) Randomized Clinical Trial of Fibrin Sealant versus Titanium Tacks for Mesh Fixation in Laparoscopic Umbilical Hernia Repair. British Journal of Surgery, 98, 1537-1545.
 Colon, M.J., Kitamura, R., Telem, D.A., Nguyen, S. and Divino, C.M. (2013) Laparoscopic Umbilical Hernia Repair Is the Preferred Approach in Obese Patients. American Journal of Surgery, 205, 231-236.
 Bansal, V.K., Misra, M.C., Kumar, S., Keerthi Rao, Y., Singhal, P., Goswami, A., et al. (2011) A Prospective Randomized Study Comparing Suture Mesh Fixation versus Tacker Mesh Fixation for Laparoscopic Repair of Incisional and Ventral Hernias. Surgical Endoscopy, 25, 1431-1438.
 Bellows, Ch. and Berger, D. (2006) Infiltration of Suture Sites with Local Anesthesia for Management of Pain Following Laparoscopic Ventral Hernia Repairs: A Prospective Randomized Trial. Journal of the Society of Laparoendoscopic Surgeons, 10, 345-350.
 Beldi, G., Wagner, M., Bruegger, L.E., Kurmann, A. and Candinas, D. (2011) Mesh Shrinkage and Pain in Laparoscopic Ventral Hernia Repair: A Randomized Clinical Trial Comparing Suture versus Tack Mesh Fixation. Surgical Endoscopy, 25, 749-755.
 Kaoutzanis, C., Leichtle, S.W., Mouawad, N.J., Welch, K.B., Lampman, R.M. and Cleary, R.K. (2013) Postoperative Surgical Site Infections after Ventral/Incisional Hernia Repair: A Comparison of Open and Laparoscopic Outcomes. Surgical Endoscopy, 27, 2221-2230.
 Cihan, A., Ozdemir, H., Ucan, B.H., Acun, Z., Comert, M., Tascilar, O., et al. (2006) Fade or Fate. Seroma in Laparoscopic Inguinal Hernia Repair. Surgical Endoscopy and Other Interventional Techniques, 20, 325-328.
 Bedi, A.P., Bhatti, T., Amin, A. and Zuberi, J. (2007) Laparoscopic Incisional and Ventral Hernia Repair. Journal of Minimal Access Surgery, 3, 83-90.
 Morales-Conde, S. (2012) A New Classification for Seroma after Laparoscopic Ventral Hernia Repair. Hernia, 16, 261-267.