Laparoscopic Repair of Primary and Secondary Epigastric Hernias. Technical Considerations of the IntraPeritoneal On Lay Mesh + Defect Closure (IPOM-Plus Technique)

Abstract

We present our experiences with the laparoscopic repair of primary and secondary (incisional) epigastric hernias that occur in the vicinity of bony structures. In our institute, we retrospectively reviewed 51 patients with primary and secondary epigastric hernias from 2002 to 2016. The European Hernia Society guidelines were used for classifying these hernias. Laparoscopic dissection of the falciform ligament, intracorporeal suturing of the defect and intraperitoneal composite mesh onlay placement was performed in all patients. There were 32 males and 19 females with a mean age of 40 years and a mean BMI of 29.5kg/m2. There were multiple defects in eight patients (15.68%). The mean hernial defect size was 5.75 cm2 (range 3–8.5 cm2). The surface of the used mesh was ranging from 225–400 cm2 (mean 312.5 cm2). Mean follow-up was nine months. Morbidity rate was 11.7% and the recurrence rate was 1.9%. Upper abdominal hernias are difficult to manage laparoscopically because of the complexity of dissection and their anatomic proximity to the falciform ligament, xiphoid and costal margins. Multiple defects and associated hernias can also be easily identified and laparoscopically repaired simultaneously with the placement of a large mesh. The mesh borders can be adequately fixed beyond the bony confines via the laparoscopic approach, which would otherwise be impossible in the open technique. Laparoscopic repair of these hernias is safe and effective and provides all the benefits of minimally invasive surgery.