Laparoscopic Umbilical Hernia Repair

Abstract

Introduction: Laparoscopic hernia repairs are usually performed in adults because the defects are large and mesh is required. For umbilical hernias in children, an open repair through the umbilicus is common.1 However, there are some circumstances in which the hernia defect is large and a laparoscopic approach may be of benefit to the child. Materials and Methods: This video shows a repair done in a 16-year-old male with a large, umbilical hernia defect. Access to the right lower quadrant was achieved by an open Hasson technique and a Step™ trocar (Auto-Suture; Covidien) was placed using a 5 mm incision. Pneumoperitoneum was established using 5 L/minute of carbon dioxide under 15 mm Hg of pressure, then a 30° telescope camera was inserted into the peritoneal cavity. Next, a 2 mm incision was made at the umbilical scar, and under camera observation, a GraNee needle with 2-0 Ethicon suture was introduced and inserted ∼0.5 cm from the defect margin. The needle was then withdrawn and reinserted, through the same umbilical incision, across the defect to grab the suture and pull it back up toward the umbilicus. After this process, horizontal sutures were placed across the length of the hernia. Once all the sutures were in place, the abdomen was deflated before pulling the sutures closed, so that there would be no unnecessary tension. Additional sutures were placed afterward with the abdominal cavity under low inflation. Finally, the port was removed and the incisions were closed with interrupted sutures. Results and Conclusions: There were no postoperative complications. At initial follow-up and at 6 weeks, 6 months, and 1 year follow-up, there was no reoccurrence of the hernia. No competing financial interests exist. Runtime of video: 2 mins 34 secs