Umbilical Laparoscopic Transabdominal Preperitoneal Repair for Medium-Sized Umbilical Hernia in Overweight and Obese Patients

Abstract

INTRODUCTION: Despite high prevalence of umbilical hernia, an open anterior approach is still frequently performed. Moreover, suture repair is still routinely applied in cases of small umbilical hernia. However, mesh use may lead to more frequent surgical site infection, especially in obese patients. Some of these limitations may be reconciled by transabdominal-preperitoneal repair (TAPP). The aim of this study was to analyze feasibility, safety and efficacy of umbilical TAPP (u-TAPP). METHODS: A prospective study of early and mid-term outcomes was conducted for all umbilical hernia repair performed in overweight and obese patients. An analysis included 36 patients undergoing elective surgery for primary umbilical hernia between March 2019 and November 2021. The intra- and postoperative data were recorded. All patients reported the outcomes 1 and 3 months after the procedure. RESULTS: The mean width of defect was 26 mm. The operation time was 93.2 ± 22.3 minutes. An area of synthetic mesh in u-TAPP was 164.2 cm2. Median mesh size was 10×15 cm. After 30-day and 3-month follow-up, there was no recurrence or significant postoperative pain. The patients declared their overall satisfaction and quality of life as good or excellent. CONCLUSION: TAPP technique in umbilical hernia repair allows for placement of a large mesh and fulfills current recommendations, especially for patients with additional risk factors, such as obesity or coexistence of diastasis recti. TAPP allows a mesh to be introduced into the preperitoneal space, allowing to avoid direct contact between mesh and intestines. Laparoscopic umbilical TAPP is feasible and safe, but the operation time is longer than with open methods.