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Erschienen in:
01.08.2009
Laparoscopic correction of umbilical hernias using a transabdominal preperitoneal approach: results of a pilot study
Erschienen in: Surgical Endoscopy | Ausgabe 8/2009
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Background
Laparoscopic repair of umbilical hernias is usually based on the open underlay procedure in which the mesh is placed intra-abdominally. To prevent complications such as adhesions, bowel obstruction and fistula formation we developed a new laparoscopic approach, placing the mesh in the preperitoneal space.
Methods
Our laparoscopic approach concerns a standardised procedure with introduction of three intra-abdominally placed trocars. The ventral abdominal wall is incised in a lengthwise manner approximately 5 cm from the umbilical defect, followed by development of the preperitoneal space, reposition of the umbilical peritoneal sac and placement and fixation of a ProleneTM mesh. The mesh is secured using transfascial ProleneTM sutures; the peritoneal defect is closed with a running VicrylTM suture. Data on 17 patients with primary umbilical hernias laparoscopically operated on between April 2002 and March 2006 are presented.
Results
The 11 men and 6 women had a mean age of 57.8 years (range 37–91 years) and a mean body mass index (BMI) of 30.6 kg/m2 (range 23.7–37.9 kg/m2). Mean hernia size was 1.95 cm (range 1–3 cm), average mesh size was 110 cm2 (range 100–150 cm2). Mean operating time was 85.6 min (range 60–120 min). Mean hospital stay was 2.2 days (range 1–3 days). No major complications were seen. No recurrences were observed during a mean follow-up of 36.2 months (range 13–62 months).
Conclusions
The preperitoneal laparoscopic technique for umbilical hernia repair combines the advantages of a laparoscopic, minimally invasive, approach, avoiding the potential complications related to intra-abdominal mesh position.