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Published on: September 11, 2021
Laparoscopic Subxiphoid Hernia Repair with Intracorporeal Suturing of Mesh to the Diaphragm as a Means to Decrease
Omar M Ghanem1, Hamid R Zahiri2, Stephen Devlin2
11 Department of General Surgery, Union Memorial Hospital , Baltimore, Maryland.
Background:
Subxiphoid hernias are a rare complication of median sternotomy with an incidence of 1%-4.2%. Repair of subxiphoid hernias is technically demanding with recurrence rates of 42% and 30% following open and laparoscopic repairs, respectively. We present a novel approach to the laparoscopic repair of subxiphoid hernias with improved overlap and fixation.
Materials And Methods:
A novel technique for repairing subxiphoid hernias is described. The falciform ligament is dissected superiorly toward the diaphragm to allow proper subfascial positioning of the mesh with adequate overlap. Multiple nonabsorbable intracorporeal sutures are used to anchor the mesh to the diaphragm above the costal margins. Transfascial nonabsorbable sutures and tacks are used to fix the mesh to the anterior abdominal wall below the costal margin.
Results:
We have used this method in 4 patients with a mean age of 60.5 years and a female to male ratio of 4:0. The average hernia defect size was 20.5 cm(2), and the average duration of operation was 93 minutes. There were no reported postoperative complications or evidence of recurrence at the 1-year follow-up.
Conclusions:
Laparoscopic repair of subxiphoid hernias can be safely accomplished with mesh sutured to the diaphragm for improved overlap and fixation with the goal of reducing recurrence rates.
Insights
This study introduces a new laparoscopic technique for subxiphoid hernia repair, enhancing mesh fixation to the diaphragm. This novel approach aims to significantly reduce recurrence rates in patients undergoing this challenging surgical procedure.
Area of Science:
- General Surgery
- Minimally Invasive Surgery
- Hernia Repair
Background:
- Subxiphoid hernias are a rare but challenging complication post-median sternotomy.
- Current repair methods, both open and laparoscopic, have high recurrence rates (42% and 30%).
Purpose of the Study:
- To present a novel laparoscopic technique for subxiphoid hernia repair.
- To improve mesh overlap and fixation to reduce hernia recurrence.
Main Methods:
- A new laparoscopic technique involving falciform ligament dissection for optimal mesh positioning.
- Secure mesh fixation using nonabsorbable sutures to the diaphragm and anterior abdominal wall.
Main Results:
- The technique was successfully applied in 4 patients with no postoperative complications.
- A 1-year follow-up showed no evidence of hernia recurrence.
- Average operative time was 93 minutes for an average defect size of 20.5 cm².
Conclusions:
- Laparoscopic subxiphoid hernia repair is feasible and safe with this enhanced technique.
- Suturing mesh to the diaphragm improves fixation and overlap, potentially lowering recurrence rates.
