Laparoscopic correction of umbilical hernias using a transabdominal preperitoneal approach: Results of a pilot study

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 Prolene ^TM mesh. The mesh is secured using transfascial Prolene^TM sutures; the peritoneal defect is closed with a running Vicryl^TM 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 cm ² (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.