AI Article Synopsis
- Subxiphoid hernias occur in 1%-4.2% of patients after median sternotomy and are challenging to repair, with high recurrence rates of 42% and 30% for open and laparoscopic methods, respectively.
- A new laparoscopic technique for repairing these hernias involves using the falciform ligament to better position the mesh and secure it with sutures and tacks to enhance overlap and fixation.
- In a study of 4 patients treated with this method, there were no complications or recurrences after one year, suggesting it may be a safer option for repair.
Article Abstract
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.
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| http://dx.doi.org/10.1089/lap.2015.0518 | DOI Listing |
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