Laparoscopic repair of poststernotomy subxiphoid epigastric hernia

Abstract

Background: The repair of a subxyphoid hernia is a difficult procedure that nonetheless results in a high rate of recurrence. The laparoscopic approach is a promising new technique for more efficacious treatment of this condition. This is the first report in the English-language literature to describe the use of this approach for the correction of poststernotomy subxiphoideal hernia.

Methods: Information was retrieved from the patients' hospitalization and outpatient clinic files. Of 984 patients who had a median sternotomy, 10 developed a substernal subxiphoid epigastric hernia. These patients had all been treated laparoscopically using Gore-Tex mesh.

Results: Nine patients were admitted electively and one urgently. The fascial defect sizes were 4-15 cm (mean, 8.5) in length. Intraabdominal content was adherent to the hernia in six patients; in the other four cases, the defect was adhesion free. In four patients, an incidental surgical procedure was performed (three cholecystectomies and one inguinal hernia repair using the trans abdominal preperitoneal [TAPP] technique). The operations lasted 25-120 min (average, 55). No death occurred as a result of the operations, and none of the operations was converted to an open procedure. Three patients had minor postoperative complications. During 20-42 months of follow-up, one patient suffered a recurrence.

Conclusions: Laparoscopic repair of a poststernotomy subxiphoideal epigastric hernia is feasible and has a low rate of minor complications. Our review of the literature indicates that this technique produces a better outcome than the conventional open repair.