Fig. 39.1.
The peritoneum is opened bluntly at the site of the epigastric hernia and incarcerated fat (asterisk) is removed by traction.
Fig. 39.2.
Once the fat has been removed, the fascial midline defect is visible.
Fig. 39.3.
Sutures are passed around the hernia defect (asterisk).
Fig. 39.4.
In this case the procedure is performed in the lasso technique with the help of a percutaneous Tuohy needle at the site of the hernia.
Fig. 39.5.
After the suture is tied, closure of the epigastric hernia (asterisk) is confirmed by laparoscopy.
Pearls/Pitfalls
In contrast to most other laparoscopic surgeries, the target area in epigastric hernias is the ventral abdominal wall. Therefore, the surgeon must learn to operate upward, which can be very challenging initially. In cases where the defect is located close to the umbilicus, the focus distance is short and the operating space small. Therefore, lesions that are closer than 4–5 cm from the umbilicus often are easier performed by the open technique through a small incision in the umbilicus and tunneling upward toward the defect from the outside [10]. As mentioned above, pushing down on the abdominal wall beyond the defect may increase maneuverability since it provides a more direct angle onto the defect [10, 13, 14].
Postoperative Care
Outcomes
Complications
General complications such as bleeding, wound infection, recurrence, and injury to intra-abdominal viscera and vessels are at least conceivable, but seem exceedingly rare [10, 13, 14].
Some adult publications classify epigastric hernias as ventral hernias. After laparoscopic ventral hernia repair, a recurrence rate of 4.7 % has been described. Risk factors were found to be a large defect, obesity, previous open repair, and perioperative complications [15, 16]. It must be noted, however, that these epigastric hernias are not the congenital type seen in the pediatric population or subject of this chapter.
Summary
Epigastric hernias are defined as defects in the linea alba located between the umbilicus and the xiphoid process.
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