title: Laparoscopic correction of umbilical hernias using a transabdominal preperitoneal approach: results of a pilot study.
abstract: 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 mesh. The mesh is secured using transfascial Prolene sutures; the peritoneal defect is closed with a running Vicryl 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/m(2) (range 23.7-37.9 kg/m(2)). Mean hernia size was 1.95 cm (range 1-3 cm), average mesh size was 110 cm(2) (range 100-150 cm(2)). 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.
authors.affiliation: Department of Surgery, Reinier de Graaf Hospital, P.O. Box 5011, 2600, GA Delft, The Netherlands.
authors.forename: Denise E
authors.initials: DE
authors.lastname: Hilling
authors.forename: Linetta B
authors.initials: LB
authors.lastname: Koppert
authors.forename: Richard
authors.initials: R
authors.lastname: Keijzer
authors.forename: Laurents P S
authors.initials: LP
authors.lastname: Stassen
authors.forename: I Hok
authors.initials: IH
authors.lastname: Oei
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005260:Female; D006554:Hernia, Umbilical / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011183:Postoperative Complications / Q000517:prevention & control; D013525:Surgical Instruments; D013526:Surgical Mesh; D013536:Suture Techniques