title: Laparoscopic repair of suprapubic hernias: transabdominal partial extraperitoneal (TAPE) technique.
abstract: BACKGROUND
  Suprapubic hernias are considered difficult to repair laparoscopically due to deficient posterior rectus sheath and proximity to important neurovascular structures and the urinary bladder.
  
  
  METHODS
  We retrospectively reviewed 72 patients (18 males, 54 females) who, between 1998 and 2008, had undergone laparoscopic repair for suprapubic hernial defects located less than 5 cm from the pubic arch. Five patients (6.9%) had recurrent hernias. A peritoneal flap was dissected distally to facilitate a mesh overlap of at least 5 cm from the hernial defect. The lower margin of the mesh was fixed under direct vision to Cooper's ligaments bilaterally. The raised peritoneal flap was reattached to the anterior abdominal wall thereby partially extraperitonealizing the mesh.
  
  
  RESULTS
  Mean diameter of the hernial defect was 5.2 cm (range=3.1-7.3 cm) as measured intraperitoneally. Mean size of the mesh used was 328.8 cm2 (range=225-506 cm2). Mean operating time was 116 min (range=64-170 min). Overall complication rate was 27.8%. There were no conversions. No recurrences were observed at a mean follow-up of 4.8 years (range=1.2-6.9 years) and a follow-up rate of 84.7%
  
  
  CONCLUSIONS
  A mesh overlap of at least 5 cm and fixation of the lower margin of the mesh under direct vision to Cooper's ligaments appears to confer increased strength and durability and contribute to low hernia recurrence rates in patients with suprapubic hernias.
authors.affiliation: Max Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Super Speciality Hospital-East Block, 2, Press Enclave Road, Saket, New Delhi, 110 017, India. a_sharma1@vsnl.com
authors.forename: Anil
authors.initials: A
authors.lastname: Sharma
authors.forename: Ashish
authors.initials: A
authors.lastname: Dey
authors.forename: Rajesh
authors.initials: R
authors.lastname: Khullar
authors.forename: Vandana
authors.initials: V
authors.lastname: Soni
authors.forename: Manish
authors.initials: M
authors.lastname: Baijal
authors.forename: Pradeep K
authors.initials: PK
authors.lastname: Chowbey
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006555:Hernia, Ventral / Q000209:etiology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013526:Surgical Mesh; D016896:Treatment Outcome