title: Laparoscopic Subxiphoid Hernia Repair with Intracorporeal Suturing of Mesh to the Diaphragm as a Means to Decrease Recurrence.
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.
  
  
  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.
authors: 1 Department of General Surgery, Union Memorial Hospital , Baltimore, Maryland.
authors: Omar M
authors: OM
authors: Ghanem
authors: 2 Department of General Surgery, Abdominal Wall Reconstruction Program, Anne Arundel Medical Center , Annapolis, Maryland.
authors: Hamid R
authors: HR
authors: Zahiri
authors: 2 Department of General Surgery, Abdominal Wall Reconstruction Program, Anne Arundel Medical Center , Annapolis, Maryland.
authors: Stephen
authors: S
authors: Devlin
authors: 2 Department of General Surgery, Abdominal Wall Reconstruction Program, Anne Arundel Medical Center , Annapolis, Maryland.
authors: Udai
authors: U
authors: Sibia
authors: 2 Department of General Surgery, Abdominal Wall Reconstruction Program, Anne Arundel Medical Center , Annapolis, Maryland.
authors: Adrian
authors: A
authors: Park
authors: 2 Department of General Surgery, Abdominal Wall Reconstruction Program, Anne Arundel Medical Center , Annapolis, Maryland.
authors: Igor
authors: I
authors: Belyansky
mesh_terms: D000368:Aged; D003964:Diaphragm / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000209:etiology / Q000601:surgery*; D059685:Herniorrhaphy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D012008:Recurrence; D056346:Sternotomy; D013526:Surgical Mesh; D016896:Treatment Outcome