Laparoscopic repair of poststernotomy subxiphoid epigastric hernia

Background: The repair of a subxyphoid hernia is a difficult procedure that nonetheless results in a high rate of recurrence. The laparoscopic approac h is a promising new technique for more efficacious treatment of this condi tion. This is the first report in the English-language literature to descri be the use of this approach for the correction of post-sternotomy subxiphoi deal hernia. Methods: Information was retrieved from the patients' hospitalization and o utpatient clinic files. Of 984 patients who had a median sternotomy, 10 dev eloped a substernal subxiphoid epigastric hernia. These patients had all be en treated laparoscopically using Gore-Tex mesh. Results: Nine patients were admitted electively and one urgently. The fasci al 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 de fect 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 patie nts had minor postoperative complications. During 20-42 months of follow-up , one patient suffered a recurrence. Conclusions: Laparoscopic repair of a poststernotomy subxiphoideal epigastr ic 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.