Minimally invasive approach to supra-pubic and non-midline lower abdominal incisional hernia: an extended indication of TAPE technique

Abstract

OBJECTIVE: TAPE technique has been described for the repair of supra-pubic midline incisional hernia with satisfactory outcome. Our aim is to study the feasibility and safety of repairing non-midline lower abdominal hernia as an extended indication for TAPE technique. METHOD: Patients with IPOM ventral hernia repair in all affiliated Hospitals of the University of Hong Kong were reviewed. Prospectively collected data were retrospectively analyzed. SURGICAL TECHNIQUE: Peritoneal incision was created just below the defect with pre-peritoneal dissection. Non-adhesive mesh then placed partial intra-peritoneally to cover the defect, and partially cover the whole extra-peritoneal space prepared. Meshes were fixed by tackers for intraperitoneal part, most inferior fixation points were at peritoneal incision line. Extra-peritoneal part of meshes covered up by the peritoneal flap. Fixation of this part of the meshes were facilitated by the peritoneal flap and subsequent fibrosis and adhesion to the extra-peritoneal structures. RESULTS: From 1.2008 to 6.2016, among 123 patients reviewed, 3 with lateral lower abdominal hernia requiring extended TAPE repair were included for the analysis with 1 right lower paramedian and 2 post-TRAM flap donor site incisional hernia. All are female patients with mean age of 49.7 years old, mean size of defect was 123.3 cm2 and mean follow-up time of 22.2 months. All patient recovered uneventfully and no morbidity or recurrence noted. CONCLUSION: Repair of lateral lower abdominal incisional hernia with this novel modified technique is safe and feasible. A larger case series and longer follow-up is required for validation.