Needlescopic surgery for large umbilical hernia in a patient with

Background The European and American guidelines recommend that symptomatic umbilical hernias (UHs) are repaired using an open approach with a preperitoneal flat mesh. However, the standard treatment procedure for large UH in patients with extreme obesity is yet to be established. Here, we present the first case of a patient with morbid obesity undergoing laparoscopic UH repair using needlescopic instruments and an intraperitoneal onlay mesh plus repair (IPOM plus). Case presentation A 29-year-old man, who was classified as morbidly obese (body mass index, 36.7 kg/m2) noticed a reducible nontender mass in the umbilical region and was subsequently diagnosed with an UH, with a diameter of 4 cm. Laparoscopic IPOM plus repair was planned using a needlescopic method for a large UH in the patient with morbid obesity. A 3-mm rigid laparoscope was mainly used in the procedure. After a 12-mm trocar and two 3-mm trocars were inserted, fascial defect closure was performed using intracorporeal suturing with 0 monofilament polypropylene threads. Then, IPOM was performed laparoscopically using an 11.4-cm round mesh coated with collagen to prevent adhesions. The operative time and blood loss were 57 min and 1 g, respectively. The postoperative course was uneventful. Conclusions Reduced-port laparoscopic surgery using needlescopic instruments and an IPOM plus technique is a minimally invasive and convenient combination option for large UH in a patient with morbid obesity.

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Abdominal CT showing the small bowel herniation through the 5-mm port

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One 5 mm umbilical trocar and two 3 mm trocars are inserted at the

Abstracts from IPEG 2013The 22nd Annual Congress for Endosurgery in ChildrenJune 17–22, 2013Beijing, China

Akira UMEMURA, Doctor of Medicine, Iwate Medical University, Morioka, Department of Surgery

Akira UMEMURA, Doctor of Medicine, Iwate Medical University, Morioka, Department of Surgery

Closure versus non-closure of fascial defects in laparoscopic ventral and incisional hernia repairs: a review of the literature

Needlescopic surgery for large umbilical hernia in a patient with morbid obesity using intraperitoneal onlay mesh with fascial defect closure: a case report, Surgical Case Reports

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PDF) Left paraduodenal hernia treated by single-incision laparoscopic surgery: a case report