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Laparoscopic Repair of Atypical Hernias: Suprapubic, Subxiphoid, and Lumbar


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Introduction

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    Suprapubic, subxiphoid, and lumbar/flank hernias, often referred to as atypical hernias, occur close to bony structures or off midline, making them challenging to repair. Their location can limit the surgeon’s ability to provide wide mesh overlap and adequate fixation. The laparoscopic approach is a viable option for repairing these hernias for surgeons with a thorough knowledge of abdominal wall and intra-abdominal anatomy of the pelvis and lumbar region and various surgical techniques.

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Clinical Anatomy

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    Safe laparoscopic repair of atypical hernias requires a thorough knowledge of the intra-abdominal anatomy.

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Suprapubic Hernias

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    To prevent iatrogenic injuries, special attention to the pelvic structures, especially in the area of the bladder and iliac vessels, is required ( Fig. 3.1 ). Extensive knowledge of this anatomy as well as the inguinal ligament and Cooper ligament is helpful when attaching mesh in the pelvis.

    Fig. 3.1

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