Laparoscopic repair of suprapubic incisional hernia using a modified transabdominal partial extraperitoneal technique

Introduction: Herein, we describe a novel technique for suprapubic incisional hernia repair using a modified transabdominal partial extraperitoneal technique in four patients. Materials and Surgical Technique: We implemented four-trocar placement to achieve a coaxial setting for the pubic bone. The pubic bone and Cooper's ligament were exposed by an incision dorsal to the hernial orifice, and the bladder was mobilized as an inferior peritoneal flap. The retropubic space was dissected approximately 5 cm from the hernial defect and this was closed with an intracorporeal non-absorbable barbed suture. A mesh was introduced into the intra-abdominal cavity, positioned to cover the closed defect, and tied to Cooper's ligament, the pubic bone, and rectus muscles. The dissected peritoneal flap was reattached to the abdominal wall by tacking and suturing. Discussion: The modified transabdominal partial extraperitoneal technique for suprapubic incisional hernia repair may contribute to decreased recurrence and seroma formation.