Laparoscopic transabdominal preperitoneal repair (umbilical TAPP) versus open ventral patch repair for medium size umbilical hernias in overweight and obese patients

Introduction
Despite high prevalence of umbilical hernias an open anterior approach is still frequently performed. Mesh use, although necessary in recurrence prevention, may lead to more frequent surgical site infections, especially in obese patients. Intraperitoneal onlay mesh (IPOM) may promote intraperitoneal adhesions. Some of these limitations may be reconciled by transabdominal-preperitoneal repair (TAPP).

Aim
To compare the feasibility, safety and efficacy of umbilical TAPP (u-TAPP) with ventral patch repair technique (VPR).

Material and methods
The analysis included overweight/obese patients undergoing elective surgery for primary umbilical hernia (22 in VPR, 21 in u-TAPP).

Results
There were no differences between groups regarding size of the hernia defect. The mean width of the defect was 26 mm in VPR and 30 mm in u-TAPP (p = 0.185). The operation time was significantly shorter (p < 0.001) in VPR (43.1 ±11.6 min) than in u-TAPP (93.2 ±22.3 min). However, in VPR it was possible to place a much smaller area of synthetic mesh than in u-TAPP (34.3 vs. 164.2 cm2; p < 0.001). After 30 days of follow-up, there was no recurrence in any of the groups. No significant differences were observed between the two groups regarding post-operative pain.

Conclusions
TAPP technique in umbilical hernia repair allows for placement of a much larger mesh than an anterior approach surgery, and is closer to current recommendations, especially for patients with additional risk factors, such as obesity or coexistence of diastasis recti. TAPP allows a mesh to be introduced into the preperitoneal space, allowing one to avoid direct contact between the mesh and the intestines. Laparoscopic umbilical TAPP is feasible and safe, but the operation time is longer compared to open methods.