Robotic Subxiphoid Hernia Repair: Transabdominal Preperitoneal (TAPP)

Abstract

Subxiphoid hernias (SHs) are classified as M1 by the European Hernia Society. They usually arise within 3 cm caudal to the xiphoid and are most often encountered as incisional hernias after sternotomy incisions for cardiac surgery or subcostal incisions for hepatobiliary or foregut procedures. Robotic transabdominal preperitoneal (TAPP) repair for SHs is analogous to the TAPP repair of centrally located hernias, which involves developing a large peritoneal pocket, reducing the hernia sac, closing the hernia defect, placing mesh with wide overlap, and closing the pocket. These hernias' proximity to the costal margin and the diaphragm makes defect closure, adequate mesh overlap, and fixation difficult. Therefore, placing the mesh in the preperitoneal or retrorectus space helps to overcome these technical difficulties. Ensuring a large mesh overlap, even in the absence of mesh fixation, is key to successful robotic TAPP.