This video demonstrate Epigastric hernias that are even further away from the umbilicus are good candidates for a laparoscopic repair. In the typical laparoscopic procedure, 2 or 3 ports are used to repair the defect. Anadol and associates described a single-port laparoscopic repair using a special device such as a suture passer.

Epigastric hernia is a type of ventral hernia occurring in the midline between the umbilicus and the xiphoid process. Traditionally repaired using open surgery, advances in minimally invasive surgery have made laparoscopic repair a preferred option because of less postoperative pain, smaller scars, and faster recovery. The two-port laparoscopic technique, pioneered and popularized in advanced laparoscopic training centers such as World Laparoscopy Hospital (WLH), represents an evolution toward minimal access with maximum precision.

Laparoscopic hernia repair has replaced many open procedures because it is safe, efficient, and effective when performed by trained surgeons.

About the Two-Port Concept

Conventional laparoscopic hernia repair typically uses three or more ports. The two-port technique reduces the number of incisions while maintaining operative safety and visualization.

Key principle:

• One optical / working port (10–12 mm)

• One accessory working port (5 mm)

This approach has been shown to be feasible and effective for ventral hernias, including epigastric defects.

At WLH, surgeons have demonstrated two-port ventral hernia repair techniques for many years, showing it can be safely applied with proper patient selection and advanced laparoscopic skills.

Patient Selection

Ideal candidates include:

• Small to moderate epigastric hernia defects

• Primary hernias without extensive adhesions

• Patients fit for general anesthesia

Contraindications may include very large defects, strangulated hernia, or patients unfit for pneumoperitoneum.

Preoperative Preparation

• General anesthesia

• Supine positioning

• Abdomen prepared and draped

• Prophylactic antibiotics as per protocol

Creation of pneumoperitoneum is commonly achieved using Veress needle or open technique.

Port Placement in Two-Port Epigastric Hernia Repair

Typical placement includes:

• One 10–12 mm balloon or camera port

• One 5 mm working port placed laterally opposite the hernia (often left side)

Lateral placement improves ergonomics and instrument movement.

Step-by-Step Surgical Technique

1. Access and Diagnostic Laparoscopy

• Pneumoperitoneum created

• Laparoscope introduced

• Hernia defect and contents assessed

2. Adhesiolysis

• Adhesions released using scissors or energy device

• Non-dominant hand may compress abdominal wall externally to aid dissection

This maneuver helps bring tissues closer to instruments for safer dissection.

3. Reduction of Hernia Contents

• Hernia sac contents reduced into abdominal cavity

• Care taken to avoid bowel injury

4. Defect Preparation

• Hernia margins cleared circumferentially (typically 4–6 cm clearance)

Adequate clearance reduces recurrence risk and allows proper mesh placement.

5. Mesh Placement and Fixation

• Composite mesh introduced via 10–12 mm port

• Mesh overlap usually at least 3 cm beyond defect margins

• Fixation methods:

  • Transfascial sutures (central or peripheral)

  • Tackers or fasteners

Mesh fixation ensures durable repair and prevents recurrence.

6. Final Inspection and Closure

• Hemostasis confirmed

• Ports removed under vision

• Skin closed cosmetically

Outcomes and Benefits

Clinical studies of two-port laparoscopic ventral hernia repair show:

• Operative time approximately 15–70 minutes

• Short hospital stay (often 1–2 days)

• Low recurrence rates with proper technique

These findings support the safety and efficiency of the approach.

Advantages of Two-Port Epigastric Hernia Repair

For Patients

• Fewer incisions

• Less postoperative pain

• Faster recovery

• Better cosmetic outcome

For Surgeons

• Reduced port-site complications

• Efficient operative ergonomics

• Cost effectiveness

Role of World Laparoscopy Hospital

World Laparoscopy Hospital is known for structured training in advanced minimally invasive procedures. The institute has demonstrated innovations like the two-port technique for ventral hernia repair, emphasizing:

• Precision dissection

• Minimal access philosophy

• Evidence-based surgical practice

Postoperative Care

• Early mobilization

• Oral diet once bowel sounds return

• Avoid heavy lifting for several weeks

• Regular follow-up for recurrence or seroma

Possible Complications

Although uncommon:

• Seroma

• Wound infection

• Bowel injury

• Chronic pain (usually temporary)

• Recurrence

Studies show overall complication rates are low when performed by experienced surgeons.

Conclusion

Laparoscopic repair of epigastric hernia using a two-port technique represents a significant advancement in minimally invasive surgery. With reduced trauma, excellent cosmetic results, and reliable clinical outcomes, it is an effective approach when performed by trained laparoscopic surgeons. At centers like World Laparoscopy Hospital, this technique is part of advanced surgical training, helping surgeons deliver safer and more patient-friendly hernia repair.