This video demonstrate Laparoscopic Repair of Epigastric Hernia by Two Ports performed by Dr R K Mishra at World Laparoscopy Hospital. An epigastric hernia is a type of hernia in the epigastric region of the abdominal wall. It's above the belly button and just below the sternum of your rib cage. This type of hernia is a somewhat common condition in both adults and children. About 2 to 3 percent of all abdominal hernias are epigastric hernias.

Epigastric hernias are defects that occur in the upper part of the abdominal wall, typically between the xiphoid process and the umbilicus. These hernias often contain preperitoneal fat or occasionally small bowel loops, leading to discomfort, pain, or swelling in the upper abdomen. With advancements in minimally invasive surgery, laparoscopic repair has emerged as a safe, effective, and cosmetically favorable technique. Recently, surgeons have started performing this procedure using only two ports, minimizing invasiveness and promoting faster recovery.

What is Laparoscopic Two-Port Repair?

Traditional laparoscopic hernia repair usually requires three or more ports. However, two-port laparoscopic repair utilizes just one camera port and one working port. This approach reduces surgical trauma, postoperative pain, and visible scarring, while still allowing complete visualization of the hernia defect and surrounding structures.

Indications

Two-port laparoscopic repair is ideal for:

• Small to medium-sized epigastric hernias

• Patients seeking minimal scarring

• Cases without extensive adhesions or multiple defects

It is less suited for large hernias or patients with prior upper abdominal surgery due to potential adhesions.

Surgical Technique

1. Patient Preparation: The patient is placed in a supine position under general anesthesia. The abdomen is prepared and draped under sterile conditions.

2. Port Placement:

   • A 10 mm umbilical port is inserted for the laparoscope.

   • A 5 mm working port is placed, usually in the left or right upper quadrant, depending on hernia location.

3. Hernia Identification: The hernia sac is identified, and any adhesions are carefully dissected.

4. Reduction of Contents: Preperitoneal fat or bowel loops are gently reduced back into the abdominal cavity.

5. Defect Closure: The hernia defect is closed using laparoscopic suturing or mesh fixation techniques.

6. Mesh Placement: A small piece of synthetic mesh may be placed to reinforce the defect, secured with tackers or sutures.

7. Closure: Ports are removed, and skin incisions are closed with absorbable sutures or adhesive strips.

Advantages of Two-Port Technique

• Minimally invasive: Reduced postoperative pain and faster recovery

• Cosmetic benefit: Only two small scars

• Short hospital stay: Often performed as a day-care procedure

• Enhanced visualization: Laparoscopic view allows precise repair and identification of multiple defects

Postoperative Care

Patients are usually mobilized on the same day and can resume light activities within a few days. Pain is typically mild and controlled with oral analgesics. Full recovery and return to normal activities occur within 1–2 weeks, depending on patient health and occupation.

Conclusion

Two-port laparoscopic repair of epigastric hernia is a modern, patient-friendly approach that combines the safety and efficacy of laparoscopy with minimal invasiveness. With careful patient selection and proper surgical expertise, it offers excellent functional and cosmetic outcomes.