The 3-step Laparoscopic Intra-peritoneal On-lay Mesh Repair for Intermediate-size Primary Umbilical Hernia in Adults: A Useful Modification of Hybrid Technique

Despite numerous operative advances, today’s surgeon continues to remain perplexed while offering optimal choice for umbilical hernia repair. We propose a beginner-friendly, three-step modification of the existing hybrid technique. We prospectively studied 52 patients with medium-sized defects who, under defined criteria, underwent umbilical hernioplasty by applying the 3-step laparoscopic Intra-Peritoneal On-lay Mesh (IPOM) technique. The procedure was successfully completed in all but three patients. The mean operative time and hospitalization were 38.5 min and 19.5h, respectively. Nobody developed seroma or haematoma. Two patients had superficial umbilical wound infection that settled with conservative management. There were no major complications or deaths. With a learning curve of 5 cases, our technique was well appreciated by our postgraduate residents and fellowship trainees. Satisfactory cosmetic outcomes were obtained as assessed by a locally-devised scale. On median follow-up of 37.5 months, all patients were free of recurrence. With encouraging results, we recommend our modification for wider application. However, large-volume randomized studies are needed for its establishment and wide acceptance.