• Skip to main content
  • Skip to header right navigation
  • Skip to site footer

Log in
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
www.sages.org

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Awards
    • Who Is SAGES?
    • Leadership
    • Our Mission
    • Advocacy
    • Committees
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Committee Rosters
      • SAGES Past Presidents
  • Meetings
    • SAGES NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2026 Scientific Session Call for Abstracts
      • 2026 Emerging Technology Call for Abstracts
    • CME Claim Form
    • SAGES Past, Present, Future, and Related Meeting Information
    • SAGES Related Meetings & Events Calendar
  • Join SAGES!
    • Membership Application
    • Membership Benefits
    • Membership Types
      • Requirements and Applications for Active Membership in SAGES
      • Requirements and Applications for Affiliate Membership in SAGES
      • Requirements and Applications for Associate Active Membership in SAGES
      • Requirements and Applications for Candidate Membership in SAGES
      • Requirements and Applications for International Membership in SAGES
      • Requirements for Medical Student Membership
    • Member Spotlight
    • Give the Gift of SAGES Membership
  • Patients
    • Join the SAGES Patient Partner Network (PPN)
    • Patient Information Brochures
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find A SAGES Surgeon
  • Publications
    • Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Sustainability in Surgical Practice
    • SAGES Stories Podcast
    • Patient Information Brochures
    • Patient Information From SAGES
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • MesSAGES – The SAGES Newsletter
    • COVID-19 Archive
    • Troubleshooting Guides
  • Education
    • Wellness Resources – You Are Not Alone
    • Avoid Opiates After Surgery
    • SAGES Subscription Catalog
    • SAGES TV: Home of SAGES Surgical Videos
    • The SAGES Safe Cholecystectomy Program
    • Masters Program
    • Resident and Fellow Opportunities
      • MIS Fellows Course
      • SAGES Robotics Residents and Fellows Courses
      • SAGES Free Resident Webinar Series
      • Fluorescence-Guided Surgery Course for Fellows
      • Fellows’ Career Development Course
    • SAGES S.M.A.R.T. Enhanced Recovery Program
    • SAGES @ Cine-Med Products
      • SAGES Top 21 Minimally Invasive Procedures Every Practicing Surgeon Should Know
      • SAGES Pearls Step-by-Step
      • SAGES Flexible Endoscopy 101
    • SAGES OR SAFETY Video Activity
  • Opportunities
    • Fellowship Recognition Opportunities
    • SAGES Advanced Flexible Endoscopy Area of Concentrated Training (ACT) SEAL
    • Multi-Society Foregut Fellowship Certification
    • Research Opportunities
    • FLS
    • FES
    • FUSE
    • Jobs Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • OWLS/FLS
You are here: Home / Abstracts / Laparoscopic Repair of Subxiphoid Hernias: A New Technique for Mesh Fixation

Laparoscopic Repair of Subxiphoid Hernias: A New Technique for Mesh Fixation

David Ryan, MD, Ibrahim M Daoud, MD. St. Francis Hospital

Objective:

Superior epigastric and subxiphoid hernias pose a difficult problem for repair. In an open repair the immobility of the tissues makes approximating the fascia difficult. In a laparoscopic repair, one often is unable to fix the superior or superior lateral aspect of the mesh to the abdominal wall as this can overlap the diaphragm, costal margin or pericardium. We describe a technique of fixating the mesh inferiorly with a standard tacking device and using a fibrin sealant to adhere the superior portion of the mesh.

Description of Methods:

Laparoscopic access to the abdomen is attainted with a midline 12mm trochar and 5mm trochars in each side of the abdomen. The falciform ligament is taken off the abdominal wall using a vessel sealing device. The herniating contents are then reduced completely into the abdomen. 5cm of tissue are cleared in all directions of the defect, as this is the overlap we seek. This typically includes freeing the left lateral segment of the liver. An appropriate mesh is elevated to the abdominal wall and tacked in place inferiorly and laterally up to the level that it is safe (the costal margin in our cases). A fibrin sealant is then placed on the anterior surface of the unsecured mesh and it is elevated to the abdominal wall.

Preliminary Results:

Five hernias requiring this technique have been repaired since 2011. All involved had herniation of fat within the falciform ligament causing life limiting discomfort. Two of the defects abutted the xiphoid process and the hernia sac was adjacent to the pericardium. All patients have reported improvement from their preoperative symptoms and no recurrences have been note with the shortest follow up of six months.

Conclusions/Expectations:

This is a method that we have not seen formally described but we have found it successful in treating multiple difficult hernias. Although we do not propose a fibrin sealant to be equivalent to a tack or transfascial suture, we have found it to be successful in these particular cases where those options are not plausible. The position of the liver to maintain the mesh position on the abdominal wall likely has assisted in the success of the technique. Further study and follow up are essential to determine the long term success of this technique as well as if it may be applied to other areas that standard methods of fixation may not be safe. At this time, the authors have not applied the technique to other areas of the abdomen.

1,024

Share this:

  • Click to share on X (Opens in new window) X
  • Click to share on Facebook (Opens in new window) Facebook
  • Click to share on LinkedIn (Opens in new window) LinkedIn
  • Click to share on Pinterest (Opens in new window) Pinterest
  • Click to share on WhatsApp (Opens in new window) WhatsApp
  • Click to share on Reddit (Opens in new window) Reddit
  • Click to share on Pocket (Opens in new window) Pocket
  • Click to share on Mastodon (Opens in new window) Mastodon
  • Click to share on Threads (Opens in new window) Threads
  • Click to share on Bluesky (Opens in new window) Bluesky

Related


sages_adbutler_leaderboard

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064

1-310-437-0544

[email protected]

Monday – Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Bluesky
  • X
  • Instagram
  • Facebook
  • YouTube

Copyright © 2025 · SAGES · All Rights Reserved

Important Links

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals