Minimal access surgery of pediatric inguinal hernias: a review

Inguinal hernia is a common problem among children, and herniotomy has been its standard of care. Laparoscopy, which gained a toehold initially in the management of pediatric inguinal hernia (PIH), has managed to steer world opinion against routine contralateral groin exploration by precise detection of contralateral patencies. Besides detection, its ability to repair simultaneously all forms of inguinal hernias (indirect, direct, combined, recurrent, and incarcerated) together with contralateral patencies has cemented its role as a viable alternative to conventional repair. Numerous minimally invasive techniques for addressing PIH have mushroomed in the past two decades. These techniques vary considerably in their approaches to the internal ring (intraperitoneal, extraperitoneal), use of ports (three, two, one), endoscopic instruments (two, one, or none), sutures (absorbable, nonabsorbable), and techniques of knotting (intracorporeal, extracorporeal). In addition to the surgeons’ experience and the merits/limitations of individual techniques, it is the nature of the defect that should govern the choice of technique. The emerging techniques show a trend toward increasing use of extracorporeal knotting and diminishing use of working ports and endoscopic instruments. These favor wider adoption of minimal access surgery in addressing PIH by surgeons, irrespective of their laparoscopic skills and experience. Growing experience, wider adoption, decreasing complications, and increasing advantages favor emergence of minimal access surgery as the gold standard for the treatment of PIH in the future. This article comprehensively reviews the laparoscopic techniques of addressing PIH.     

Surgical technique and complications during laparoscopic repair of diaphragmatic hernias

Diaphragmatic hernias can present as retrocostoxiphoid hernias (RCXH) or diaphragmatic dome hernias. The RCXH include the Larrey hernia (LH), the Morgagni hernia (MH), and the Larrey–Morgagni hernia (LMH). These congenital hernias are usually asymptomatic, and the diagnosis is simplified by two exams: chest X-ray, and thoraco-abdominal computed tomography (CT) scan. The potential risk in this condition is small-bowel incarceration in the hernia defect and subsequent obstruction. We report two cases of LH and one case of LMH treated by laparoscopy between February 2004 and October 2005, with a review of the surgical techniques. Two different laparoscopic techniques were used: the tension-free technique, and resection of the hernia sac with closure of the defect and reinforcement by prosthesis. One patient presented a postoperative cardiac tamponade due to a clip-induced bleeding of an epicardial artery at the inferior surface of the heart. Treatment by laparoscopy is feasible, but a consensus regarding the best laparoscopic repair is needed.     

Laparoscopic repair of umbilical hernias in conjunction with other laparoscopic procedures.

BACKGROUND: This study evaluates the feasibility of laparoscopic transfascial suture repair of umbilical hernias when combined with another laparoscopic procedure that potentially contaminates the peritoneal cavity. METHOD: From August 1997 to November 2001, 32 patients underwent laparoscopic umbilical suture repair in association with another laparoscopic procedure. The repair was performed with the Carter-Thomason suture passer. RESULTS: Of the 32, 26 patients with more than 1-year follow-up were included in the study. The mean diameter of the umbilical hernia defect was 1.67 cm (range, 0.5 to 3). At a mean follow-up of 34 months (range, 12 to 60), there were only 2 recurrences (7.7%) both of which happened in patients with hernia defects larger than 2 cm in diameter. Apart from 2 wound infections, no other complications occurred. CONCLUSION: Laparoscopic suture repair of umbilical hernias with the suture passer method is effective and durable even when combined with other laparoscopic procedures that potentially contaminate the peritoneal cavity with bile or enteric contents.     

Ventralex mesh in umbilical/epigastric hernia repairs: clinical outcomes and complications

BACKGROUND: Umbilical and epigastric hernias have historically been repaired without mesh resulting in recurrence rates in some series of up to 40%. Recent data suggests mesh repair of these hernias may decrease recurrent hernia rates. Ideal placement of the mesh is behind the defect, which is difficult to do without a large incision in these hernias unless done laparoscopically. The Ventralex hernia patch is a composite PTFE/polypropylene patch allowing intraperitoneal placement behind the hernia defect through a small incision, and without the cost of laparoscopy. To date, only one study exists evaluating this new prosthesis. METHODS: This study is a retrospective chart review of all umbilical and epigastric hernias repaired with the Ventralex hernia patch by a single surgeon. Patient characteristics and operative and post-operative data were collected. Hernia recurrence is the primary outcome. Secondary outcomes include complication rates. RESULTS: Eighty-eight patients from 2003-2006 were evaluated. The population included patients aged 25-86 (mean 52) with nineteen females (22%). The average BMI was 32 (range 18-68). Eighteen patients were smokers, five patients were diabetic, and two patients were chronic steroid users. The size of patches used were small (72%), medium (27%), and unknown (1%). Average operating room time was 52 min (range 19-194). The different types of hernias repaired were umbilical (68%), epigastric (30%), and incisional (2%). Follow-up visits ranged from 8 days to 3.1 years in all but five patients (6%). No hernia recurrences were found in follow-up. Complications included two patients (2.2%) with mesh infection requiring removal of the patch, one patient with post-operative urinary retention, and seroma formation in another patient. CONCLUSIONS: The composite PTFE/polypropylene hernia patch is effective in preventing hernia recurrence in umbilical, epigastric, and small ventral hernia repairs and can be accomplished with a low rate of complications.     

Day surgery for laparoscopic repair of abdominal wall hernias

Laparoscopic repair of abdominal wall hernias is still a controversial and nongeneralized therapeutic option. The aim of this paper is to evaluate the results of laparoscopic surgery on abdominal wall hernias at a day-surgery unit and to describe our procedure protocol. Prospective analysis of 300 patients undergoing laparoscopic surgery for abdominal wall hernias was conducted: 260 preperitoneal and 40 intraperitoneal. The patients' clinical features, hernia type, intraoperative and postoperative complications, and follow-up are studied for both types of surgery. All the patients receiving surgery with extraperitoneal laparoscopy were completed as a day-surgical procedure with a rate of conversion to open surgery of 2.3%. Twelve (30%) of the 40 patients operated on for ventral hernias using intraperitoneal laparoscopy required hospitalization: five for perioperative complications and seven for pain (16%). There was no case of infection or mesh rejection. The recurrence rates were 0.78% (two cases) for the inguinal hernias and 2.5% (one case) for the ventral hernias. In conclusion, laparoscopic repair of abdominal wall hernias in a day-surgery setting is an efficient alternative to open surgery. Electronic Publication     

A novel technique to facilitate laparoscopic repair of large paraesophageal hernias

BACKGROUND: Laparoscopic repair of large paraesophageal hernias (LPEH) is technically challenging, and requires advanced laparoscopic skills. We have developed a novel technique for facilitating laparoscopic repair of LPEHs safely and easily, using a Nelaton catheter. PATIENTS AND METHODS: Seven patients with LPEHs were operated on through a laparoscopic approach. During surgery, the left lobe of the liver and right diaphragmatic crus were elevated using a suspended thread covered by a Nelaton catheter. RESULTS: All patients were operated on laparoscopically using this technique. No patient required conversion to open method. The median operating time was 205 minutes and the range was from 155 to 295 minutes. No intraoperative or early complications occurred in any patient. Late complications occurred in 2 patients due to a small sliding hernia: a slipped fundoplication in 1 patient, and a gastric ulcer in the other. CONCLUSIONS: In conclusion, laparoscopic repair of LPEH is a challenging procedure that requires wide experience in laparoscopic gastroesophageal surgery. Further refinement for this operation may be necessary.     

Three-dimensional mesh for ventral hernias: a new technique for an old problem

The morbidity/mortality associated with ventral hernias continues to be a serious medical problem due to high rates of recurrence. Meshes offer a simple and effective solution and, bearing this in mind, we describe a new protocol developed in our department, which consists of dissecting the hernia to free the peritoneal space, in which the three-dimensional mesh (PHS) is lodged. From July 1999–November 2002, this technique was used in 32 adult and elderly patients: four eventrations caused by trocars, seven eventrations from laparotomy, 14 umbilical hernias, five epigastric hernias, and two spigelian hernias. The size of the hernial ring was 10 cm or less in all cases. All patients underwent surgery under spinal anaesthesia and with antibiotic prophylaxis. No patient required readmission, experienced infection of the mesh or recurrence, or required more oral analgesia than prescribed on discharge. The mean hospital stay was 30±15 h, and only five of 32 patients required more than 1 day of stay. No deaths occurred. Therefore, we think that the use of the PHS mesh in ventral hernia is a safe, effective, and simple technique.     

Results of laparoscopic versus open abdominal and incisional hernia repair.

BACKGROUND: Incisional hernia is a frequent complication of abdominal surgery. The object of this study was to confirm the safety, efficacy, and feasibility of laparoscopic treatment of abdominal wall defects. METHODS: Fifty consecutive laparoscopic abdominal and incisional hernia repairs from September 2001 to May 2003 were compared with 50 open anterior repairs. RESULTS: The 2 groups were not different for age, body mass index, or American Society of Anaesthesiologists scores. Mean operative time was 59 minutes for the laparoscopic group, 164.5 minutes for the open group. Mean hernia diameter was 10.6 cm for the laparoscopic group, 10.5 cm for the open group. Mean length of stay was 2.1 days for the laparoscopic group, 8.1 days for the open group. Complications occurred in 16% of the laparoscopic and 50% of open group. Median follow-up was 9.0 months for the laparoscopic group, 24.5 months for the open group. Recurrence rates were 2% for laparoscopic group and 0% for the open group. CONCLUSION: Results for laparoscopic abdominal and incisional hernia repair seem to be superior to results for open repair in terms of operative time, length of stay, wound infection, major complications, and overall hospital reimbursement.     

Classification of primary and incisional abdominal wall hernias

Purpose  A classification for primary and incisional abdominal wall hernias is needed to allow comparison of publications and future studies on these hernias. It is important to know whether the populations described in different studies are comparable. Methods  Several members of the EHS board and some invitees gathered for 2 days to discuss the development of an EHS classification for primary and incisional abdominal wall hernias. Results  To distinguish primary and incisional abdominal wall hernias, a separate classification based on localisation and size as the major risk factors was proposed. Further data are needed to define the optimal size variable for classification of incisional hernias in order to distinguish subgroups with differences in outcome. Conclusions  A classification for primary abdominal wall hernias and a division into subgroups for incisional abdominal wall hernias, concerning the localisation of the hernia, was formulated.

Seroma and recurrence in laparoscopic ventral hernioplasty.

BACKGROUND: Recurrence after laparoscopic ventral hernioplasty is a severe problem despite surgeons' increased experience in recent years. It is well known that the main reasons for recurrences are lack of experience, bad technique, infection, and seroma. The aim of this study was to investigate the events, what caused recurrences, and the technique to prevent recurrence in laparoscopic ventral hernioplasty. METHODS: From May 1996 through December 2005, 78 patients who underwent 80 laparoscopic ventral hernioplasties (67 incisional hernias, 8 large epigastric, 5 large umbilical) were separated into 2 groups. Group A (n=28): ePTFE dual mesh patch secured intraperitoneally by full-thickness stitches and endoscopic tacks to cover the hernia defect and to overlap healthy margins by at least 2.5 cm (n=17, subgroup A1) or 4 cm (n=11, subgroup A2). In subgroup A2, a full-thickness suture was placed in the center of the hernia defect to reduce the "dead space." Group B (n=52): The same technique as in group A, but the hernia sac was cauterized by monopolar cautery (n=5) or Harmonic scalpel (n=47). The overlapping healthy margins were at least 2.5 cm (n=16, subgroup B1) or 4 cm (n=36, subgroup B2). In subgroup B2, a full-thickness suture was placed in the center of the hernia defect to reduce the dead space. Postoperatively, CT-scans were used to confirm complications or recurrences. RESULTS: In group A, 7 seromas [4 clinical (A1) and 3 subclinical (A1=1, A2=2)], 3 hematomas (A1=2, A2=1), 2 infections (A1), and 3 recurrences (10.7%) were observed (A1=2 or 11.8%, A2=1 or 9%). Two recurrences were observed in symptomatic seromas (subgroup A1) and 1 in a patient without seroma (subgroup A2). In group B, 1 subclinical seroma, 1 hematoma, and 1 recurrence (6.2%) were noted in subgroup B1. In subgroup B2, no recurrence was observed. Significantly fewer total seromas occurred in group B compared with group A (P=0.004). The total recurrence rate in group B was 1.95% (NS vs group A), but a significant difference was observed between subgroups A1 and B2 (P=0.036). CONCLUSION: Cauterization of the hernia sac and a central full-thickness suture to reduce dead space seems to prevent seroma. This technique combined with a large patch to cover at least 4 cm of healthy margins and the surgeon's experience may be sufficient to prevent recurrences in laparoscopic ventral hernioplasty.     

Minimally invasive closure of pediatric umbilical hernias

Background

Pediatric umbilical hernias may close spontaneously by concentric fibrosis and scar tissue formation. Some hernias do not close. This study was developed to assess this novel minimally invasive closure (MIC), using injectable material to close the umbilical defect.

Method

Twenty-five children with umbilical hernias of 1.5 cm or less were included in the study. Deflux (Q Med, Uppsala, Sweden), a biodegradable compound of dextranomer microspheres in hyaluronic acid, was injected percutaneously in the border and preperitoneal space in 4 quadrants of the hernia defect, thereby occluding the lumen. Follow-up visits were obtained at approximately 1 week, 3 months, and 1 year.

Results

Two to twenty-four months after surgery, 21 of the 25 umbilical hernias were closed (84%). To date, there have been no complications from the injected compound substance. The average age at the time of the MIC was 6 years and 7 months, ranging from 4 months to 17 years. The average defect was more than 6.4 mm, ranging from 4 to 14 mm.

Conclusion

Minimally invasive closure procedure with injection of dextranomer hyaluronic acid copolymer can safely be used to close umbilical hernias. The procedure closed or reduced the size of hernias in our patients immediately after surgery; and within months, 21 (84%) of 25 were closed. One defect has not closed in 1 year and will need repair. The remaining 3 defects are small and may go on to close by ongoing fibroblast ingrowth and collagen deposit. The MIC procedure may be an alternative to open repair of umbilical hernias. Increased experience and long-term follow-up will determine the true efficacy of this new technique.     

腹腔镜脐环缝扎术治疗小儿脐疝的体会

目的:探讨腹腔镜脐环缝扎术治疗小儿脐疝的临床疗效。方法:回顾分析为21例脐疝患儿行腹腔镜脐环缝扎术的临床资料。结果:21例手术均获成功。手术时间20～45 min,平均32.5 min;术中均无出血,术后康复快。术后18例患儿随访6～72个月,无复发或肠粘连、肠梗阻等并发症发生。结论:腹腔镜脐环缝扎术治疗小儿脐疝安全、有效,手术微创、美观,值得推广应用。     

Laparoscopic correction of umbilical hernias using a transabdominal preperitoneal approach: results of a pilot study

Background  Laparoscopic repair of umbilical hernias is usually based on the open underlay procedure in which the mesh is placed intra-abdominally. To prevent complications such as adhesions, bowel obstruction and fistula formation we developed a new laparoscopic approach, placing the mesh in the preperitoneal space. Methods  Our laparoscopic approach concerns a standardised procedure with introduction of three intra-abdominally placed trocars. The ventral abdominal wall is incised in a lengthwise manner approximately 5 cm from the umbilical defect, followed by development of the preperitoneal space, reposition of the umbilical peritoneal sac and placement and fixation of a Prolene^TM mesh. The mesh is secured using transfascial Prolene^TM sutures; the peritoneal defect is closed with a running Vicryl^TM suture. Data on 17 patients with primary umbilical hernias laparoscopically operated on between April 2002 and March 2006 are presented. Results  The 11 men and 6 women had a mean age of 57.8 years (range 37–91 years) and a mean body mass index (BMI) of 30.6 kg/m² (range 23.7–37.9 kg/m²). Mean hernia size was 1.95 cm (range 1–3 cm), average mesh size was 110 cm² (range 100–150 cm²). Mean operating time was 85.6 min (range 60–120 min). Mean hospital stay was 2.2 days (range 1–3 days). No major complications were seen. No recurrences were observed during a mean follow-up of 36.2 months (range 13–62 months). Conclusions  The preperitoneal laparoscopic technique for umbilical hernia repair combines the advantages of a laparoscopic, minimally invasive, approach, avoiding the potential complications related to intra-abdominal mesh position.     

A novel technique for the repair of lumbar hernias after iliac crest bone harvest

BACKGROUND: Lumbar hernia is a clinical entity that has been increasingly more common since the advent of iliac bone harvest for bone grafting procedures. These can be very technically difficult to repair and have a high recurrence rate. METHODS: Using a corkscrew anchor suture device, we have developed a novel and simple way to repair these hernias with no recurrence. Here we present our experience with the corkscrew suture anchor device. RESULTS: This technique has been performed in 2 patients at our institution, and in both cases, the hernia was successfully repaired. Our 1-year follow-up on this technique demonstrates intact repairs with no sign of recurrence. CONCLUSIONS: The placement of corkscrew suture anchors along the iliac crest remnant is a simple technique requiring minimal bony exposure. The anchors facilitate the long-term fixation of mesh despite the lack of fascia in this area. We conclude that this is a simple and effective approach for repair of these challenging hernias.     

Critical evaluation of a novel DualMesh repair for large hiatal hernias

Background  The use of mesh for laparoscopic repair of large hiatal hernias may reduce recurrence rates in comparison to primary suture repair. However, there is a potential risk of mesh-related oesophageal complications due to prosthesis erosion. The aim of this study was to critically evaluate a novel mesh (DualMesh) repair of hiatal hernias with particular reference to intraluminal erosion. Method  Medical records of 19 patients who underwent laparoscopic hiatal hernia repair with DualMesh reinforcement of the crural closure were reviewed from a prospectively collected database. Quality of life and symptom analysis was performed using quality of life in reflux and dyspepsia (QOLRAD) questionnaires pre- and postoperatively after 6 weeks, 6 months, 1 year and 2 years. Barium studies were performed on patients pre-operatively and two years postoperatively to assess hernia recurrence. After 2 years, oesophagogastric endoscopy was performed to assess signs of erosion. Results  Mean patient age was 70.5 years (range 49–85 years). Two years after hiatal hernia repair, there was significant improvement in quality-of-life scores (QOLRAD: p < 0.001). Follow-up barium studies performed at 31.3 months (range 29–40 months) after surgery showed moderate recurrent hernias (>4 cm) in 1/14 patients (7%). Endoscopies performed at 34.4 months (range 28–41 months) after surgery did not show any signs of prosthetic erosion. Conclusion  Laparoscopic reinforcement of primary hiatal closure with DualMesh leads to a durable repair in patients with large hiatal hernias. Long-term endoscopic follow-up did not show any signs of mesh erosion after prosthetic reinforcement of the crural repair.     

Laparoscopic cure of small ventral hernias with composite mesh

BACKGROUND: The use of mesh is recommended to reduce the rate of recurrence after the curing of ventral hernias. METHODS: A multicentre prospective trial was conducted to assess the laparoscopic cure of small ventral hernias with a composite mesh. RESULTS: Around 222 patients entered the trial and received laparoscopic repair for ventral hernias of less than 5 cm. There was one conversion. The mean length of post-operative hospitalisation was 2.5 days. At 1 year, the recurrence rate was 2%. Two meshes were removed due to infection, 3% of the patients were using analgesics and 86.1% of the patients described no pain on EVA scoring. CONCLUSION: The laparoscopic cure of small ventral hernias with composite mesh is efficient. Further technical progress is warranted to reduce the rate of seroma formation.     

小切口辅助腹腔镜手术在巨大造口旁疝修补术中的应用

目的:探讨小切口辅助腹腔镜手术修补巨大造口旁疝的临床效果与手术经验.方法:回顾分析2008年8月至2010年12月为37例巨大造口旁疝患者行小切口辅助腹腔镜手术的临床资料,观察手术时间、隐匿疝、小切口长度、住院时间、切口感染、浆液肿、慢性疼痛、复发率等情况.结果:37例均顺利完成手术,手术时间平均(127.97±18.54) min,小切口长度平均(5.89±1.02) cm,发现隐匿疝12例,术中肠道损伤修补3例,无手术死亡病例.术后平均住院(5.35±1.27)d,术后3例疼痛时间大于3个月,4例发生浆液肿,无一例切口感染.术后随访6 ～ 30个月,无一例复发.结论:小切口辅助腹腔镜手术修补巨大造口旁疝是安全、可靠的,有效减少了术后并发症的发生,达到了腹壁塑性的效果.     

Robot-assisted laparoscopic mesh repair of incisional hernias with exclusive intracorporeal suturing: a pilot study

Background The da Vinci robot laparoscopic incisional hernia repair with intracorporeal suturing may offer an alternative to transabdominal sutures and tackers. Methods From 2003 to 2005, 11 patients (median age, 71 years; median body mass index [BMI], 28) with small and medium-sized incisional hernias (median fascial defect, 19.6 cm²) were treated with the da Vinci robot system using intracorporeal mesh fixation with interrupted sutures. This pilot study aimed to assess the feasibility and report the morbidity with special reference to postoperative pain and long-term recurrence. Results The median operative time was 180 min. There was no conversion to open or standard laparoscopy and no postoperative mortality. The overall morbidity rate was 27%. One patient underwent reoperation on postoperative day 3 for peritonitis secondary to small bowel injury. The median visual analog pain score on postoperative day 1 was 3. Seven patients (63%) needed parenteral paracetamol until postoperative day 2. The median hospital stay was 3 days. During a median follow-up period of 25 months, no patient experienced recurrent hernia. One patient had a trocar-site herniation at 6 months. No patient experienced chronic suture site pain or discomfort. Conclusion This is the first report of robot-assisted laparoscopic incisional hernia with exclusive intracorporeal suturing for mesh fixation in humans. The findings show that this technique is feasible and may not be associated with chronic postoperative pain. Further evaluation is needed to assess the benefit to the patient, but this investigation may be the basis for a future, prospective, randomized study.     

Open intraperitoneal versus retromuscular mesh repair for umbilical hernias less than 3cm diameter

Background

Mesh techniques are the preferable methods for repair of small ventral hernias, as a primary suture repair shows high recurrence rates. The aim of this prospective study was to compare the retromuscular sublay technique with the intraperitoneal underlay technique for primary umbilical hernias.

Methods

From February 2004 to April 2007, all patients treated for umbilical hernias with maximum diameters of 3 cm were prospectively followed. During the first period of 15 months, all patients were treated with retromuscular repair using a large pore mesh (Vypro). After that period, for all patients, mesh repair using an intraperitoneal Ventralex patch was performed. All patients underwent general anesthesia. This analysis included 116 patients, of whom 56 had retromuscular repair (group I; mean age, 54.8 years; mean body mass index, 28.2 kg/m²) and 60 had open intraperitoneal repair (group II; mean age, 48.1 years; mean body mass index, 29.4 kg/m²). Operating time was evaluated as skin-to-skin time, and drain management was noted for both techniques. Follow-up was ≥2 years for all patients, and both early and late complications were registered, including seroma and hematoma formation, wound infection, fistula formation, and recurrence rates. Preoperative and postoperative pain was evaluated using a visual analogue scale (range, 0–10) on the day of the first outpatient visit; on postoperative days 1, 7, and 21; and after 1 year. Quality of life was estimated using the EQ-5D questionnaire 1 year after surgery. All data were analyzed using SPSS version 15 software. Wilcoxon's rank-sum test was used to analyze continuous variables, and repeated-measures analysis of variance was used for visual analogue scale scores. The χ² test and Fisher's exact test were used to assess the differences between categorical data. P values < .05 were considered statistically significant.

Results

The mean operative times were 79.9 minutes in group I and 33.9 minutes in group II (P < .001). The mean hospital stay was significantly longer in group I (3.8 vs 2.1 days, P < .001). Seromas and superficial wound infections in the early postoperative period were not different between both groups, although seromas occurred more frequent in the retromuscular group. Postoperative visual analogue scale scores were significantly lower with the intraperitoneal technique at all time points (P < .003, repeated-measures analysis of variance). However, 3 patients with the Ventralex patch had to be readmitted for severe pain. The recurrence rate was higher with the intraperitoneal repair (n = 5 [8.3%] vs n = 2 [3.6%]) than for the retromuscular mesh repair, but not statistically significant. Quality of life was comparable in the two groups after 1 year.

Conclusions

The open intraperitoneal technique using a Ventralex mesh for umbilical hernias seems a very elegant and quick technique. However, possibly because of the less controllable mesh deployment, recurrence rates seem higher. In case open mesh repair is the preferred treatment, a retromuscular repair should be the first choice.     

A Collective Review on Mesh-Based Repair of Umbilical and Epigastric Hernias

In accordance with the tension-free principles for other hernias, umbilical and epigastric hernia repair should probably be mesh-based. The number of randomized studies is increasing, most of them showing significantly less recurrences with the use of a mesh. Different devices are available and are applicable by several approaches. The objective of this review was to evaluate recent literature for the different types of mesh for umbilical and epigastric hernia repair and recurrences after mesh repair. A multi-database search was conducted to reveal relevant studies since 2001 reporting mesh-based repair of primary umbilical/epigastric hernia and their outcomes in adult patients. A total of 20 studies were included, 15 of them solely involved umbilical hernias, whereas the remaining studies included epigastric hernias as well. A median of 124 patients (range, 17–384) was investigated per study. Three quarters of the included studies had a follow-up of at least 2 years. Six studies described the results of laparoscopic approach, of which one reported a recurrence rate of 2.7 %; in the remaining studies, no recurrences occurred. Two comparative studies reported a lower incidence of complications and postoperative pain after laparoscopic repair compared to open repair. Seventeen studies reported results of open techniques, of which seven studies showed no recurrence. Other studies reported recurrence rates up to 3.1 %. A wide range of complication rates were reported (0–33 %). This collective review showed acceptable recurrence rates for mesh-based umbilical and epigastric hernia repair. A wide range of devices was investigated. A tendency toward more complications after laparoscopic repair was found compared to open repair.