ROBOTIC TRANSABDOMINAL PREPERITONEAL (TAPP) REPAIR FOR M1 (SUBXIPHOID) VENTRAL HERNIA: A CASE REPORT

Abstract

Background: Background: The subxiphoid, or M1, region of the European Hernia Society classification is an unusual and technically challenging site for a ventral hernia, owing to how closely it lies to the costal margin, sternum and diaphragm. Such defects can follow prior sternotomy, or, less often, arise where a specimen was withdrawn through an epigastric trocar during upper abdominal laparoscopy such as cholecystectomy. We describe a 55-year-old man with diabetes and hypertension who developed a reducible, cough-impulse-positive epigastric swelling eight months after laparoscopic cholecystectomy, during which the gallbladder had been extracted via the epigastric port. Imaging demonstrated a 3 × 4 cm fascial gap at the M1 level. He underwent robotic transabdominal preperitoneal (TAPP) repair on the CMR Versius platform: the peritoneal flap was raised as far as the diaphragmatic central tendon, the defect closed primarily, and a sublay polypropylene mesh secured beneath the re-approximated peritoneum. Recovery was uneventful, with no recurrence at follow-up. Conclusion: Robotic TAPP allows accurate, sutured preperitoneal dissection and peritoneal closure within the narrow subxiphoid field, making it a dependable option for repair of M1 hernias.