Falciform Ligament Laparoscopic Approach for Preperitoneal Ventral Hernia Repair.

Background and Objectives: To overcome the limitations of intraperitoneal mesh and technically demanding extraperitoneal techniques, the "Falciform Ligament Laparoscopic Approach for Preperitoneal Ventral Hernia Repair" method, enables direct optical entry into the preperitoneal space using the falciform fat as a safety buffer. This approach avoids fascial division to maintain structural integrity. Methods: Between December 2018 and December 2024, 50 patients with primary, midline, medium-sized ventral hernias underwent repair using the technique. Primary outcomes included operative duration, complication rate and recurrence. Preperitoneal entry was achieved by a 5-mm optical trocar in the epigastrium. Upon space creation and hernia reduction, mesh was placed without fixation. Results: Fifty patients (mean age 41.2 ±7.6 years; body mass index [BMI] 29.4 ±4.7 kg/m2) with umbilical/paraumbilical hernia (M3-European Hernia Society classification) and mean defect size 2.9 ±0.6 cm underwent repair using the technique. All surgeries were completed laparoscopically without intraoperative complications. Median operative time was 85 minutes; median hospital stay was 1 day. Pain scores (visual analogue scale) were low: 1.7 (evening), 1.3 (day 1), 0.8 (day 7). No complications occurred, except one hematoma-resolved after aspiration; two seromas-no intervention needed; no recurrences observed over a 41-month median follow-up. Conclusion: It is a feasible, safe, structurally preserving technique with favorable outcomes. By eliminating mesh fixation and enabling early discharge with minimal postoperative pain, it offers a potential cost advantage. Further multicenter validation is warranted.