Laparoscopic anterior abdominal hernia repair is essentially identical to ventral hernia repair as mentioned in previous chapters. The patient will receive antibiotics prior to the skin incision. A Veress needle in the left upper quadrant at the cos­tal margin is an ideal way to insuf fl ate the abdomen safely. Alternatively one can use a Hasson trocar, but this makes a large hole that can lead to hernia formation. Most of the pri­mary abdominal wall hernias can be repaired using all 5-mm trocars and we place two of these laterally on each side of the abdomen (Fig. 18.9 ). The contents of the hernia sac are reduced. Speci fi cally with these hernias, it is the key to take down the peritoneum and reduce the preperitoneal fat that can still be felt if left in situ. For epigastric hernias it is important to remove the falciform ligament from the peritoneal surface of the abdominal wall. Once the fascial defect is clearly delin­eated, it is measured and a 5-cm overlap is typically used to estimate the size of mesh needed. Four transfascial sutures are used to fi x the mesh superiorly, inferiorly, and laterally on each side. A laparoscopic tacker is then used to tack the mesh circumferentially to help with fi xation and prevent internal hernias. If the hernia is very large, additional transfascial sutures should be used. We also use a compression bandage for the laparoscopic repair and an abdominal binder. Patients should be advised to be aware of postoperative seroma that is commonly seen after the laparoscopic approach.