Hernia

, Volume 17, Issue 5, pp 619–626

Single-access laparoscopic primary and incisional prosthetic hernia repair: first 50 patients

  • G. Dapri
  • J. Bruyns
  • M. Paesmans
  • J. Himpens
  • G.-B. Cadière
Original Article

Abstract

Background

Primary and incisional hernia can be repaired by multitrocar laparoscopy. Single-access laparoscopy (SAL) recently gained interest to decrease the invasiveness and to reduce the abdominal trauma, besides improved cosmetic results. The authors report first 50 patients who consulted for primary and incisional hernia and treated by SAL prosthetic repair.

Patients and methods

Between December 2009 and March 2012, 50 patients (24 females, 26 males) were submitted to SAL for primary (23) and incisional hernia (27). Mean age was 49.1 ± 15.1 years (17–75), and mean body mass index 29.7 ± 5.7 kg/m2 (19–44.1). A total of 26 primary and 30 incisional hernias were treated. The technique consisted in implied the use of an 11-mm trocar for 10-mm scope, curved reusable instruments without trocars, and dualface prosthesis fixed by tacks without transfascial closures.

Results

No conversion to open surgery nor addition of one or more trocars was necessary. Mean perioperative hernia sizes were 7.0 ± 5.0 cm (2–24) in length and 6.0 ± 3.4 cm (1–16) in width, for a surface of 55.0 ± 64.6 cm2 (2.8–268.2). Mean prosthesis size used was 188.1 ± 113.4 cm2 (56.2–505.6). Mean laparoscopic time was 60.2 ± 32.8 min (26–153), and mean final scar length was 21.2 ± 4.5 mm (13–35). Mean hospital stay was 2.2 ± 1.2 days (1–8). Perioperative complications were registered in 4 patients and minor early complications in 13 patients of each group. After a mean follow-up of 16.1 ± 8.8 months (4–34), 2 late complications were observed in one patient of each group.

Conclusion

Primary and incisional hernia can safely be treated by SAL prosthetic repair, but a learning curve is unavoidable. Thanks to this approach, in patients with primary hernia, only a small scar is finally visible, and in patients who proved to be prone to develop incisional hernia, the number of fascial incisions can be reduced.

Keywords

Single-access Single-incision Single-port Single-site Umbilical hernia Ventral hernia Incisional hernia Laparoscopy 

References

  1. 1.
    Conze J, Prescher A, Schlachter M, Schumacher O (2007) The umbilical hernia. In: Fitzgibbons RJ, Schumpelick V (eds) Recurrent hernia prevention and treatment. Springer, Berlin, pp 359–364CrossRefGoogle Scholar
  2. 2.
    Mudge M, Hughes LE (1985) Incisional hernia: a 10 year prospective study of incidence and attitudes. Br J Surg 72(1):70–71PubMedCrossRefGoogle Scholar
  3. 3.
    Luijendijk RW, Hop WC, van den Tol MP, de Lange DC, Braaksma MM, IJzermans JN, Boelhouwer RU, de Vries BC, Salu MK, Wereldsma JC, Bruijninckx CM, Jeekel J (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 343(6):392–398PubMedCrossRefGoogle Scholar
  4. 4.
    Akman PC (1962) A study of five hundred incisional hernias. J Int Coll Surg 37:125–142PubMedGoogle Scholar
  5. 5.
    Read RC, Yoder G (1989) Recent trends in the management of incisional herniation. Arch Surg 124(4):485–488PubMedCrossRefGoogle Scholar
  6. 6.
    Sauerland S, Walgenbach M, Habermalz B, Seiler CM, Miserez M (2011) Laparoscopic versus open surgical techniques for ventral or incisional hernia repair. Cochrane Database Syst Rev Mar 16(3):CD007781Google Scholar
  7. 7.
    Forbes SS, Eskicioglu C, McLeod RS, Okrainec A (2009) Meta-analysis of randomized controlled trials comparing open and laparoscopic ventral and incisional hernia repair with mesh. Br J Surg 96(8):851–858PubMedCrossRefGoogle Scholar
  8. 8.
    Bingener J, Buck L, Richards M, Michalek J, Schwesinger W, Sirinek K (2007) Long-term outcomes in laparoscopic vs open ventral hernia repair. Arch Surg 142(6):562–567PubMedCrossRefGoogle Scholar
  9. 9.
    Lomanto D, Iyer SG, Shabbir A, Cheah WK (2006) Laparoscopic versus open ventral hernia mesh repair: a prospective study. Surg Endosc 20(7):1030–1035PubMedCrossRefGoogle Scholar
  10. 10.
    Lau H, Patil NG (2003) Umbilical hernia in adults. Surg Endosc 17(12):2016–2020PubMedCrossRefGoogle Scholar
  11. 11.
    Gonzales R, Mason E, Duncan T, Wilson R, Ramshaw BJ (2003) Laparoscopic verus open umbilical hernia repair. JSLS 7(4):323–328Google Scholar
  12. 12.
    Wright BE, Beckerman J, Cohen M, Cumming JK, Rodriguez JL (2002) Is laparoscopic umbilical hernia repair with mesh a reasonable alternative to conventional repair? Am J Surg 184(6):505–508PubMedCrossRefGoogle Scholar
  13. 13.
    DeMaria EJ, Moss JM, Sugerman HJ (2000) Laparoscopic intraperitoneal polytetrafluoroethylene (PTFE) prosthetic patch repair of ventral hernia. Prospective comparison to open prefascial polypropylene mesh repair. Surg Endosc 14(4):326–329PubMedCrossRefGoogle Scholar
  14. 14.
    Carbajo MA, Martin del Olmo JC, Blanco JI, de la Cuesta C, Toledano M, Martin F, Vaquero C, Inglada L (1999) Laparoscopic treatment vs open surgery in the solution of major incisional and abdominal wall hernias with mesh. Surg Endosc 13(3):250–252PubMedCrossRefGoogle Scholar
  15. 15.
    LeBlanc KA, Booth WV (1993) Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: preliminary findings. Surg Laparosc Endosc 3(1):39–41PubMedGoogle Scholar
  16. 16.
    Chelala E, Gaede F, Douillez V, Dessily M, Alle JL (2003) The suturing concept for laparoscopic mesh fixation in ventral and incisional hernias: preliminary results. Hernia 7(4):191–196PubMedGoogle Scholar
  17. 17.
    Wassenaar E, Schoenmaeckers E, Raymakers J, van der Palen J, Rakic S (2010) Mesh-fixation method and pain and quality of life after laparoscopic ventral or incisional hernia repair: a randomized trial of three fixation techniques. Surg Endosc 24(6):1296–1302PubMedCrossRefGoogle Scholar
  18. 18.
    Eriksen JR, Bisgaard T, Assaadzadeh S, Jorgensen LN, Rosenberg J (2011) Randomized clinical trial of fibrin sealant versus titanium tacks for mesh fixation in laparoscopic umbilical hernia repair. Br J Surg 98(11):1537–1545PubMedCrossRefGoogle Scholar
  19. 19.
    Pierce RA, Spitler JA, Frisella MM, Matthews BD, Brunt LM (2007) Pooled data analysis of laparoscopic vs open ventral hernia repair: 14 years of patient data accrual. Surg Endosc 21(3):378–386PubMedCrossRefGoogle Scholar
  20. 20.
    Heniford BT, Park A, Ramshaw BJ, Voeller G (2003) Laparoscopic repair of ventral hernias: 9 years’ experience with 850 consecutive hernias. Ann Surg 238(3):391–399PubMedGoogle Scholar
  21. 21.
    Helgstrand F, Rosenberg J, Bisgaard T (2011) Trocar site hernia after laparoscopic surgery: a qualitative systematic review. Hernia 15(2):113–121PubMedCrossRefGoogle Scholar
  22. 22.
    Bucher P, Pugin F, Morel P (2011) Single-port access prosthetic repair for primary and incisional ventral hernia: toward less parietal trauma. Surg Endosc 25(6):1921–1925PubMedCrossRefGoogle Scholar
  23. 23.
    Noel JK, Fahrbach K, Estok R, Cella C, Frame D, Linz H, Cima RR, Dozois EJ, Senagore AJ (2007) Minimally invasive colorectal resection outcomes: short-term comparison with open procedures. J Am Coll Surg 204(2):291–307PubMedCrossRefGoogle Scholar
  24. 24.
    Laurent C, Leblanc F, Bretagnol F, Capdepont M, Rullier E (2008) Long-term wound advantages of the laparoscopic approach in rectal cancer. Br J Surg 95(7):903–908PubMedCrossRefGoogle Scholar
  25. 25.
    Roberts KE, Panait L, Duffy AJ, Bell RL (2010) Single-port laparoscopic umbilical hernia repair. Surg Innov 17(3):256–260PubMedCrossRefGoogle Scholar
  26. 26.
    MacDonald E, Pringle K, Ahmed I (2009) Single port laparoscopic repair of incarcerated ventral hernia. Re: laparoscopic repair of incarcerated ventral abdominal wall hernias, Shah RH et al. (2008). Hernia 13(3):339PubMedCrossRefGoogle Scholar
  27. 27.
    Podolsky ER, Mouhlas A, Wu AS, Poor AE, Curcillo PG 2nd (2010) Single port access (SPA) laparoscopic ventral hernia repair: initial report of 30 cases. Surg Endosc 24(7):1557–1561PubMedCrossRefGoogle Scholar
  28. 28.
    Bower CE, Love KM (2011) Single incision laparoscopic ventral hernia repair. JSLS 15(2):165–168PubMedCrossRefGoogle Scholar
  29. 29.
    Tsivian A, Tsivian M, Sidi AA (2011) Laparoendoscopic single-site repair of incisional hernias after urological surgery. Urology 78(3):715–718PubMedCrossRefGoogle Scholar
  30. 30.
    Barbaros U, Demirel T, Sumer A, Deveci U, Tukenmez M, Cansumar MI, Kalayci M, Dinccag A, Seven R, Mercan S (2011) SILS Incisional hernia repair: is it feasible in giant hernias? A report of three cases. Diagn Ther Endosc 2011:387040Google Scholar
  31. 31.
    Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E, Dietz UA, Eker HH, El Nakadi I, Hauters P, Hidalgo Pascual M, Hoeferlin A, Klinge U, Montgomery A, Simmermacher RK, Simons MP, Smietański M, Sommeling C, Tollens T, Vierendeels T, Kingsnorth A (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13(4):407–414PubMedCrossRefGoogle Scholar
  32. 32.
    Hanna GB, Shimi SM, Cuschieri A (1998) Task performance in endoscopic surgery is influenced by location of the image display. Ann Surg 227(4):481–484PubMedCrossRefGoogle Scholar
  33. 33.
    Romanelli JR, Earle DB (2009) Single-port laparoscopic surgery: an overview. Surg Endosc 23(7):1419–1427PubMedCrossRefGoogle Scholar
  34. 34.
    Hanna GB, Drew T, Clinch P, Hunter B, Cuschieri A (1998) Computer-controlled endoscopic performance assessment system. Surg Endosc 12(7):997–1000PubMedCrossRefGoogle Scholar
  35. 35.
    Ahmed I, Paraskeva P (2011) A clinical review of single-incision laparoscopic surgery. Surgeon 9(6):341–351PubMedCrossRefGoogle Scholar
  36. 36.
    Berger D, Muller A, Bientzle M (2003) Laparoscopic repair of ventral hernia. Eur Surg 35:25–27CrossRefGoogle Scholar
  37. 37.
    Hesselink VJ, Lujendijk RW, de Wilt JH, Heide R, Jeekel J (1993) An evaluation of risk factors in incisional hernia recurrence. Surg Gynecol Obstet 176(3):228–234PubMedGoogle Scholar
  38. 38.
    Eryilmaz R, Sahin M, Tekelioglu MH (2006) Which repair in umbilical hernia of adults: primary or mesh? Int Surg 91(5):258–261PubMedGoogle Scholar
  39. 39.
    Theodoropoulou K, Lethaby D, Hill J, Gupta S, Bradpiece H (2010) Laparoscopic hernia repair: a two port technique. JSLS 14(1):103–105PubMedCrossRefGoogle Scholar
  40. 40.
    Berger D, Bientzle M, Muller A (2002) Postoperative complications after laparoscopic incisional hernia repair. Incidence and treatment. Surg Endosc 16(12):1720–1723PubMedCrossRefGoogle Scholar
  41. 41.
    Gurusamy KS, Allen VB, Samraj K (2012) Wound drains after incisional hernia repair. Cochrane Database Syst Rev Feb 15(2):CD005570Google Scholar

Copyright information

© Springer-Verlag France 2012

Authors and Affiliations

  • G. Dapri
    • 1
  • J. Bruyns
    • 1
  • M. Paesmans
    • 2
  • J. Himpens
    • 1
  • G.-B. Cadière
    • 1
  1. 1.Department of Gastrointestinal Surgery, European School of Laparoscopic SurgerySaint-Pierre University HospitalBrusselsBelgium
  2. 2.Data Centre, Institut Jules Bordet, Université Libre de BruxellesBrusselsBelgium

Personalised recommendations