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Single-port access prosthetic repair for primary and incisional ventral hernia: toward less parietal trauma

Bucher, Pascal ; Pugin, François ; Morel, Philippe

In: Surgical Endoscopy, 2011, vol. 25, no. 6, p. 1921-1925

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    Titre
    • Single-port access prosthetic repair for primary and incisional ventral hernia: toward less parietal trauma
    Auteur
    • Bucher, Pascal. Department of Surgery, University Hospital Geneva, Geneva, Switzerland
    • Pugin, François. Department of Surgery, University Hospital Geneva, Geneva, Switzerland
    • Morel, Philippe. Department of Surgery, University Hospital Geneva, Geneva, Switzerland
    Type de document
    • Postprint
    Identifiant OAI-PMH
    • oai:doc.rero.ch:310967
    Summary
    Background: Although still under development, single-port access (SPA) approach may be of interest in patients prone to port-side incisional hernia, ensuring absence of increased fascial incision. This forms the basis for evaluating SPA for prosthetic ventral hernia repair. We report a new SPA technique of ventral hernia repair using working-channel endoscope, standard laparoscopic instruments, and 10-mm port. Methods: Prospective experience with SPA prosthetic repair of primary and incisional ventral hernia in 52 patients for 55 ventral hernias is presented. Median (range) patient age was 46 years (26-85 years), and BMI was 28kg/m2 (20-38kg/m2). Mean fascial defect was 16.2cm2 for primary hernia (n = 23) and 48.3cm2 for incisional hernia (n = 32). Intraperitoneal composite mesh repair was achieved through single 10-mm flank port using working-channel endoscope. Meshes were fixed using absorbable tackers and transfascial stitches. Results: SPA repair of primary and incisional ventral hernia was completed in all cases without conversion to standard laparoscopy. Median (range) operative time was 54min (39-95 min). Mesh size ranged from 118 to 500cm2. No intra- or postoperative complications were recorded, except two seromas. Median (range) hospital stay was 1 day (1-5 days). One patient presented prolonged postoperative pain on mesh fixation that resolved after 3 months. No recurrence or port-site incisional hernias have been recorded at median (range) follow-up of 16 months (3-28 months). Conclusions: SPA prosthetic repair of primary and incisional ventral hernia is easily feasible according to natural exposition by pneumoperitoneum and gravity. In the present series, SPA ventral hernia repair appears to be safe for experienced SPA surgeons. It may decrease parietal trauma and scarring in patients prone to incisional hernia. SPA repair may be associated with a decrease in rate of port-site incisional hernia compared with multiport laparoscopy, but this has to be verified by randomized trial with standard laparoscopic approach on long-term follow-up