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

Abstract

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 28 kg/m 2 (20-38 kg/m 2 ). Mean fascial defect was 16.2 cm 2 for primary hernia (n = 23) and 48.3 cm 2 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 54 min (39-95 min). Mesh size ranged from 118 to 500 cm 2 . 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.

Laparoscopic ventral/incisional hernia repair: updated guidelines from the EAES and EHS endorsed Consensus Development Conference

“…In the studies examined [147][148][149][150], a total of 104 patients was reported. It is suggested that the single access decreases the possibility of future trocar hernia.…”

An Ergonomic Study of Single-Port versus Multi-Port Laparoscopic Mesh Insertion for Ventral Hernia Repair

“…Some recent studies have shown that the single-port access for ventral hernia repair allows the surgeon to perform virtually the same procedure as multi-port laparoscopic surgery through one incision [12,13,14,15]. Also, some of these studies [12,15] suggest the possibility of placement of a prosthetic mesh with SILS without the need for significant technical modifications of standard laparoscopic techniques, and suggest that the technique is ready for widespread implementation for surgeons experienced in conventional multi-port laparoscopic procedures.…”

“…Some authors suggest that the single-port access approach is easily feasible [13,14] and easy to adopt, because it generally does not require extra training [12]. Other authors [15] have claimed SILS as easily feasible for laparoscopic surgeons routinely performing laparoscopic incisional ventral hernia repair, as it only reproduces the standard laparoscopic technique.…”

“…Incisional ventral hernia repair through single-port access laparoscopic surgery has been also shown to be feasible [12,13,14,15]. Some authors suggest that the single-port access approach is easily feasible [13,14] and easy to adopt, because it generally does not require extra training [12].…”

Single-incision Laparoscopic Versus Conventional Laparoscopic Ventral Hernia Repair

“…3 It may therefore be advantageous to further minimize abdominal wall trauma in this patient group. 4,5 This could be realized through a single-port technique [laparoendoscopic single-site surgery (LESS)] that requires a minimal fascia incision to perform the procedure.…”