Surgical Outcome of Modified Laparoscopic Retrorectus Approach for Upper Midline Ventral and Umbilical Hernias

Abstract

Background: The incidence of ventral hernias such as umbilical, epigastric and midline incisional hernias has increased over the years. Many surgical modalities of treatment have been evolved for better management and outcome of hernia repair. Igor Belyansky performed the rst successful endoscopic Rives Stoppa procedure (eTEP). The current Laparoscopic retrorectus repair needs more than three ports, and it also requires USG marking of the retrorectus space. Crossing over to the opposite retrorectus space will be difcult for beginners. This study standardises the easy and ergonomically better Laparoscopic Retrorectus approach for umbilical and upper midline hernias using three ports in the suprapubic area. Aim And Objectives: To study the feasibility and effectiveness of the Modied Laparoscopic Retrorectus approach. Material And Methods: This prospective study involved 18 patients admitted to tertiary health center, with umbilical hernia, epigastic hernia and upper midline ventral hernia. We performed the analysis after taking institutional ethical committee approval and informed consent from patients. A qualied surgeon performed laparoscopic retrorectus hernioplasty (e -TEP) with modication in port placement. An observational analysis was done on the feasibility and outcome of the modied approach. SPSS version 20. was used to perform the statistical analysis. Unpaired t-test, Pearson's correlation coefcient was applied. Results: A total of 18 patients were included in the study, with a mean age of 48.78 years. The hernia was predominantly seen in the female gender, overweight or obese patients. The mean duration of the procedure with the modied approach was 160minutes. The patients' numeric rating scale of pain on postoperative day 1 and day 2 was mild in 66.6% of patients. We noted seroma formation in two patients, which was signicantly associated with the duration of surgery (p =0.0069). Most of the patients were discharged on postoperative day 5. Follow up of patients up to 1 year had no history of recurrence or chronic pain. Conclusion: The standard of care for ventral hernia repair is the laparoscopic e – TEP approach. This study's modication of port placement showed better cosmetic results with reduced risk of chronic pain and low recurrence rate. The prolene mesh used during this procedure is very economical, making laparoscopic hernia surgery affordable for low socio–economic populations in developing countries.