Koji Hattori, MDPhD, Takeshi Tanaka, MD, Kazunao Nakano, MD, Isao Toura, MDPhD. Endoscopic Surgery Center, Gyotoku General Hospital.
Since 2009 we had performed Single Incision Laparoscopic Cholecystectomy in 200 cases. We recognize this procedure for patients to prefer to. So in a few cases we tried to perform Hiatal Hernia Repair with the procedures of Single Incision Laparoscopic Surgery. But these procedures have several problems for example difficult handling without keeping of triangular formation and high cost. We should consider to design the well-balanced methods between patients satisfaction and procedures difficulties and cost. Then we had constructed the new procedures with the concept of Reduced Port Surgery and some ideas. So we compared those procedures of Reduced Port Laparoscopic Hiatal Hernia Repair(RPLHHR) with ones of Usual 5 Ports Laparoscopic Hiatal Hernia Repair(5PLHHR) in the prospective study. Furthermore, some comparisons were made with those in several cases of Single Incision Laparoscopic Hiatal Hernia Repair(SILHHR:n=2).
The study enrolled 10 patients who were diagnosed Hiatal hernia and were operated from April 2011 to June 2013 in our hospital. They randomly assigned them to one of two groups (RPLHHR:n=5 or 5PLHHR:n=5). Data measures were operative time, estimated blood loss, length of hospital stay, adverse events, conversions to 5PLHHR or laparotomy, pain and patient satisfaction.
RPLHHR:We make a 15mm vertical incision in the navel. Through the incision we insert two 5mm ports, for the left hand forceps and the scope. And we make a left abdominal incision for a 12mm port using the right hand forceps. We mainly use a oblique-viewing endoscope and straight forceps. So we can prevent the scope and the left hand forceps from interfering in each other. Because the right hand forceps is inserted at the separated position from the navel incision, without using bent forcepses we are able to work under keeping the triangular formation. One or two needle devices usually are required to revolve the organs.
No cases in the both groups had adverse events and were converted to other laparoscopic approaches or laparotomy. The two study groups did not differ in terms of patient demographics.
The RPLHHR group had a statistically significant longer operative time than the 5PLHHR group (240 vs 162min.), by the way SILHHR group (288min.) had a longest time than both groups, but no difference in operative blood loss and hospital stay. And there was no difference in the pain score. After 3months later from operation, only left abdominal scar of all patients in the RPLHHR group were recognized and these patients had grate satisfactions with their surprises. Both groups were almost same cost to use disposable goods.
Conclusion / Perspective
Compared with 5PLHHR, RPLHHR is a feasible approach with comparable operative outcomes. We think that longer operative time of RPLHHR group is acceptable and RPLHHR is well-balanced procedures.