Reduced Port Surgery for Laparoscopic Ventral Hernia Repair

Takeshi Aoki, MD, PhD, T Abe, MD, PhDD, H Imoto, MD, PhD, H Karasawa, MD, PhD, M Ishida, MD, PhD, K Kudo, MD, PhD, N Tanaka, MD, PhD, M Nagao, MD, PhD, K Watanabe, MD, PhD, S Ohnuma, MD, PhD, T Morikawa, MD, PhD, F Motoi, MD, PhD, T Naitoh, MD, PhD, M Unno, MD, PhD. Department of Surgery, Tohoku University Graduate School of Medicine

Background: Since 2012, Laparoscopic Ventral Hernia Repair (LVHR) is approved as an insurance adaptation technique in Japan. In our institution, conventional three port LVHR (C-LVHR) had been performed as a regular surgical option. Ventral Hernia has reduced the patient’s Quality of Life, and it’s repair with the shorter incision and less stress could be beneficial. Recently, we innovated the Reduced Port LVHR (RP-LVHR), using 3mm forceps device.

Aim: In this study, we assessed the safety and efficacy of RP-LVHR.

Patients and method: Patients who underwent the LVHR in our institute during 2004 and 2015 are included in this study. We compare RP-LVHR and C-LVHR to patient’s background, operative time, blood loss and postoperative complications.

RP-LVHR procedures: We made a small transverse incision about 2cm at abdominal flank. Then, we applied a wound protect device (oval type) to the wound. Two 5mm trocars are inserted to this device. Creating pneumoperitoneum with carbon dioxide gas, about 10cm caudal region from this device, 3mm port is placed, and 3mm diameter forceps is inserted from the port. The intra-abdominal adhesion is dissected and the hernia orifice is observed. Stabbing the thin needle from the abdominal surface, we confirmed and marked the edge of the hernia orifice. We choose a PCO mesh enough covering the hernia orifice, and put it into the abdominal cavity from the small incision. The mesh is lifted the abdominal wall by four non-absorbable surgical sutures. After lifting the mesh, the mash is fixed to the abdominal wall using the laparoscopic absorbable tacker.

Results: RP-LVHR was performed in 13 cases, and C-LVHR was in 16 cases.  Between two groups, there was no significant difference in termes of operative time (RP-LVHR : C-LVHR = 119 : 119 min), blood loss (RP-LVHR : C-LVHR = 8 : 15 g). There were no postoperative complications in each group. No recurrence of the hernia was observed in both C-LVHR and RP-LVHR groups.

Conclusion: RP-LVHR seemed to have the same outcome compared with C-LVHR. In addition, RP-LVHR is theoretically less invasive and cosmetically beneficial. Therefore, RP-LVHR would be safe and acceptable procedure for ventral hernia repair.

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