Masaki Wakasugi, Naoto Tsujimura, Yujiro Nakahara, Takashi Matsumoto, Hiroyoshi Takemoto, Ko Takachi, Kiyonori Nishioka, Satoshi Oshima. Kinki Central Hospital
Purpose: To evaluate the feasibility and safety of single-incision laparoscopic surgery surgery for totally extraperitoneal repair (SILS-TEP) of our initial experience.
Patients and Methods:
Clinical setting
We performed a retrospective analysis of 26 patients undergoing SILS-TEP from April 2016 to August 2016 at Kinki Central Hospital.
Exclusion criteria
SILS-TEP was contraindicated for the following conditions in our hospital: a history of radical prostatectomy; a small indirect inguinal hernia in a young patient, and unsuitability for general anesthesia.
Surgical procedure
A single, 2.5-cm, intraumbilical incision was made, followed by the dissection of the subcutaneous tissue down to the rectus abdominis sheath. The anterior sheath was opened, and blunt dissection using a finger or gauze was performed between the muscle and the posterior sheath to create a preperitoneal space. After placing a Lap-Protector Mini in this space, three 5-mm trocars (one for a 5-mm flexible scope and two for surgical devices) were inserted through a single-port access device. The preperitoneal space was dissected gradually, using conventional straight laparoscopic instruments without a dissection balloon. Mesh was placed in this preperitoneal space, covering the inguinal floor, and was fixed with three absorbable tacks: at the pubic bone, at Cooper’s ligament, and above the iliopubic tract, respectively. After the completion of the operation, the preperitoneal space was deflated carefully deflated to avoid displacing the mesh. The anterior rectus sheath was closed with a 2-0 absorbable suture, and the skin was closed with a 4-0 polydioxanone suture.
Results: Twenty six patients (20 men, 6 women), including 20 with unilateral hernias and 6 with bilateral hernias underwent SILS-TEP. The mean age of patients was 70 years (range, 40–85 years), and mean BMI was 22.0 kg/m2 (range, 17.1–28.3 kg/m2). The median operative times were 102 min (range 52-204 min) for unilateral hernia and 165 min (range 83-173 min) for bilateral hernias, respectively. The median blood loss was minimal (range 0-177 ml). One case (1/26) was converted to mesh plug repair. The mean postoperative hospital stay was 1.5 days (range 1-2 days). Postoperative complications developed in 12 % (3/26) of the patients. A seroma developed in 4% (1/26) of the patients. A hematoma developed in 4 % (1/26) of the patients. A delirium developed in 4 % (1/26) of the patients. These complications were managed conservatively. No other major complications or hernia recurrence were noted.
Conclusions: SILS-TEP, which offers good cosmetic results, could be safely introduced in our hospital.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 77747
Program Number: P045
Presentation Session: Poster (Non CME)
Presentation Type: Poster
