Single Incision Laparoscopic Surgery (SILS): Bilateral Total Extraperitoneal (tep) Inguinal Hernia with Simultaneous Umbilical Hernia Repair

INTRODUCTION: Single incision laparoscopic surgery (SILS) is a novel alternative to laparoscopic surgery, and can be performed with multiple trocars or a single port access (SPA) device. While SILS has been demonstrated in a variety of procedures, its use for inguinal hernias is just emerging and may continue to evolve. This video demonstrates the feasibility of a SILS bilateral total extraperitoneal (TEP) inguinal hernia repair with a SPA device and simultaneous open umbilical hernia repair.
METHODS: Demonstrated in this video is a 36 year-old male with a bilateral inguinal hernias and an incarcerated umbilical hernia. An infraumbilical incision (27mm) is made and the anterior fascia overlying the left rectus is incised. After using a balloon dissector, a SPA device is inserted accommodating three trocars. The dissection of the myopectineal orifice, reduction of an indirect hernia, and insertion of hernia mesh is demonstrated using standard laparoscopic instruments. Finally, the SPA device is removed, the anterior rectus sheath closed, and the umbilical hernia repaired in a standard fashion.
RESULTS: The patient in this case presentation did well having no immediate complaints, though a small seroma did spontaneously drain. At the first post-operative visit there were no recurrences or inguinal seromas, and no evidence of an incisional hernia. Postoperative incisional pain was present for the first 3 days but did not require a narcotic in this patient.
CONCLUSION(S): Using a single skin incision, a bilateral laparoscopic TEP inguinal hernia repair can be performed using a SPA device. The same skin incision can then be used to simultaneously repair an umbilical hernia. The actual operative steps and instruments used are completely unchanged from traditional laparoscopy. As this technique continues to evolve, advantages and disadvantages will need to be proven. Further evaluation is required.

Session: Video Channel

Program Number: V055

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