Kazuo Tanoue, MD, PhD, FACS, Hidenobu Okino, MD, PhD, Masamitsu Kanazawa, MD, PhD, Kiichiro Ueno, MD, PhD. Ueno Hospital
BACKGROUND: Inguinal hernia repair is the most common procedure in general and visceral surgery worldwide. Laparoscopic Transabdominal preperitoneal mesh hernioplasty (TAPP) has been also popular surgical method in Japan. Single incision laparoscopic surgery is one of the newest branches of advanced laparoscopy, and its indication has been spread to not only simple surgery such as cholecystectomy, but also complex surgery.We report our experience with single incision laparoscopic TAPP (S-TAPP) for Japanese patients with inguinal hernia.
PATIENTS AND METHODS: A consecutive series of 250 patients (217 male, 33 female) who underwent S-TAPP during June 2010 to September 2016 in a single institution. Twenty five of the patients had bilateral inguinal hernia. The mean follow-up was 958 days. The average age of the patients was 61.2 ±16.5 years.
Establishment of the ports: A 25-mm vertical intra-umbilical incision is made for port access. One 5-mm optical port and two 5-mm ports were placed side-by-side through the umbilical scar.
Surgical Procedure: The procedure was carried out in the conventional fashion with a wide incision in the peritoneum to achieve broad and clear access to the preperitoneal space, and an appropriate placement of polypropylene mesh (3DMaxTM light, Bard) with fixation using the tacking device (AbsorbaTack®, Covidien). The hernia sac is usually reduced by blunt dissection, or is ligated and transected with ultrasound activated device. The peritoneal flap is closed by one suture with 4-0 PDS and the 6-7 tacks using AbsorbaTack®.
RESULTS: In one patient, we encountered a large sliding hernia on the right side having sigmoid colon as content of the sac, which required conversion to the conventional laparoscopic procedure. There were nine recurrence cases after surgery of laparoscopic or anterior approach, and two cases after prostatectomy. There was no intra-operative complication. The mean operative time was88.8±31.1 min, and blood loss was minimum in all cases. The average postoperative stay was 5.7 ±2.7 days. There was one recurrence case (0.4%) 16 months after the surgery. There was no severe complication after the surgery, but there were 14 seromas (5.4%) and one hematoma(0.4%). Two patients had blunt tactile sense in the area of the lateral femoral cutaneous nerve (0.8%), which improved in two months.
DISCUSSION: Our results suggest that S-TAPP is a safe and feasible method without additional risk. Moreover, cosmetic benefit is clear. However, further evaluation for postoperative pain and long-term complications compared to standard laparoscopic TAPP mesh hernioplasty should be required.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78212
Program Number: P060
Presentation Session: Poster (Non CME)
Presentation Type: Poster