Ragui W Sadek, MD, FACS, Andrew M Wassef, BS. Rutgers Robert Wood Johnson Medical School
Ventral hernias (VH) account for 25% of abdominal wall hernias with a greater prevalence in female patients. Being one of the most common procedures amongst general surgeons, laparoscopic repair of ventral hernias spurs quite the debate with respect to the topic of trocar placement. Trocar placement is seldom thought to be a function of a severely reduced rate of VH recurrence. Yet, placement of trocars ispilateral to the VH may lead to an increased rate of recurrence and pain post operatively. The following study tests a new contralateral 3 trocar technique utilizing centrality bars mesh with a balloon anchoring system in comparison to a standard laparoscopic VHR technique. We propose a 3 trocar contralateral technique is sufficient for reducing the rate of recurrence, while decreasing complications postoperatively in comparison to patients who have ispilateral trocar placement.
The following study includes prospecting patients from January of 2009 to December of 2013. Patients were categorized in two groups, Group A (n=15) consisted of patients we underwent VHR with ispilateral trocar placement. Group B (n=20) included patients who underwent VHR with contralateral trocar placement. All patients were accessed for quality of life, pain, use of narcotics, postoperative narcotic analgesia, length of hospital stay, complications following surgery, and rate of VH recurrence.
Patients in Group A and B showed a statically significant difference in the rate of VH recurrence with respect to each other (P=0.1). Group A Patients had 3 VH recurrences (20%), while Group B has had 2 VH recurrences (10%). Patients in Group A, and B showed no notable difference in the length of hospital stay (avg= 8.7 hrs), or the QOF of patients (p=.001). Patients in Group A and Group B showed no notable difference in postoperative narcotic analgesia in the PACU (p=0.01). Patients reported significantly greater pain in Group B than Group A (p=0.09). The average follow-up time was 3-32 months, (median=27). There were no complications during surgery for either Group A or B.
Contralateral 3 trocar placement utilizing centrality bars mesh and dissecting balloon, as apposed to a traditional ipsilateral trocar placement VH repair, significantly minimizes postoperative pain, and leads to a significant reduction in VH recurrence. Contralateral versus Ispilateral placement of trocars does not have any effect on the length of hospital stay, the amount of postoperative narcotic analgesia in the PACU, the QOF of patients postoperatively, nor the rate of complications during surgery.