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23.12.2016 | Original Article | Ausgabe 1/2017

Hernia 1/2017

First 200 consecutive transumbilical single-incision laparoscopic TEPs

Zeitschrift:
Hernia > Ausgabe 1/2017
Autoren:
G. Dapri, L. Gerard, M. Paesmans, G.-B. Cadière, S. Saussez
Wichtige Hinweise
This paper was presented in part as an oral presentation at the 1st World Conference on Abdominal Wall Hernia Surgery, Milan (Italy), April 25–29, 2015. It was presented entirely as an oral presentation at the 15th World Congress of Endoscopic Surgery, Shanghai–Suzhou (China), November 9–12, 2016.

Abstract

Background

Endoscopic pre-peritoneal mesh repair (TEP) through single-incision laparoscopy (SIL) permits placement of a large mesh through a final millimetric umbilical scar. This prospective study evaluates the first 200 consecutive SILTEPs performed by a single surgeon.

Patients and methods

Between November 2011 and September 2015, 200 consecutive SILTEPs were performed in 161 patients. The mean age was 49.8 ± 16.3 years and the mean BMI was 24.5 ± 3.4 kg/m2. The technique involved one 11-mm trocar, one 10-mm 0° scope and curved reusable instruments. A supplementary 1.8-mm straight trocarless grasping forceps was percutaneously inserted for perioperative complications or difficulties.

Results

A unilateral hernia repair was performed in 122 patients, and a bilateral repair in 39 patients. The total operative time was 57.4 ± 22.3 min, and pure laparoscopic time was 46.6 ± 21.6 min. There was no need for insertion of a supplementary 5-mm trocar, and the need for insertion of 1.8-mm trocarless grasper was 32.9%. Perioperative complications occurred in 73 patients. The mean final scar length was 15.3 ± 2.6 mm. The mean hospital stay was 1.0 ± 0.3 days. Postoperative complications at the access site affected 15 patients and at the hernia site 31 patients. After a mean follow-up of 25.4 ± 12.3 months, there was one asymptomatic, small incisional hernia at the access site as well as one reoperation for recurrent inguinal hernia at 16 months. No other late complications were registered.

Conclusion

Transumbilical SILTEP permits placement of a large mesh through a final millimetric scar. Getting over the learning curve in conventional multitrocar TEP is mandatory. As per our institute’s algorithm, the contraindications continue to be giant inguino-scrotal, incarcerated and recurrent inguinal hernias.

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ACKNOWLEDGEMENT TO REFEREES

Acknowledgement to referees 2016

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