A Technique of Bilateral Inguinal Hernia Repair Using 10 mm Single Port Access and Bioresorbable Composite Mesh Fixed with Endoclose Sutures: Three Cases Reported

Wuttichai Thanapongsathorn

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DOI: 10.4236/ss.2011.27085                

Abstract

Purpose: To report a novel technique of laparoscopic 10 mm Single Port Access IntraPeritoneal Onlay Mesh (SPA-IPOM) using bioresorbable composite mesh fixed with Endoclose suture (percutaneous subcutaneous suture) in 3 cases of bilateral inguinal hernia. Methods: Laparoscopic SPA-IPOM is done through a 10 mm trocar with one 10 mm instrument that has 5 mm optical lens and 5 mm channel for grasper. After inserting 10 mm trocar at umbilicus using semi-open technique, intraperitoneal anatomical landmark of inguinal her-nia is identified. A 10 × 15 cm pre-tied bioresorbable composite mesh is then placed to cover hernia defect and all three potential area of indirect, direct and femoral hernia. Using Endoclose? needle, each pair of pre-tied sutures is retrieved percutaneously through a needle wound and extracorporeal tied with knot in subcutaneous space. After the upper half of mesh is sutured to the posterior surface of abdominal wall, the lower half of mesh is fixed by hernia tacker to Symphysis Pubis, Cooper Ligament and Iliopubic tract. Re-sults: Three men, average 48 year olds were operated by laparoscopic 10 mm SPA-IPOM for bilateral in-guinal hernia repair using bioresorbable composite mesh. Average operative time was 36 minutes. No imme-diate complication. All patients were discharge on the 2nd post-operative day and average 6 months follow up has no recurrence. Conclusions: Laparoscopic SPA-IPOM is an optional operation and is much easier to be performed. Benefits include operative time saving, cosmesis, early discharge and early return to work. Bio-resorbable composite mesh prevents bowel adhesion, however, is much more expensive. Long term follow up study for complications and recurrence is needed.

Keywords

10 mm Single Port Access, IntraPeritoneal Onlay Mesh, Percutaneous Subcutaneous Suture, Bioresorbable Composite Mesh, Bilateral Inguinal Hernia Repair

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	C. J. Davis and M. E. Arregui, “Laparoscopic Repair for Groin Hernias,” Surgical Clinics of North America, Vol. 83, December 2003, pp. 1143-1161.
[2]	P. Roy and A. De, “Single-Incision Laparoscopic TAPP Mesh Hernioplasty Using Conventional Instruments: An Evolving Technique,” Langenbeck’s Archives of Surgery, Vol. 395, No. 8, November 2010, pp. 1157-1160. doi:10.1007/s00423-010-0656-8
[3]	E. R. MacDonald and I. Ahmed, “‘Scar Less’ Laparoscopic TAPP Inguinal Hernia Repair Using a Single Port,” The Surgeon, Vol. 8, No. 3, June 2010, pp. 179-181. doi:10.1016/j.surge.2009.11.006
[4]	C. Menenakos, M. Kilian and J. Hartmann, “Single-Port Access in Laparoscopic Bilateral Inguinal Hernia Repair: First Clinical Report of a Novel Technique,” Hernia, Vol. 14, No. 3, June 2010, pp. 309-312.
[5]	K. He, H. Chen, R. Ding, R. Hua and Q. Yao, “Single Incision Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair,” Hernia, Vol. 15, No. 4, May 2010, pp. 451-453.
[6]	O. Surgit, “Single-Incision Laparoscopic Surgery for Total Extraperitoneal Repair of Inguinal Hernias in 23 Patients,” Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, Vol. 20, No. 2, April 2010, pp. 114-118. doi:10.1097/SLE.0b013e3181d848c3
[7]	S. Agrawal, A. Shaw and Y. Soon, “Single-Port Laparo-Scopic Totally Extraperitoneal Inguinal Hernia Repair with the Triport System: Initial Experience,” Surgical Endoscopy, Vol. 24, No. 4, April 2010, pp. 952-956. doi:10.1007/s00464-009-0663-4
[8]	H. Mofid and C. Zornig, “Single-Access Surgery Laparoscopic Cholecystectomy and Appendectomy,” Surgical Technology International, Vol. 19, April 2010, pp. 61-64. http://www.springerlink.com/content/q26131ut15503w15/
[9]	T. H. Hong, H. L. Kim, Y. S. Lee, J. J. Kim, K. H. Lee, Y. K. You, S. J. Oh and S. M. Park, “Transumbillical Single-Port Laparoscopic Appendectomy,” Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A, Vol. 19, No. 1, February 2009, pp. 75-78. doi:10.1089/lap.2008.0338
[10]	M. Desai, “Single-Port Surgery for Donor Nephrectomy: A New Era in Laparoscopic Surgery?” Nature Clinical Practice Urology, Vol. 6, No. 1, January 2009, p. 1. doi:10.1038/ncpuro1278
[11]	J. H. Kaouk, R. K. Goel, G. P. Haber, S. Crouzet, M. M. Desai and I. S. Gill, “Single-Port Laparoscopic Radical Prostatectomy,” Urology, Vol. 72, No. 6, December 2008, pp. 1190-1193.
[12]	J. Leroy, R. A. Cahil, M. Asakuma, B. Dallemagne and J. Marescaux, “Single-Access Laparoscopic Sigmoidectomy as Definitive Surgical Management of Prior Diverticulitis in a Human Patient,” Archives of Surgery, Vol. 144, No. 2, February 2009, pp. 173-179. doi:10.1001/archsurg.2008.562
[13]	J. Teixeira, K. McGill, S. Binenbaum and G. Forrester, “Laparoscopic Single-Site Surgery for Placement of an Adjustable Gastric Band: Initial Experience,” Surgical Endoscopy, Vol. 23, No. 6, June 2009, pp. 1409-1414. doi:10.1007/s00464-009-0411-9
[14]	M. G. Neto, A. Ramos and J. Campos, “Single Port Laparoscopic Access Surgery,” Techniques in Gastrointestinal Endoscopy, Vol. 11, No. 2, April 2009, pp. 84-93. doi:10.1016/j.tgie.2009.06.007
[15]	A. Moreno-Egea, J. A. Bustos, E. Girela and J. L. Aguayo-Albasini, “Long-Term Results of Laparoscopic Repair of Incisional Hernias Using an Intraperitoneal Composite Mesh,” Surgical Endoscopy, Vol. 24, No. 2, February 2010, pp. 359-365. doi:10.1007/s00464-009-0573-5
[16]	S. Olmi, A. Scaini, L. Erba, A. Bertolini and E. Croce, “Laparoscopic Repair of Inguinal Hernias Using an Intraperitoneal Onlay Mesh Technique and a Parietex Composite Mesh Fixed with Fibrin Glue (Tissucol). Personal Technique and Preliminary Results,” Surgical Endoscopy, Vol. 21, No. 11, November 2007, pp. 1961-1964. doi:10.1007/s00464-007-9355-0