Single-incision Laparoscopic surgery for total extraperitoneal repair of inguinal hernias in 23 patients.

Surgit, Onder

BACKGROUND Laparoscopic surgery has long been the treatment of choice for recurrent or bilateral hernias, and for unilateral hernias when the patient does not want to undergo open surgery. Each laparoscopic incision or trocar presents risks for hemorrhage, organ injury, incisional hernia, and poor cosmetic outcome. For this reason, single-incision laparoscopic surgery (SILS) is being increasingly used to treat a variety of conditions. The aim of this study was to evaluate the use of SILS for total extraperitoneal (TEP) repair of hernias in the largest series performed to date. PATIENTS AND METHODS During the period from June to September 2009, 23 consecutive patients underwent SILS for TEP repair of inguinal hernias. SILS was performed under general anesthesia, with the use of a single access port device and articulating as well as standard laparoscopic instruments. Demographic and clinical data, intraoperative findings, and postoperative course were recorded. RESULTS In the 23 patients (mean age 48.4 y; 18 males and 5 females), a total of 27 hernias were repaired. Unilateral hernias were present in 19 patients and bilateral hernias in four. Of the unilateral hernias, 11 were on the right and 8 on the left. Indirect hernias occurred in 15 patients, direct hernias in 7 patients, and a direct+indirect hernia was seen in 1 patient. All hernias were repaired successfully with SILS except in 1 patient. In this patient, due to the large size of the hernia and the presence of adhesions, the procedure was converted to a standard laparoscopic TEP repair. Mean operative times for unilateral and bilateral hernias were 48.4 minutes (range: 32-62 min) and 96.7 minutes (range: 85-120 min), respectively. None of the patients experienced intraoperative or postoperative complications. Mean hospital stay was 1.17 days. CONCLUSIONS The use of SILS for TEP repair of hernias provides excellent cosmetic results, and articulating instruments seem to be useful for this procedure.