Laparoscopic Abdominal Hernia Repair with SILS® Port - part 1

Recurrent umbilical hernia repair procedure in a 56-year old male patient was reviewed. A SILS® port (Covidien Inc.) was placed in the anterior axillary line at the level of the umbilicus. The port was placed through a 2 cm skin and fascia incision. Layers of the abdominal wall were cut approximately 3 cm apart (Figure 1). Following dissection of some adhesions, the ligamentum teres of the liver was freed close to the umbilicus to provide a 5 cm space margin for mesh implantation. Parietex Composite® (10 × 15 cm, Covidien Inc.) was mounted with 5 cm margins and 2 transabdominal PDS (2-0) sutures (Ethicon Inc.) that fixed the long axis of the mesh and Double Crown stapling technique (Protac® staplers, Covidien Inc.). After removal of the port the peritoneum and external fascia were closed with absorbable suture (Polysorb 2-0). The skin was adapted with intradermal absorbable suture (Vicryl Rapid 4-0, Ethicon Inc.).
The procedure lasted 46 minutes. Neither intraoperative complications nor intra-abdominal bleeding were noted. SILS® port placement allowed for easy manoeuvres with the tools, including the stapler (change of the axis of the tool was not possible). Laparoscopic scissors were used, also without change of the axis, which had no impact on operative technique. Manoeuvring and unfolding the mesh and placement of transabdominal sutures could be done without restraint or conflict of working tools with the camera. Slightly larger 2 cm incision of the abdominal wall layers allowed for easy and safe access to the peritoneum and visualization of each layer while closing the wound. What is more, shifting the incisions on the port placement resulted in additional strength of the incision line, when the layers returned to their normal position after port removal. In the authors’ opinion, this practice may decrease the risk of incisional hernias. Standard analgesia was used in the post-operative period (according to PROSPECT group guidelines, www.postoppain.org). Midazolam in 1 γ dose was administered every 8 hours. The patient was discharged 18 hours following surgery with no complaints of postoperative pain.