Laparoscopic Abdominal Hernia Repair with SILS® port – part 2

In recent years, reconstructive laparoscopic procedures for abdominal hernias have been gaining more and more interest due to significant improvement of life quality and shortening of postoperative convalescence [3, 4, 7]. Smaller operative wound and limited abdominal wall preparation limit the rate of surgical site infection. In clinical case series rare cases of wound infection were reported. In randomized trials however, this number is even lower and amounts to 2.5% in laparoscopic and 7% in open procedures [1, 4, 5]. The surgical access we describe allows for shortening of the surgery duration. Similarly, hospitalization time following laparoscopy is shorter than after the open procedure. This was confirmed in published randomized trials, with hospitalization after open surgery being 2-5 times longer [2, 3, 7]. This is not only due to smaller operative wound – neither wound nor abdominal cavity drainage is needed [2, 3, 8].

Single incision for the SILS® port seems to be another step towards minimization of operative access – and we believe at the moment that it is the limit of minimization, as a mesh (which is too big) cannot be pulled through and a stapler (there are no flexible ones) cannot be used with the NOTES technique. The procedure described above has brought some benefits of SILS® port application. A larger incision (2 cm) allows accurate visualization of each layer of the abdominal wall on mini-laparotomy and a view of the peritoneal cavity before the port is placed. Thorough wound closure with visual control, safe laparotomy and insertion of the port even in intraperitoneal adhesions are advantages of the method. Besides, incision of each layer made in a different plane can additionally protect against incisional hernia, as the slits are away from one another after muscle retraction to their original position. This complication, reported in numerous studies, is an important issue of the IPOM technique [9-12]. Positioning of the camera and the tools in the same axis can be useful in dissecting the adhesions, when another trocar cannot be introduced with video guidance. This advantage in the near future may expand indications for laparoscopic hernioplasty in patients who so far could not have benefited from this technique due to extensive intra-abdominal adhesions. The procedure we performed had no influence on duration of surgery, which was comparable to other reports [2, 3]. Nor was the patient’s hospital stay prolonged. No complications attributable to port implantation were seen during the follow-up, which confirms similarity with classical laparoscopic IPOM method.