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First 200 consecutive transumbilical single-incision laparoscopic TEPs

par Dapri, Giovanni ;Gérard, L;Paesmans, Marianne ;Cadière, Guy-Bernard ;Saussez, Sven
Référence Hernia, 21, 1, page (29-35)
Publication Publié, 2017-02

Article révisé par les pairs

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Résumé :

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.