Welcome to the AHS 2020 ePoster Session. Please scroll down to view all of the submitted posters or press Control-F to search. To view the poster and its abstract, click on the poster image. Many posters also have a brief audio introduction which can be played by going to the bottom of the poster screen.
P034: INTRODUCTION OF SILS FOR ETEP RIVES-STOPPA REPAIR
Takeshi Nagahama, MD; Kudanzaka Hospital
Aims: eTEP Rives-Stoppa repair is established method for the repair of ventral hernia. However, there are some technically difficult procedures like midline crossover. Since SILS TEP from sub-umbilical midline incision have been our standard procedure for inguinal hernia repair for 8 years, we have introduced this SILS technique into Rives-Stoppa repair (SILS R-S repair) to solve problems mentioned above.
Method: From 2016/11 22 patients of midline incisional hernia, primary ventral hernia underwent SILS R-S method.
For this method, small midline incision 5-6cm away from hernia orifice was carried out initially. This procedure can be done either upward (caudal to cranial) or downward (cranial to caudal) and decided by the location of hernia orifice. However, to carry out transversal abdominal muscle release (TAR) easily we usually adopt upward dissection from supra-pubic incision. Then dissection of intraperitoneal adhesion was carried out by SILS with SILS device. Subsequently after peritoneal closure of initial laparotomy, unilateral anterior rectus sheath was incised from the same incision and dissection of retro-rectus space was done under laparoscopic vision. Dissecting the other side was carried out by same fashion. Initial dissection of linea alba could be done by open surgery from initial incision. Further dissection of linea alba, retro-rectus space, and hernia orifice was carried out by SILS. Defect closure of anterior and posterior rectus sheath using barbed suture was also done by SILS and self-grip mesh was inserted. Additional trocar to assist retro-rectus dissection, defect closure, and decompression of intraperitoneal cavity was inserted as required.
Result: For twenty-two patients SILS R-S method was carried out successfully. Duration of surgery was ranged from 93-260min and transverse diameter of hernia orifice was 20-90 mm. Ten patients received laparoscopic TAR by SILS (Unilateral 2, Bilateral 8). In the perioperative period we have no experience of seroma formation, hemorrhage, and infection. During follow up ranged 1 to 40months, we have experienced no case of recurrence. Among 22 patients 21 patients needed 1 additional trocar and only one patient needed 2 additional trocars.
Discussion: eTEP Rives-Stoppa repair was one of the most effective procedures for midline incisional hernia repair where Robot was unavailable. However, procedures such as midline crossover, initial retro-rectus dissection can be an obstacle for most surgeons. We have introduced SILS TEP procedure for incisional hernia repair, since preperitoneal and retro-rectus dissection carried out from midline incision is same procedure in eTEP Rives-Stoppa repair. Using SILS TEP technique, we can observe and dissect linea-alba in front and do not need midline cross over. Handling of needle holder from midline was ergonomic for midline defect closure. TAR procedure was also possible from midline incision by SILS. Our SILS R-S method demonstrated some solution for introducing Rives-Stoppa procedures for midline incisional hernia. SILS TEP device and midline incision contributed to easier preparation of whole retro-rectus spaces and defect closure.
Conclusion: SILS R-S method can assist introducing of eTEP Rives-Stoppa procedure easier.
Click the image below to expand: