Department of Surgery, University Hospital Geneva, Geneva, Switzerland,
Surg Endosc. 2011 Jun;25(6):1921-5. doi: 10.1007/s00464-010-1488-x. Epub 2010 Dec 7.
Although still under development, single-port access (SPA) approach may be of interest in patients prone to port-side incisional hernia, ensuring absence of increased fascial incision. This forms the basis for evaluating SPA for prosthetic ventral hernia repair. We report a new SPA technique of ventral hernia repair using working-channel endoscope, standard laparoscopic instruments, and 10-mm port.
Prospective experience with SPA prosthetic repair of primary and incisional ventral hernia in 52 patients for 55 ventral hernias is presented. Median (range) patient age was 46 years (26-85 years), and BMI was 28 kg/m2 (20-38 kg/m2). Mean fascial defect was 16.2 cm2 for primary hernia (n=23) and 48.3 cm2 for incisional hernia (n=32). Intraperitoneal composite mesh repair was achieved through single 10-mm flank port using working-channel endoscope. Meshes were fixed using absorbable tackers and transfascial stitches.
SPA repair of primary and incisional ventral hernia was completed in all cases without conversion to standard laparoscopy. Median (range) operative time was 54 min (39-95 min). Mesh size ranged from 118 to 500 cm2. No intra- or postoperative complications were recorded, except two seromas. Median (range) hospital stay was 1 day (1-5 days). One patient presented prolonged postoperative pain on mesh fixation that resolved after 3 months. No recurrence or port-site incisional hernias have been recorded at median (range) follow-up of 16 months (3-28 months).
SPA prosthetic repair of primary and incisional ventral hernia is easily feasible according to natural exposition by pneumoperitoneum and gravity. In the present series, SPA ventral hernia repair appears to be safe for experienced SPA surgeons. It may decrease parietal trauma and scarring in patients prone to incisional hernia. SPA repair may be associated with a decrease in rate of port-site incisional hernia compared with multiport laparoscopy, but this has to be verified by randomized trial with standard laparoscopic approach on long-term follow-up.
虽然单孔入路（SPA）方法仍在发展中，但对于易于发生切口侧疝的患者，它可能具有吸引力，因为它可以确保没有增加的筋膜切口。这是评估 SPA 在假体腹疝修复中的基础。我们报告了一种使用工作通道内镜、标准腹腔镜器械和 10mm 端口的新型 SPA 技术用于腹疝修复。
前瞻性评估了 52 例 55 例原发性和切口性腹疝患者采用 SPA 假体修复的经验。中位（范围）患者年龄为 46 岁（26-85 岁），BMI 为 28kg/m2（20-38kg/m2）。原发性疝（n=23）的平均筋膜缺损为 16.2cm2，切口疝（n=32）的平均筋膜缺损为 48.3cm2。通过单 10mm 侧腹部端口使用工作通道内镜完成腹膜内复合网片修复。使用可吸收钉和跨筋膜缝线固定网片。
所有病例均成功完成 SPA 修复原发性和切口性腹疝，无需转换为标准腹腔镜。中位（范围）手术时间为 54 分钟（39-95 分钟）。网孔大小范围为 118-500cm2。除 2 例血清肿外，无术中或术后并发症。中位（范围）住院时间为 1 天（1-5 天）。1 例患者在网片固定后出现长期术后疼痛，3 个月后缓解。中位（范围）随访 16 个月（3-28 个月）时，无复发或端口部位疝。
根据气腹和重力的自然显露，SPA 假体修复原发性和切口性腹疝很容易实施。在本系列中，对于有经验的 SPA 外科医生来说，SPA 腹疝修复似乎是安全的。它可能减少了切口疝患者的壁创伤和疤痕形成。与多端口腹腔镜相比，SPA 修复可能与端口部位疝的发生率降低相关，但这需要通过标准腹腔镜方法的长期随机试验来验证。
