Single-Incision Transumbilical Laparoscopic Bilateral Inguinal Hernia Repair (TEP)

Abstract

Introduction:

Laparoscopic repair of inguinal hernia by total extraperitoneal mesh placement (TEP) has been popularized. ¹ Recently, with the advent of single-incision transumbilical laparoscopy, ² this procedure has to be considered because it allows to place a big mesh with a very small final scar, which is also cosmetically acceptable.

Video:

A 48-year-old male was admitted to the hospital for right direct and indirect and left direct inguinal hernia. A single-incision transumbilical laparoscopic bilateral TEP was proposed. The patient was placed in the supine position with the legs straight. The surgeon stood first on patient's left and later on the patient's right. The natural umbilical scar was incised and the rectus fascia on the left side was open. After have placed a purse-string suture, an 11-mm reusable metallic trocar was introduced behind the left rectus muscle into the pre-peritoneal space. A 0°, normal length, and rigid scope was used to dissect the pre-peritoneal space. At the time of the hernia sac retraction, a monocurved reusable grasping forceps according to DAPRI (Karl Storz-Endoskope, Tuttlingen, Germany) was introduced inside the purse-string suture, at 9 o'clock position, parallel to the 11-mm trocar. The bilateral hernia sac plus peritoneal sheet was retracted and the spermatic elements were skeletonized. Two polypropylene meshes (Bard Davol, Inc., Warwick, RI) of 15 cm (latero-lateral) × 10 cm (medial craniocaudal) × 8 cm (lateral craniocaudal) were introduced through the 11-mm trocar. Both meshes were adequately positioned using the monocurved grasping forceps, and the space was finally desufflated under view.

Results:

The operative time was 67 minutes, and the final incision length was 12 mm. The patient was discharged within 24 hours.

Conclusions:

Single-incision transumbilical laparoscopic bilateral TEP makes sense because it allows to place two big meshes using a very small final scar.

G. Dapri is consultant for Karl Storz-Endoskope, Tuttlingen, Germany. The other authors have no conflicts of interest or financial ties to disclosure.

Runtime of video: 6 mins 42 secs