2005 SAGES Abstracts

POSTER ABSTRACTS
SAGES 2005
METHODS: A closed insertion technique is used for peritoneal
access and three 5mm ports are placed lateral to the hernia in
a standard fashion. After adhesiolysis and reduction of the
hernia contents, a 2-2.5 cm incision is made over the existing
hernia defect and is extended through the hernia sac into the
peritoneal cavity. The mesh is inserted through this incision
into the abdomen through the existing fascial defect and is
positioned and anchored using standard techniques. The mesh
insertion site is closed in two layers with absorbable suture;
no port sites require fascial closure. Data (given as mean ±
S.D.) from patients undergoing LVHR utilizing this technique
were collected prospectively and analyzed.
RESULTS: LVHR for incisional hernia repair using 5mm ports
exclusively was carried out in 10 patients. Mean patient age
was 60.7±10.8 years and the mean BMI was 35.1±7.0. Four
patients were operated on for recurrent incisional hernias.
Mean operative time was 118±45.4 minutes. Mean size of the
defect repaired was 133.1±150.2 cm2 and the mean mesh size
used was 363.2±234.7 cm2 (range 144-825 cm2). There were
no conversions to open repair and the average length of stay
postoperatively was 2.5 days. Three patients developed a seroma;
one was aspirated once and the other two resolved spontaneously.
One patient developed Candida sepsis from a urinary
source that led to secondary Candida peritonitis that
required mesh removal. Over a mean follow-up period of one
year, there was one hernia recurrence (the patient who had
mesh removed) and there were no port site recurrences or
complaints of prolonged port site discomfort.
CONCLUSION: This approach appears to be safe and can be
utilized for most patients undergoing laparoscopic incisional
hernia repair with acceptable morbidity and a short length of
stay. The 5mm port technique eliminates the fascial defects
associated with larger ports and should result in fewer port
site hernias and possibly less postoperative pain as well.
P325–Hernia Surgery
USE OF PERI-OPERATIVE FLOMAX TO PREVENT POST-OPER-
ATIVE URINARY RETENTION FOLLOWING LAPAROSCOPIC
INGUINAL HERNIA REPAIR, Abdelrahman A Nimeri MD,
L.Michael Brunt MD, Department of Surgery and Institute for
Minimally Invasive Surgery, Washington University School of
Medicine, St. Louis, MO
Background: Postoperative urinary retention is one of the
more common complications after laparoscopic inguinal hernia
repair (LIHR). The development of urinary retention in this
setting leads to increased patient discomfort, prolonged recovery
room stays, and possible hospital readmission after discharge.
Since alpha 1 receptor antagonists reduce urinary
symptoms in patients with bladder outlet obstruction, it was
hypothesized that the oral alpha 1 antagonist Flomax could be
used to decrease the urinary retention rate in patients undergoing
LIHR.
Methods: Data from all patients undergoing laparoscopic total
extraperitoneal (TEP) inguinal hernia repair by a single surgeon
from March 2003 through July 2004 were collected
prospectively. Patients received Flomax 0.4 mg/day orally for a
total of five days beginning two days prior to surgery. All TEP
procedures were done under general anesthesia without a urinary
catheter in place. Patients were discharged home after
voiding in the recovery area. Data are expressed as mean ±
SD.
Results: Flomax was administered to 24 of 26 consecutive
patients undergoing outpatient TEP inguinal hernia repair.
Mean patient age was 50.5 ± 10.9 years (28-72 yrs). Eight
patients were operated on for recurrent inguinal hernias; 12
patients (50%) had bilateral hernias repaired and two patients
had concomitant umbilical hernia repair. Mean operative time
was 59.2 ± 21.5 minutes. The mean amount of intra-operative
fluids given was 963 ± 230ml. None of the patients given
Flomax preoperatively developed urinary retention and all
were discharged home the same day of surgery. In contrast,
the 2 patients undergoing TEP repairs who did not receive
Flomax starting 2 days preoperatively both developed urinary
retention that required catheter placement.
Conclusion: Peri-operative administration of Flomax in the setting
of laparoscopic inguinal hernia repair under general anesthesia
was associated with no cases of post-operative urinary
retention in this small pilot study. The use of peri-operative
Flomax should be tested in larger numbers of patients and in a
prospective, randomized trial to determine its impact on the
postoperative urinary retention rate. If successful, this
approach could result in shortened outpatient recovery room
stays and potential savings in health care costs.
P326–Hernia Surgery
HERNIAL RELAPSE IN LAPAROSCOPY: PERSONAL EXPERI-
ENCE, Annibale Casati MD, Giovanni Perrucchini MD, Eugenio
Guidotti MD,Luca Magni MD, Clinica Castelli (BG)
Background: Since 1998 we started our approach to the repair
of the inguinal and crural hernias with a laparoscopic method,
even for the primitive hernias.
Methods: from October 1998 to October 2003, we saw 1611
people suffering from inguinal hernial pathology. 1502 people
were operated using the transperitoneal laparoscopy technique
(TAPP) and 109 ( 6,9% ) using the traditional technique(
Linckenstein ).Patients that underwent the laparoscopy technique
were divided M=1021 ( 68% ), F= 481 (32%) ranging from
25 to 82 years old, bilateral hernia was 7%.
Results: The accidents were 4 ( 0,26% ); one due to the bleeding
of a trocar wound, one due to the jejunal perforation an
intestinal occlusion due to an ileal ansa incarcerated and one
severe infection haematology due to the prosthesis infection.
Conclusion: basing ourselves on our results and on our data,
we can state that the laparoscopy technique represents a safe
repair method for the inguinal hernia., with few accidents and
a low chance to have the appearance of recurrences, but only
if done by operators who have performed a good number of
such an operation. The surgical timing overlaps the traditional
technique, the functional recovery is faster and the aesthetic
result is better. Regarding the costs, we need to say that the
limited use in disposable material and the less expensive
social cost for a more rapid renewal of the working activity,
allow this technique to be done from the economic point of
view.
P327–Hernia Surgery
A MODIFIED, OPEN, VENTRAL HERNIA REPAIR WITH FENES-
TRATED MESH: LESSONS LEARNED FROM LAPAROSCOPY,
Todd A Ponsky MD, Arthur Nam MD,Bruce A Orkin MD,Paul P
Lin MD, The George Washington University
Introduction: Recent literature suggests that the laparoscopic
repair of ventral hernias may have the lowest recurrence rates.
Laparoscopy, however, may not be feasible in certain situations.
For those situations in which laparoscopy cannot be performed,
we describe an open technique that utilizes the tension-free
principles of the laparoscopic repair without the need
for subcutaneous flaps.
Methods: A midline incision is made over the hernia. The peritoneum
is entered and the adhesions are taken down to at
least 5cm from the fascial edge circumferentially. A piece of
DualMesh (Gore, Inc.) is then measured to fit around the
defect with a 5cm circumferential overlap. A vertical incision is
then made in the mid-portion of the mesh and Gore-Tex
Sutures (Gore, Inc.) are then sutured circumferentially around
the mesh and the tails are left long to serve as anchoring
sutures similar to a laparoscopic approach. The mesh is then
placed into the peritoneal cavity over the bowel. Using a
suture passer (Gore Inc.), the ties are brought out through the
abdominal wall though 2mm skin incisions on the left side and
tied down. The right side of the mesh is then raised in order to
visualize its underside and it is tacked to the fascia with a spiral
tacking device. The right sided sutures are then brought
through the abdominal wall with a Suture-Passer and tied
down. The right side of the mesh is then tacked to the overlying
fascia by passing the spiral tacking device through the incision
in the mesh. The incision in the mesh is then closed with
suture. The overlying fascia may then be closed if feasible.
Conclusion: For those situations in which laparoscopy cannot
be performed, we describe an open technique for ventral hernia
repair that utilizes the tension-free principles of the laparoscopic
repair without the need for subcutaneous flaps.
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