Laparoendoscopic single-site repair of incisional hernias after urological surgery

Objective: To report the first series of postoperative ventral hernias (POVH) repair with laparoendoscopic single-site (LESS) approach after urological procedures. POVH are well-known complications of urological surgery and often require surgical correction. Minimally invasive repair techniques have been developed to diminish parietal trauma and enhance functional results. Methods: This study was based on a retrospective review of patients undergoing POVH repair after urological surgery at an academic institution from 2004 to 2010. Patient characteristics, perioperative details, as well as follow-up were reviewed and summarized. Using a transperitoneal approach, abdominal wall defect was identified, prepared, and closed with a mesh tailored to cover 3-5 cm beyond the edge of the defect and secured in a double-crown fashion. Results: In 3 patients POVH was represented by a port-site hernia after laparoscopic partial nephrectomy; in the remaining 2 patients POVH occurred at midline following radical cystectomy. Hernia occurrence was identified within 2 months from the initial surgery in all but 1 patient. Blood loss was minimal, operative times were 30-150 minutes, and no intraoperative complications occurred. Three patients developed a transient seroma and 1 patient had ileus. Over a 1- to 20-month follow-up, there have been no wound or mesh complications, and no hernia recurrences were identified. Conclusion: In this initial series, POVH after urological surgery were successfully treated with LESS approach. In experienced hands, LESS may provide a viable alternative to conventional laparoscopy for POVH repair. More studies are needed to confirm these initial results and to determine whether reduced parietal trauma favors LESS in POVH repair.