Laparoscopic repair of parastomal hernia with DynaMesh®

A 73-year-old male patient, previously submitted to a radical cystoprostatectomy with ileal conduit as urinary diversion for urothelial cancer, was admitted to the emergency department because of stomal tumefaction and malfunction. There was no evidence of oncologic relapse.
CT-scan revealed an abscess in the parastomal area as well as a parastomal hernia. The abscess was treated with percutaneous drainage and antibiotics. In a second time, he was submitted to a laparoscopic correction of the parastomal defect.
The procedure was performed with no-flexible cameras and straight laparoscopic instruments. For defect correction, a laparoscopic intraperitoneal mesh repair (IPOM) technique was used.
No complications were observed and the patient was discharged on postoperative day 6.

Background: In this video, the authors report the case of a 65-year-old man who consulted for a subxiphoidal incisional hernia after open cardiac surgery. A transumbilical single access laparoscopic repair was proposed.

Video: The umbilical scar was incised and, after having placed a fascial umbilical purse-string suture, an 11mm reusable trocar was introduced. DAPRI curved reusable instruments (Karl Storz Endoskope, Tuttlingen, Germany) were introduced. The subxiphoidal hernia was put in evidence. The fatty tissue covering the defect was freed and the hernia defect was measured to be 8cm cranio-caudally and 6cm latero-laterally. A dual face mesh of 15 and 14cm (Surgimesh XB, Aspide Medical, Saint-Etienne, France) was chosen and introduced into the cavity through the 11mm trocar. The mesh was fixed against the abdominal wall using absorbable tacks (Sorbafix, Bard Davol Inc., Warwick, RI, US), and against the pericardial sheet using a polypropylene suture, in order to prevent any potential cardiac tamponade.

Results: The final umbilical scar was 15mm. Operative time was 65 minutes, and operative bleeding was insignificant. The patient was discharged on postoperative day 1. At visit consultations, no recurrence was evidenced.

Conclusion: Subxiphoidal incisional hernia after open cardiac surgery can be treated successfully using a transumbilical single access laparoscopy.

The laparoscopic repair of incarcerated incisional hernias is still debated in the literature. The recent EAES/EHS guidelines state that laparoscopic surgery is not contraindicated and may be considered in selected patients with incarcerated hernia. This video shows the case of an 83-year-old woman with an incarcerated incisional hernia in the left iliac fossa (L2 zone – W2) successfully managed laparoscopically with an intraperitoneal onlay mesh reinforcement (IPOM-plus).

Background: Laparoscopic inguinal hernia repair offers various advantages both to the patient and the surgeon. Transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP) repairs represent the two laparoscopic options. A personal technique of single incision laparoscopic TEP has already been published on WebSurg (Link: http://www.websurg.com/MEDIA/?noheader=1&doi=vd01en4054).
Video: This video demonstrates the single incision laparoscopic treatment of a peritoneal hole, which occurred accidentally during a right TEP procedure.
Results: The TEP procedure lasted 41 minutes and the peritoneal repair 8 minutes. The final umbilical scar length was 10mm and the patient was discharged within 24 hours.
Conclusions: Peroperative complications can occur during single incision laparoscopy, as well as during conventional laparoscopy and open surgery. The procedure can be performed without conversion or additional trocars, depending on the complications which occurred.

We present the case of a 64 year-old man who complained of a right inguinal lump for 10 days. His surgical history included an open left inguinal herniorrhaphy 5 years ago. His past medical history included a malignant lymphoma. From April to October 2015, he received chemotherapy. In July 2015, the patient was found to have a Herpes zoster in the right buttock. A single port total extraperitoneal (TEP) herniorrhaphy was performed.