Laparoendoscopic single-site repair of incisional hernias after urological surgery

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.

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.

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.

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.