Minimally Invasive Approach Utilizing Linear Stapler for Midline Incisional Hernia: Stapler Repair Technique

We successfully established the stapler repair technique (SRT), a straightforward laparoscopic Rives-Stoppa approach utilizing a linear stapler. This study retrospectively evaluated its short-term outcomes to determine its safety and efficacy.

The surgical outcomes of 87 patients who underwent laparoscopic median incisional hernia repair at our hospital were reviewed between August 2017 and May 2024. Patients were treated with intraperitoneal onlay mesh (IPOM), laparoscopic trans-abdominal retromuscular (TARM), or SRT.

Among these patients, 37 were treated with IPOM, 16 with TARM, and 34 with SRT, with no significant differences in patient characteristics. The median surgical time (range) was 96 min (50-211) for IPOM, 256 min (196-300) for TARM, and 112 min (60-289) for SRT, respectively. The median mesh areas (ranges) were 210 cm² (80-500) for IPOM, 500 cm² (270-780) for TARM, and 379 cm² (176-864) for SRT, respectively. The SRT group had significantly shorter operative times (p < 0.001) and smaller mesh areas (p = 0.005) than the TARM group. Compared to the IPOM group, there was no significant difference in operative time in the SRT group (p = 0.444), but the mesh area was significantly larger (p < 0.001). The SRT group had no significant intraoperative complications or conversions to open surgery.

SRT offers a comparable operative time to IPOM and a significantly shorter time than TARM. Additionally, SRT can be performed extraperitoneally with no significant intraoperative complications or conversion to open surgery. These findings suggest that SRT is a safe and effective minimally invasive approach in median laparoscopic incisional hernia repair.