Abstract
PurposeThe purpose is to present a new hybrid approach of lateral incisional hernia repair associated with reduced operative trauma and anatomically optimal mesh placement.MethodsVideo-Assisted Mini-Open Sublay (VAMOS) consists of a laparoscopic atraumatic dissection of the hernia sac, diaphanoscopy, laparoscopically-assisted closure of the fascial gap and mesh placement in sublay position through a minimized skin incision. Feasibility of this concept was assessed in a cohort of 7 consecutive patients.ResultsVAMOS approach was feasible in all 7 patients. Median hernia size was 8 cm, the median skin incision width was 7.7 cm. Median operative time was 86 min. In all patients a sufficient mesh overlap on all sides of the fascial gap was ensured. On short-term follow-up no procedure related complications were recorded, seroma formation occurred in 2 patients. Pain medication was necessary for median 4.9 days. There was no need for pain medication on day 14, whatsoever.ConclusionInitial VAMOS results show that the technique is simple, time-saving and safe. It provides a substantial reduction in postoperative pain compared to an open approach. Through implantation in the intermuscular sublay position and minor access-related trauma, it is possible to achieve a biomechanically optimal mesh position, to lay the foundations for adequate remodelling of the abdominal wall, and to prevent recurrence as well as local complications. All in all, VAMOS appears to have several advantages over current surgical strategies.
Highlights
The surgical care of lateral incisional hernias is challenging (1, 2)
Initial Video-Assisted Mini-Open Sublay (VAMOS) results show that the technique is simple, time-saving and safe
The literature is full of case reports or case series with a small number of cases which present different strategies with different results (1, 5)
Summary
The surgical care of lateral incisional hernias is challenging (1, 2). These hernias occur after open urological surgery of the kidney or efferent urinary system, and after visceral surgery via a lateral approach such as conventional appendectomies, hemicolectomies or laparoscopically assisted sigmoidectomies with transverse extraction incision (3). Because of the relatively low incidence rate, only a small number of publications are available and there are no standardised evidence-based surgical methods (2, 4, 5). The literature is full of case reports or case series with a small number of cases which present different strategies with different results (1, 5). The management of lateral abdominal wall hernias is of major economic and individual medical relevance. Lateral abdominal wall hernias develop complications such as incarcerations more often than midline hernias (6–8)
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