Conventional Laparoscopic Repair Research Articles

Robot-assisted repair of hiatal hernia: Advantages and disadvantages in comparison to conventional laparoscopic repair: A literature review

Abstract The laparoscopic fundoplication has proven to be the standard technique of antireflux surgery and hiatal hernia (HH) repair over the last decade. However, robot-assisted surgery is more and more implemented in daily practice. Several studies have proven the feasibility and safety of robot-assisted HH repair and antireflux surgery. Both approaches seem to be similar regarding perioperative and postoperative complications, length of hospital stay, postoperative symptoms, and quality of life, as well as objective assessment of gastric acid exposure. Nevertheless, high total costs as well as a considerably longer total operating time of robot-assisted surgery need to be considered. The role of robot-assisted surgery in complex cases is promising but needs to be evaluated. Eventually, the decision regarding the technique used should be based on the surgeon’s discretion and experience.

8190 Laparoscopic Management of Large Vesico-Vaginal Fistula(VVF)- Case Report

Study Objective To repair Vesico-Vaginal Fistula (VVF) laparoscopically. Design Case presentation of laparoscopic surgical correction of VVF. Setting Tertiary care laparoscopic center. Patients or Participants A case of VVF that came to us post open hysterectomy with continuous dribbling of urine was included. Specific history was taken. Diagnosis of VVF was made with Vesico-fistulogram. Size was 8 mm. Interventions Correction was done 4 months after the hysterectomy. Cystoscopy was done prior to the procedure to look for the location of fistula and the patency of both ureteral orifices. The fistula was at the trigone of the bladder. Conventional laparoscopic repair was done by modified O'Conner's technique under GA. Catheter was placed post-surgery for 4 weeks. Measurements and Main Results We evaluated the post-op patient with regular follow-up after 1, 2 and 4 weeks with scan and urine culture. Patient was put on appropriate antibiotics depending upon the culture report. Catheter removed 4 weeks later, and the patient followed up regularly for vaginal discharge. There was no vaginal discharge. Cystoscopy was done after 2 months, bladder was normal. Conclusion Laparoscopic modified O'Conner's technique for VVF gives a promising outcome and patient satisfaction. To repair Vesico-Vaginal Fistula (VVF) laparoscopically. Case presentation of laparoscopic surgical correction of VVF. Tertiary care laparoscopic center. A case of VVF that came to us post open hysterectomy with continuous dribbling of urine was included. Specific history was taken. Diagnosis of VVF was made with Vesico-fistulogram. Size was 8 mm. Correction was done 4 months after the hysterectomy. Cystoscopy was done prior to the procedure to look for the location of fistula and the patency of both ureteral orifices. The fistula was at the trigone of the bladder. Conventional laparoscopic repair was done by modified O'Conner's technique under GA. Catheter was placed post-surgery for 4 weeks. We evaluated the post-op patient with regular follow-up after 1, 2 and 4 weeks with scan and urine culture. Patient was put on appropriate antibiotics depending upon the culture report. Catheter removed 4 weeks later, and the patient followed up regularly for vaginal discharge. There was no vaginal discharge. Cystoscopy was done after 2 months, bladder was normal. Laparoscopic modified O'Conner's technique for VVF gives a promising outcome and patient satisfaction.

Comparing Outcomes of Robotic-Assisted versus Conventional Laparoscopic Hiatal Hernia Repair

Robotic-assisted laparoscopic surgery for anti-reflux and hiatal hernia surgery is becoming increasingly prevalent. The purpose of this study was to compare hospital length of stay and outcomes of robotic-assisted versus conventional laparoscopic hiatal hernia repair. A retrospective review was conducted of 58 patients who underwent robotic-assisted laparoscopic (n = 16, 27.6%) or conventional laparoscopic (n = 42, 72.4%) hiatal hernia repair. Patient characteristics and comorbidities were similar between groups. The robotic-assisted group had a significantly higher use of fundoplication (81.3% vs. 38.1%; p = 0.007). Complications observed between the robotic-assisted and conventional laparoscopic groups were pneumothorax (6.3% vs. 11.9%; p = 1.000), infection (0% vs. 4.8%; p = 1.000), perforation (0% vs. 2.4%; p = 1.000), bleeding (6.3% vs. 2.4%; p = 0.479), ICU admission (31.3% vs. 11.9%; p = 0.119), and mechanical ventilation (18.8% vs. 2.4%; p = 0.60). There were no reported complications of dysphagia, deep vein thrombosis/pulmonary embolus, myocardial infarction, or death in either group. Hospital length of stay was similar for robotic versus conventional patients (3.0 vs. 2.5 days; p = 0.301). Robotic-assisted versus conventional laparoscopic hiatal hernia were compared, which demonstrated similar post-operative complication rates and hospital length of stay. The results showed robotic-assisted or conventional laparoscopic hiatal hernia repair can be performed with similar outcomes.

Laparoscopic repair of female genitourinary fistulae: 10-year single-center experience

Laparoscopic repair of different female genitourinary fistulae has been recently reported, including both conventional and laparoendoscopic single-site surgery (LESS). We present our 10-year single-center experience of the laparoscopic repair of different types of female genitourinary fistulae. A retrospective analysis of our records over the last 10years was performed. Type of fistula, etiology, laparoscopic approach, operative data, postoperative outcome, and follow-up were recorded. Overall, 46 patients with laparoscopic repair of genitourinary fistulae were reported: 25 had vesicovaginal fistulae (VVF), 14 had vesicouterine fistulae (VUF), and 7 had ureterovaginal fistulae (UVF). Thirty-three patients had conventional laparoscopic repair, whereas 7 VVF and 6 VUF had LESS repair. In all patients with VVF and VUF, extravesical repair was carried out by excising the fistulous tract and closing both the bladder and the vagina or the uterus with interposing tissue in-between. In patients with UVF, extravesical ureteric re-implantation was performed. Mean operative time was 176 ± 25min. Mean blood loss was 105 ± 25 cc. No intraoperative or postoperative complications occurred. None was converted to open surgery. Mean postoperative hospital stay was 3.2 ± 1.2days. After a mean follow-up of 6.3 ± 3.1years, all patients had undergone successful repair, except for one patient with complex VVF. Laparoscopic repair of VVF, VUF, and UVF is a feasible procedure with a high success rate and low morbidity. LESS repair of VVF and VUF has a comparable success rate to conventional laparoscopy, but with a shorter hospital stay and fewer analgesic requirements.

Laparoscopic-Assisted Percutaneous Extraperitoneal Closure for Inguinal Hernia Repair in Children: An Initial Experience

Over the past two decades, laparoscopy has advanced and multiple techniques for inguinal hernia repair have been established. Laparoscopic-assisted percutaneous extraperitoneal closure (LAPEC) for inguinal hernia repair in children, is one of the most simple and reliable methods. The present study aimed to assess the safety and feasibility of the LAPEC of inguinal hernia in children.From January 2014 to January 2016, 21 conventional LAPEC procedures were performed prospectively at our center (Group 1). Over this period, 21 patients of the same age and the same gender had open inguinal herniorrhaphies (Group2). The choice of whether to perform a LAPEC procedure was made according to the surgeon preference. All operations were performed by the same surgeon. No significant differences were found between the 2 groups in terms of sex ratio, mean age, and operating time (p=0.19; student test). There were no operative complications in group 1. Two patients (9.5%) in group 2 presented inguinal hernia recurrence.Despite a relatively high recurrence rate, LAPEC may be a practical alternative to conventional open hernioraphy. Comparative studies must be conduced to test advantages and disadvantages of this procedure in comparison with standard open herniorrhaphy and conventional laparoscopic repair techniques in a more extensive trial.

Laparoendoscopic single-site surgery (LESS) and conventional laparoscopic extravesical repair of vesicouterine fistula: single-center experience

To present for the fist time in literature laparoendoscopic single-site surgery (LESS) extravesical repair of vesicouterine fistula (VUF) and to compare this with conventional laparoscopic repair. Eleven females with VUF were included; of them, six had conventional laparoscopic repair where 5 ports were used, while five females had LESS repair. Additional 5-mm port was inserted during suturing in LESS group and both straight and pre-bent instruments were used. Fistulous tract was excised; then, uterine rent was closed through single figure of eight suture, while urinary bladder was closed in two layers; then, an omental flap was interposed in between. Sutures were done using 3/0 vicryl. Urinary bladder was drained for 3 weeks through uretheral catheter. No conversion to open surgery in both groups or from LESS to conventional repair. Blood loss in conventional laparoscopic and LESS repair was 95 ± 18 and 86 ± 15 c.c., respectively. No complications were reported in both groups. Operative time for conventional laparoscopic and LESS repair was 149 ± 18 and 144 ± 16 min, respectively. Postoperative hospital stay was 3.1 ± 0.8 and 2 days for both groups, respectively. At follow-up period of 23.6 ± 8.2 and 13.4 ± 1.8 months for both groups, respectively, all were cured. Both conventional laparoscopic and LESS extravesical repair of VUF are effective and reproducible and they follow the same principles of open surgical repair. However, LESS repair of VUF seems to be less morbid than conventional laparoscopic repair.

Laparoscopic ventral hernia repair: Does primary repair in addition to placement of mesh decrease recurrence?

The advent of laparoscopic ventral hernia repair (LVHR) not only reduced the morbidity associated with open repair but also led to a decrease in the hernia recurrence rate. However, the rate continues to remain significant. A retrospective observational study was conducted on 193 patients who were treated with LVHR by two minimally invasive surgeons in a 24-month period. The patient population was broadly divided into two groups based on the laparoscopic repair of the fascial defect with mesh underlay, or with primary suture repair and mesh underlay (PSR + MU). Patient demographics, rates of hernia recurrence, and other associated complications were compared between the two groups. Patient variables and the clinical outcomes were analyzed with descriptive statistics and chi-square test. One hundred ninety-three consecutive patients underwent LVHR for incisional (n = 136), umbilical (n = 44), epigastric (n = 9), and parastomal (n = 4) hernia. Hernia recurrence was documented in eight patients (4.1%). The mean follow-up period was 10.5 months (range 1-36 months). Incisional hernias accounted for all eight recurrences. The rate of recurrence in those treated with PSR + MU was 3% (two of 67 cases) in comparison with 4.8% (six of 126 patients) associated with mesh alone. The rate of recurrence in the recurrent hernia group, treated with mesh only, was 10.5% (four of 38 patients) compared with 4.8% (one of 21 patients) in the PSR + MU group. Primary laparoscopic repair along with mesh placement for the management of ventral hernia was found to be effective in selected cases as evidenced by the low rate of recurrence when compared with conventional laparoscopic repair with mesh alone. Further retrospective and prospective studies, with larger patient enrollment, are warranted to confirm the benefit of this technique over traditional repair.

Transumbilical Single-Port Laparoscopic Transabdominal Preperitoneal Repair of Inguinal Hernia

Conventional laparoscopic repair of inguinal hernias is generally performed by using 3 ports. In this study, the authors report their initial experiences of transumbilical single-port transabdominal preperitoneal (TAPP) repair of inguinal hernia using a unique "single port." Since November 2008, transumbilical single-port TAPP was performed in 24 patients with an inguinal hernia. A wound retractor and a surgical glove attached with 5 mm trocar and 2 pipes were inserted through a 1.5 cm-sized transumbilical incision. TAPP procedure was performed similarly compared with conventional laparoscopy. Transumbilical single-port TAPP repair of an inguinal hernia was successfully performed in 24 patients (19 male and 5 female; 17 with an indirect hernia and 7 with a recurrent hernia; mean age 54.2 y; mean body mass index 24.2 kg/m). No major or minor intraoperative and postoperative complication was encountered and no conversion to conventional 3-port approach or open surgery was required. Mean operating time was 65.6 minutes and mean hospital stay was 2.1 postoperative days. Transumbilical single-port TAPP repair of an inguinal hernia is technically feasible, provides nearly scarless surgery and can be performed safely and effectively in selected patients with an inguinal hernia.