Prvi slučaj laparoskopske operacije kroz jedan rez za potpuno ekstraperitonejsku plastiku ingvinalne hernije

Laparoscopic approach to inguinal hernia repair is indicated for recurrent and bilateral hernias or as patient choice in unilateral primary hernias. Totally extraperitoneal (TEP) approach has some advantages over transabdominal preperitoneal (TAPP) approach, but has proved to be more technically demanding. It cannot be emphasized enough that every incision and trocar placement poses a risk of bleeding, organ damage, incisional hernia and less favorable cosmetic effect. Single incision laparoscopic (SILS) TEP hernia repair has reduced the number of incisions to minimum. A 60-year-old male patient presented with unilateral right sided primary indirect inguinal hernia. Laparoscopic SILS TEP repair was performed: a single 2.5-cm infraumbilical incision was made, the anterior rectus sheath was incised and a balloon dissection device was inserted over the posterior rectus sheath, guided to the pubic symphysis and inflated, resulting in separation of the peritoneum from the rectus muscle. This creation of the extraperitoneal space allowed for laparoscopic dissection to take place. We used a 10-mm optical trocar and two 5-mm trocars placed 1 cm laterally from the optical port. The operation was free from complications and the operative time was 90 minutes. Postoperative recovery was uneventful. We report on, to our knowledge, the first case of SILS TEP hernia repair. Based on this experience, we believe that SILS TEP is feasible. Adjacent placement of trocars in SILS reduces triangulation which, along with frequent crossing of instruments, renders this approach more demanding. Cosmetic benefit is clear; however, it remains to evaluate patient recovery, postoperative pain and complications in comparison to standard TEP.Laparoskopski pristup plastici ingvinalne hernije je indiciran za rekurentne i obostrane hernije te kao bolesnikov izbor kod jednostranih primarnih hernija. Potpuno ekstraperitonejski pristup (totally extraperitoneal, TEP) je pokazao neke prednosti u odnosu na transabdominalni predperitonejski pristup (transabdominal preperitoneal, TAPP), ali se smatra tehnički zahtjevnijim. Nikada nije dovoljno naglašavati kako svaki dodatni rez ili troakar donosi dodatni rizik od krvarenja, oštećenja organa, incizijske hernije te smanjuje kozmetski učinak. TEP plastika hernije kroz jedan rez smanjuje ove rizike na najmanju mjeru. šezdesetgodišnji bolesnik je primljen zbog jednostrane primarne indirektne hernije. Izvedena je laparoskopska operacija kroz jedan rez (single incision laparoscopic surgery, SILS) za TEP plastiku ingvinalne hernije: kroz jedan rez od 2,5 cm, kroz inciziju prednje fascije rektusa uveden je balon koji se po stražnjoj fasciji spustio do pubične simfize i insuflirao, čime se odvojio peritoneum od mišića rektusa. Nastanak predperitonejskog prostora omogućio je daljnju disekciju. Rabili smo 10-mm optički troakar te dva radna troakara od 5 mm koji su postavljeni 1 cm lateralno i kranijalno u odnosu na optički troakar. Operacija je prošla bez komplikacija. Poslijeoperacijski tijek je bio uredan. U ovom izvješću prikazujemo prvi slučaj zahvata SILS TEP. Prema našem iskustvu pristup je izvediv. Triangulacija je smanjena, što uz križanje instrumenata čini zahvat zahtjevnijim. Unatoč jasnom kozmetskom rezultatu potrebno je procijeniti oporavak, poslijeoperacijsku bol te komplikacije u odnosu na standardni TEP