Bucher, P.

Morel, P.

Pugin, F.

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Hernia (2009) 13:569–570DOI 10.1007/s10029-009-0511-4LETTER TO THE EDITORSingle port laparoscopic repair of primary and incisional ventral herniaRe: Single port laparoscopic repair of incarcerated ventral hernia, MacDonald et al. (2009) Hernia, March 24 (Epub ahead of print)P. Bucher · F. Pugin · P. Morel Received: 20 April 2009 / Accepted: 28 April 2009 / Published online: 21 May 2009©  Springer-Verlag 2009Dear Editor,We read with interest the letter by MacDonald et al. [1]reporting a case of single port laparoscopic repair of ventralhernia and referring to the paper by Shah et al. [2], whohave reviewed their large experience on the laparoscopicrepair of ventral hernias. These papers deserve commentsregarding the potential of the development of single portlaparoscopic repair of ventral hernias.We Wrst want to congratulate MacDonald et al. for theirWrst report of a single port laparoscopic repair of a ventralhernia case. As with MacDonald et al. [1], we have startedto approach primary and incisional ventral hernia through asingle port technique with excellent short- and long-termresults [3].We have now completed 11 cases of ventral hernia (sixumbilical and linea alba, Wve incisional hernias) repairthrough single port access (SPA) laparoscopy with intra-peritoneal composite mesh placement. A single 12-mm portwas positioned through an open approach midway betweenthe anterior superior iliac spine and the costal margin onleft or right Xank. To conduct SPA ventral hernia repair, aworking channel endoscope (Richard Wolf GmbH) wasused with a standard straight 5-mm instrument. The sectionof adhesions, freeing the hernia contents, dissection offalciform ligament and urachal structure, when needed,were achieved similarly to the current technique of multi-port laparoscopic ventral hernia repair. In all cases, herniarepair was achieved by the placement of a composite mesh(Proceed™ surgical mesh, Johnson & Johnson) with atleast 5-cm coverage of the normal abdominal wall allaround the defect. Meshes were Wxed at least with foursutures and multiple absorbable tacks (AbsorbaTack™,Covidien). The facial incision at the port site were closedwith 2/0 Maxon under vision. The median operative timewas 58 min (range 45–78). There were no intra- or post-operative complications. No recurrences were observeduntil now with a median follow-up of 8 months (3–13).While multiport laparoscopic repair of ventral hernia hasbeen shown to oVer excellent results, the rationale for sin-gle port laparoscopic repair of ventral hernia may exist. It isassociated with excellent or better cosmetic results, but,more importantly, it implicates only a single incision, whilebeing easily feasible for laparoscopic surgeons routinelyperforming laparoscopic ventral hernia repair, as it onlyreproduces the standard laparoscopic technique. The singleport insertion using an open cut leaves only a single fascialwound, which may reduce the risk of incisional hernia onthe port, especially in patients which have proved to beprone to abdominal wall hernias [4, 5].In conclusion, we agree that the laparoscopic repair ofventral and incisional hernias are feasible, safe and mayresult in excellent short- and long-term results. But weagree with MacDonald et al. that it may also be performedusing a single port and a single incision (12 mm). The sin-gle port approach results in less scarring and may decreasethe risk of incisional hernia on the port incision in patientswhich are at risk of abdominal wall hernias. Single port lap-aroscopic mesh repair of ventral hernias has been safe andeVective in the present series, and may, in future, be theroutine of choice for ventral hernia treatment.P. Bucher (&) · F. Pugin · P. MorelVisceral and Transplantation Surgery, Department of Surgery, University Hospital Geneva, 24 rue Micheli-du-Crest, 1211 Geneva, Switzerlande-mail: pascal.bucher@hcuge.ch123570 Hernia (2009) 13:569–570References1. MacDonald E, Pringle K, Ahmed I (2009) Single port laparoscopicrepair of incarcerated ventral hernia. Hernia [Epub ahead of print(5)]2. Shah R, Sharma A, Khullar R, Soni V, Baijal M, Chowbey PK(2008) Laparoscopic repair of incarcerated ventral abdominal wallhernias. Hernia 12(5):457–4633. Bucher P, Pugin F, Morel P (2009) Scarless surgery: reality throughumbilical laparoendoscopic single site surgery (LESS)? Rev MedSuisse (in press)4. Bucher P, Pugin F, Morel P (2008) Single port access laparoscopicright hemicolectomy. Int J Colorectal Dis 23(10):1013–10165. Tonouchi H, Ohmori Y, Kobayashi M, Kusunoki M (2004) Trocarsite hernia. Arch Surg 139:1248–1256123

Single port laparoscopic repair of primary and incisional ventral hernia: Re: Single port laparoscopic repair of incarcerated ventral hernia, MacDonald et al. (2009) Hernia, March 24 (Epub ahead of print)

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Single port laparoscopic repair of primary and incisional ventral hernia: Re: Single port laparoscopic repair of incarcerated ventral hernia, MacDonald et al. (2009) Hernia, March 24 (Epub ahead of print)

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