|
 |
| COMMENTARY |
|
| Year : 2011 | Volume
: 3
| Issue : 1 | Page : 5-6 |
|
|
Laparoscopic elective colonic operation and concomitant abdominall wall hernia prosthetic repair: Safe and feasible?
Roberto Iglesias Lopes
Department of Surgery and Urology, University of São Paulo Medical School, São Paulo, Brazil
| Date of Web Publication | 30-Mar-2011 |
Correspondence Address:
Roberto Iglesias Lopes
Department of Surgery and Urology, University of São Paulo Medical School, São Paulo
Brazil
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/2006-8808.78460
How to cite this article:
Lopes RI. Laparoscopic elective colonic operation and concomitant abdominall wall hernia prosthetic repair: Safe and feasible?. J Surg Tech Case Report 2011;3:5-6 |
How to cite this URL:
Lopes RI. Laparoscopic elective colonic operation and concomitant abdominall wall hernia prosthetic repair: Safe and feasible?. J Surg Tech Case Report [serial online] 2011 [cited 2016 Jun 12];3:5-6. Available from: http://www.jstcr.org/text.asp?2011/3/1/5/78460 |
Since the introduction of laparoscopic surgery, the promise of lower postoperative morbidity and improved cosmesis has been achieved. Continuous technological developments in instrumentation, access, and optics devices were necessary to allow better surgical results and patient's safety. In recent times, innovative techniques of natural orifice transluminal endoscopic surgery (NOTES), laparoendoscopic surgery (LESS), and single-incision laparoscopic surgery (SILS) have been applied as a step toward even more less-invasive procedures. [1] The final promises of minimally invasive surgery are improved cosmetic results and earlier postoperative recovery with the same oncological and functional results in comparison to standard laparoscopic methods. Despite this, many hurdles to widespread adoption of these techniques exist, including technical challenges, such as decreased triangulation and unfamiliar viewing angles, and more philosophical issues, such as the necessity of demonstrating benefits of these techniques over conventional laparoscopy. Future research will seek to overcome these obstacles.
Therefore, studies addressing advantages and risks of minimally invasive surgical procedures are of utmost importance. I congratulate the authors for this interesting case report [2] and also for their continuous effort to study the best surgical care and techniques in their area of expertise as demonstrated in two previously published papers by this group. [3],[4]
Intra-abdominal operations, including elective colonic operations, [5] abdominal aortic aneurysm repair, [6] and renal transplantation [7] associated with abdominal wall hernia prosthetic repair, have been shown to be safe and feasible. In our service, we also perform elective colonic operation associated with prosthetic repair of abdominal wall hernias. The advantage of correcting two diseases in a single anesthetic and surgical procedure is clearly beneficial to the patient. The major drawback of a simultaneous abdominal wall hernia prosthetic repair together with any potentially contaminated intra-abdominal procedure would be surgical site or wound infection. This risk albeit rare, should be considered when performing these procedures together. Postoperative mesh infection can be avoided by meticulous dissection, hemostasis, and assepsia. Even in cases of postoperative mesh removal due to prosthetic mesh infection, hernia recurrence is uncommon. [8] The fibrous reaction evoked within the transversalis fascia by prosthetic material rather than the physical presence of the mesh is the major factor of the mesh repair strength.
In this case report, a left inguinal incision was performed to correct an inguinal hernia and to allow extracorporeal bowel resection and anastomosis after laparoscopic anterior resection. Another possibility that could be used in this case would be a laparoscopic transabdominal preperitoneal repair (TAPP) associated with laparoscopic anterior resection. Anyway, the presented case shows that a full preoperative surgical evaluation should include anatomical, anthropometric, and minimally invasive issues individualized for the patient and for the intended surgical procedure in order to optimize surgical results.
 References | |  |
| 1. | Best SL, Tracy CR, Cadeddu JA. Laparoendoscopic single-site surgery and natural orifice transluminal endoscopic surgery: Future perspectives. BJU Int 2010;106:941-4. 
[PUBMED] [FULLTEXT] |
| 2. | Suzuki T, Kawahara H, Iida N, Naruse M, Misawa T, Yanaga K. Anastomosis procedure through an inguinal hernia incision in simultaneous laparoscopic anterior resection and inguinal hernia repair. J Surg Tech Case Report 2010 [In press].
|
| 3. | Kawahara H, Kobayashi T, Watanabe K, Kobayashi S, Kashiwagi H, Yanaga K. Where is the best surgical incision for laparoscopic anterior resection? Hepatogastroenterol 2009;56:1396-402.
|
| 4. | Kawahara H, Watanabe K, Ushigome T, Noaki R, Kobayashi S, Yanaga K. Umbilical incision laparoscopic surgery with one assisted port for anterior ressection. Dig Surg 2010;27:364-6.
[PUBMED] [FULLTEXT] |
| 5. | Birolini C, Utiyama EM, Rodrigues AJ Jr, Birolini D. Elective colonic operation and prosthetic repair of incisional hernia: Does contamination contraindicate abdominal wall prosthesis use? J Am Coll Surg 2000;191:366-72.
[PUBMED] |
| 6. | Tsuji Y, Watanabe Y, Ataka K, Sanada A, Okada M. Intraabdominal nonvascular operations combined with abdominal aortic aneurysm repair. World J Surg 1999;23:469-75.
|
| 7. | Antonopoulos IM, Nahas WC, Mazzucchi E, Piovesan AC, Birolini C, Lucon AM. Is polypropylene mesh safe and effective for repairing infected incisional hernia in renal transplant recipients? Urology 2005;66:874-7.
[PUBMED] [FULLTEXT] |
| 8. | Fawole AS, Chaparala RP, Ambrose NS. Fate of the inguinal hernia following removal of infected prosthetic mesh. Hernia 2006;10:58-61.
[PUBMED] [FULLTEXT] |
|
