Hanh Tran

Safety and efficacy of single incision laparoscopic surgery for total extraperitoneal inguinal hernia repair.

Single incision laparoscopic inguinal hernia repair appears to be a safe and efficient alternative to multiport laparoscopic inguinal hernia repair.

Robotic single-port hernia surgery.

This study suggests that robotic single-port inguinal hernia surgery is feasible, safe, and efficient.

Single-port laparoscopic parastomal hernia repair with modified sugarbaker technique.

Single-port laparoscopic parastomal hernia repair with a modified Sugarbaker technique is suggested to be feasible and safe and provides an alternative to multi-port surgery.

Safety and efficacy of laparoendoscopic single-site surgery for abdominal wall hernias.

In a specialized hernia center, laparoendoscopic single-site surgery was found to be safe and effective for many types of abdominal wall hernias including parastomal hernias.

The potential role of xenogeneic antigen-presenting cells in T-cell co-stimulation

Abstract: CTLA4‐Fc is a chimeric murine construct consisting of the CD28 homologue CTLA4 and the constant portion of the heavy chain of mouse IgG2a, with a potential to suppress cellular xeno‐immune responses. The aim of this study was to determine the degree of binding of CTLA4 to B7 ligands on cells of different species and to use CTLA4‐Fc as a tool for the study of cross‐species CD28‐B7 interactions. As assessed by flow cytometry, CTLA4‐Fc bound to mouse L‐cells and human Epstein Barr virus (EBV) transformed lymphoblastoid cells and concanavalin A (Con A) or LPS‐stimulated peripheral blood mononuclear cells (PBMC) or splenocytes from rat, dog, and pig. CTLA4‐Fc inhibited the proliferation of Con A‐stimulated PBMC or splenocytes from mouse, rat, dog, and pig, in a dose‐dependent fashion with approximately 80% inhibition at a concentration of 10 μg/ml. It did not inhibit the proliferation of Con A‐stimulated human PBMC, although it did inhibit the human versus human, and human versus pig primed mixed lymphocyte culture (MLC) in a dose‐dependent fashion. At submitogenic concentrations, purified human T‐cells did not proliferate after incubation with Con A alone. However, proliferation occurred with the addition of B7 positive L‐cells or pig PBMC, but not B7‐negative OKT4 cells. Furthermore, CTLA4‐Fc inhibited proliferation in a dose‐dependent fashion. CTLA4‐Fc bound to all species tested and resulted in inhibition of Con A‐stimulated proliferation in these species, except for humans. Human T‐cells proliferated in response to co‐stimulation with xenogeneic B7, and this could be inhibited by CTLA4‐Fc, suggesting that xenogeneic B7 was capable of providing a functionally significant co‐stimulatory signal necessary for human T cell activation in vitro.

Strategies to Minimize Adhesions to Intraperitoneally Placed Mesh in Laparoscopic Ventral Hernia Repair

Fibrin sealant abolished adhesions to DualMesh and prevented adhesions to polypropylene mesh when applied over the entire surface of mesh in this animal study.

Single-port onlay mesh repair of recurrent inguinal hernias after failed anterior and laparoscopic repairs.

Background and Objectives: Despite the exponential increase in the use of laparoscopic inguinal herniorrhaphy, overall recurrence rates have remained unchanged. Therefore, a growing number of patients are presenting with recurrent hernias after conventional anterior and laparoscopic repairs have failed. This study reports our experience with single-incision laparoscopic (SIL) intraperitoneal onlay mesh (IPOM) repair of these hernias. Methods: Patients referred with two or more recurrences of inguinal hernia underwent SIL-IPOM from November 1, 2009, to June 24, 2014. A 2.5-cm infraumbilical incision was made, and an SIL port was placed intraperitoneally. Modified dissection techniques were used: chopstick and inline dissection, 5.5-mm/52-cm/30° angled laparoscope, and conventional straight dissecting instruments. The peritoneum was incised above the pubic symphysis, and dissection was continued laterally and proximally, raising the inferior flap below the previous extraperitoneal mesh while reducing any direct, indirect, femoral, or cord lipoma before placement of antiadhesive mesh, which was fixed to the pubic ramus, as well as superiorly, with nonabsorbable tacks before the inferior border was fixed with fibrin sealant. The inferior peritoneal flap was then tacked back onto the mesh. Results: Nine male patients underwent SIL-IPOM. Their mean age was 53 years and mean body mass index was 26.8 kg/m2. Mean mesh size was 275 cm2. Mean operation time was 125 minutes, with a hospital stay of 1 day. The umbilical scar length was 23 mm at the 6-week follow-up. There were no intra-/postoperative complications, port-site hernias, chronic groin pain, or recurrence of the hernia during a mean follow-up of 24 months. Conclusion: Inguinal hernias recurring after two or more failed conventional anterior and laparoscopic repairs can be safely and efficiently treated with SIL-IPOM.

Single-Incision Laparoscopic Repair of Spigelian Hernia

Introduction: Spigelian hernias represent only 1% to 2% of all abdominal wall hernias. The treatment, however, remains controversial but depends on institutional expertise. This case series reports the first experience with single-incision laparoscopic totally extraperitoneal (SILTEP) repair of Spigelian hernias with telescopic extraperitoneal dissection in combination with inguinal hernia repair. Methods: From February 2013 to April 2014, all patients referred with inguinal or Spigelian hernias, without histories of extraperitoneal intervention, underwent SILTEP repair with telescopic extraperitoneal dissection. A single-port device, 5.5 mm/52 cm/30° angled laparoscope, and conventional straight dissecting instruments were used for all cases. Extraperitoneal dissection was performed under direct vision with preservation of preperitoneal fascia overlying retroperitoneal nerves. Inguinal herniorrhaphy was performed with lightweight mesh that covered low-lying Spigelian defects. High-lying Spigelian defects were repaired with additional mesh. Results: There were 131 patients with 186 (92 direct) inguinal hernias and 7 patients with 8 Spigelian hernias (6 incidental, including 1 bilateral and 2 preoperatively diagnosed), with a mean age of 51.3 years and a mean body mass index of 25.1 kg/m2. An additional piece of mesh was used for 3 hernias. All Spigelian hernias were associated with direct inguinal hernias, and 8 combined inguinal and Spigelian hernias were successfully repaired with SILTEP repair with telescopic extraperitoneal dissection as day cases. There were no clinical recurrences during a mean follow-up period of 6 months (range, 1–15 months). Conclusions: Combined Spigelian and inguinal hernias can be successfully treated with SILTEP herniorrhaphy with telescopic extraperitoneal dissection. The high incidence of Spigelian hernias associated with direct inguinal hernias suggests a high index of suspicion for Spigelian hernias during laparoscopic inguinal herniorrhaphy.

Single-incision laparoscopic ventral hernia repair with suprapubic incision.

Single-incision laparoscopic ventral hernia repair appears to offer a virtually scarless methodology for this procedure.

Single-Port Repair of Diastasis Recti and Umbilical Hernia Combined with Abdominoplasty

Introduction: Evidence-based treatment of abdominal hernias involves the use of prosthetic mesh. However, the most commonly used method of treatment of diastasis of the recti involves plication with non-absorbable sutures as part of an abdominoplasty procedure. This case report describes single-port laparoscopic repair of diastasis of recti and umbilical hernia with prosthetic mesh after plication with slowly absorbable sutures combined with abdominoplasty. Technique Description: Our patient is a 36-year-old woman with severe diastasis of the recti, umbilical hernia and an excessive amount of redundant skin after two previous pregnancies and caesarean sections. After raising the upper abdominal flap, a single-port was placed in the left upper quadrant and the ligamenturn teres was divided. The diastasis of the recti and umbilical hernia were plicated under direct vision with continuous and interrupted slowly absorbable sutures before an antiadhesive mesh was placed behind the repair with 6 cm overlap, transfixed in 4 quadrants and tacked in place with non-absorbable tacks in a double-crown technique. The left upper quadrant wound was closed with slowly absorbable sutures. The excess skin was removed and fibrin sealant was sprayed in the subcutaneous space to minimize the risk of serorna formation without using drains. Discussion: Combining single-port laparoscopic repair of diastasis of recti and umbilical hemia repair minimizes inadvertent suturing of abdominal contents during plication, the risks of port site hernias associated with conventional multipart repair and permanently reinforced the midline weakness while achieving “scarless” surgery.