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39. A Novel Technique for Parastomal Hernia Repair Combining a Laparoscopic and Ostomy-Opening Approach.

Author

Köhler, Gernot, Fischer, Ines, Wundsam, Helwig, and Köhler, Gernot

Subjects
*HERNIA surgery, *OSTOMY, *PERITONEUM surgery, *THREE-dimensional imaging, *MEDICAL imaging systems, LAPAROSCOPIC surgery complications
Abstract

Introduction: The aim of this study was to evaluate a new method of parastomal hernia (PSH) repair by using a hybrid approach with a cylindrical-shaped mesh of 4 cm funnel length.Materials and Methods: In a pilot prospective case series, 12 patients underwent surgical repair of PSHs with a combined laparoscopic and ostomy-opening approach. After laparoscopic adhesiolysis, the ostomy opening was excised from outside and the bowel was closed. The hernia sac was excised after reduction of its content. Then, the bowel was guided through the funnel of the mesh and the implant was manually transferred into the peritoneal cavity through the hernia defect. Next, the fascial margins were narrowed with sutures. Laparoscopy was continued, and the mesh was placed and fixed with absorbable tacks in the proper position. Finally, the diverted bowel was shortened outside of the abdomen and the stoma was matured in its original location.Results: We documented no mesh-associated complications. Only one superficial peristomal wound defect occurred. No unplanned conversions were needed, and median duration of the operations was 72 minutes. There was no recurrence during the short-term follow-up of median 4 months (ranged from 3 to 8 months).Discussion: The technique described gives several advantages, such as a minimally invasive hybrid approach creating a real three-dimensional mesh-covered barrier between the trephine and stomal limb and optional shortening of a concomitant prolapse. When needed due to a concomitant incisional hernia, a second flat mesh can be laparoscopically placed in an intraperitoneal position. [ABSTRACT FROM AUTHOR]

Published
2018
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40. Evolution of Endoscopic Anterior Component Separation to a Precostal Access with a New Cylindrical Balloon Trocar

Author

Köhler, Gernot, Fischer, Ines, Kaltenböck, Richard, Lechner, Michael, Dauser, Bernhard, Jorgensen, Lars Nannestad, Köhler, Gernot, Fischer, Ines, Kaltenböck, Richard, Lechner, Michael, Dauser, Bernhard, and Jorgensen, Lars Nannestad

Abstract

INTRODUCTION: Endoscopic anterior component separation (ECS) techniques facilitate tension-free midline closure of wide ventral hernia defects. We describe a novel approach with a precostal incision and a new cylindrical ballon trocar.MATERIALS AND METHODS: A single-center analysis of 19 patients undergoing ECS between January 1, 2014 and August 2, 2017 was performed with regard to improvement of technique. We currently start with a lateral precostal incision. This access in a low-fat and stable area allows for easy identification of the external oblique muscle with the ribs functioning as dorsal abutment for entering the correct plane between external and internal oblique muscles. Then a trocar is inserted with a cylindrical ballon, thus providing sufficient pneumatic widening of the dissection plane. A second 5-mm port is inserted under direct vision below the 12th rib. From there a unidirectional incision of the external oblique aponeurosis is performed from subcostal to the inguinal ligament. If necessary, the cephalad muscular parts of the external oblique can be transected over several centimeters in both directions starting from the precostal incision.RESULTS: We documented no procedure-related complications apart from two hematomas that required no interventions. Four procedures were carried out on one side and the remaining ones bilaterally. In one case, a conversion to conventional open component separation was required due to extensive scarring after open cholecystectomy. There were no notable abdominal bulgings or lateral hernias during a structured postoperative follow-up period of 1 year postoperatively.DISCUSSION: The technique described offers advantages in terms of determination of the correct entry point for ECS, regardless of abdominal wall conditions and the precostal access allows for unidirectional dissection toward the inguinal ligament with only two trocars in total. The cylindrical shape of the ballon trocar provides

Published
2018

41. Prospective randomized controlled trial on comparison of standard CO2pressure pneumoperitoneum insufflator versus AirSeal®

Author

Luketina, Rosalia, Luketina, Theodore L. H., Antoniou, Stavros A., Köhler, Gernot, Könneker, Sören, Manzenreiter, Lisa, Wundsam, Helwig, Koch, Oliver Owen, Knauer, Michael, and Emmanuel, Klaus

Abstract

Background: AirSeal® is a valve-free insufflation system that enables a stable pneumoperitoneum with continuous smoke evacuation and CO2recirculation during laparoscopic surgery. Comparative evidence on the use of AirSeal® and standard CO2insufflator in laparoscopic general surgery procedures is scarce. The aim of this study was to compare surgical outcomes between AirSeal® and standard CO2insufflators in patients undergoing the most frequently performed laparoscopic procedures. Methods: One hundred and ninety-eight patients undergoing elective laparoscopic cholecystectomy, colorectal surgery and hernia repair were randomized to either AirSeal® (group A) or standard pressure CO2insufflator (group S). The primary endpoints were operative time and level of postoperative shoulder tip pain (Visual Analog Scale). Secondary outcomes included Clavien–Dindo grade complications, surgical side effect and length of hospital stay. Results: Patients were randomized to either group A (n= 101) or group S (n= 97) and were analyzed by intention-to-treat. There was no significant difference in mean operative time between the groups (median [IQR]; 71 min [56–94] in group A vs. 69 min [52–93] in group S; p= 0.434). Shoulder tip pain levels were significantly lower in group S (VAS 0 [0–3] in group S vs. 2 [0–4] in group A; p= 0.001). There was no significant difference in complications, surgical side effects (subcutaneous emphysema was not observed in any group) and length of hospital stay. Conclusion: This randomized controlled trial showed that using the AirSeal® system did not reduce operative time and was associated with a higher postoperative shoulder tip pain compared to standard CO2insufflator for short elective surgeries.

Published
2021
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46. Editorial

Author

Köhler, Gernot

Published
1977

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