Single incision laparoscopic primary and incisional ventral hernia repair as the standard of care in the ambulatory setting; Does less equal better outcomes; Case series and literature review

INTRODUCTION The consensus about whether the single port approach is advantageous remains controversial. As the ambulatory service becomes the standard of care, techniques are in evolution to augment the patient experience in this setting. This forms the basis for evaluating SILS (Single Incision Laparoscopic Surgery) prosthetic ventral hernia repair in the ambulatory setting. We report a SILS technique of ventral hernia repair using the Stryker Ideal-eyes articulating laparoscope and standard laparoscopic instruments in the day-case setting. PRESENTATION OF CASES We report three cases of ventral hernias (one primary and two incisional). All were completed using single port techniques. They were done in the ambulatory setting and require no admission. Single incision laparoscopic repair of primary and incisional ventral hernias was completed successfully in all cases without conversion to standard laparoscopy. Median (range) operative time was 66min (39-95min). No intra- or postoperative complications were recorded. No episodes of prolonged postoperative pain were reported. We examine the literature and subsequently discuss the feasibility of ambulatory single port ventral hernia repair. CONCLUSION SILS prosthetic repair of primary and incisional ventral hernia is easily feasible. In our series, SILS ventral hernia repair appears to be safe and effective. It may decrease parietal trauma augmenting its use in the ambulatory setting. Technology will continue to improve the wide applicability of this technique. Larger randomized trial studies are required to determine the rates of port-site incisional hernia compared with multiport laparoscopy.