MINIMALLY INVASIVE APPROACH UTILIZING LINEAR STAPLER FOR MIDLINE INCISIONAL HERNIA: STAPLER REPAIR TECHNIQUE

Abstract Background We have successfully developed the Stapler Repair Technique (SRT), a straightforward laparoscopic Rives-Stoppa approach employing a linear stapler, and retrospectively evaluated its short-term outcomes to ascertain its safety and efficacy. Surgical procedure With a small incision performed near the pubic symphysis, the rectus abdominis muscle is carefully mobilized in a ventral direction. Subsequently, the rectus abdominis muscle and posterior sheath are meticulously dissected using endoscopic techniques along the arch line, enabling precise exposure of the hernia orifice. The hernia orifice is securely closed using a linear stapler, and a mesh is delicately placed within the same space. Methods We reviewed the surgical outcomes of 63 patients who underwent laparoscopic midline incisional hernia repair in our department from August 2017 to December 2023, employing our technique. Results Among the patients, there were 26 cases treated with intraperitoneal onlay mesh (IPOM), 16 cases with Laparoscopic Trans-Abdominal Retromuscular (TARM), and 21 cases with SRT, with no significant differences in patient background. The surgical time (range) was 94 minutes (50–211) for IPOM, 256 minutes (196–300) for TARM, and 126 minutes (60–224) for SRT; the mesh area (range) was 155 cm² (80–500) for IPOM, 500 cm² (270–780) for TARM, and 391 cm² (300–720) for SRT. The surgical time (P <0.001) and mesh area (P = 0.003) were significantly lower in the SRT group than in the TARM group. Conclusions SRT presents a simple and minimally invasive approach. Further accumulation of cases and demonstration of long-term results are necessary.