The 39-year-old patient, case history no. 2634/ 426/02/09, a manual worker, was admitted electively, without concurrent diseases, with body mass index (BMI) = 25 kg/m2. Physical examination revealed a soft tumour with the diameter of 4-5 cm, becoming apparent with tightened muscles, with no palpable pain, reducible into the cavity of the abdomen, inguinal ring widened to 3 cm at the side of the hernia. Laboratory reports included normal values. Preliminary diagnosis was not verified by ultrasound. After the patient had been informed about the suggested technique and his consent obtained, he was qualified for TAPP inguinal hernioplasty performed via a single incision (SILS). The procedure was performed under endotracheal general anaesthesia.
The procedure, previously performed through 3 ports (a 10-mm port inserted in the lower region of the umbilical fold and two 5-mm ports placed at 1/3 distance between the umbilicus and the anterior iliac spine), this time was performed using the single incision approach with the SILS Port system (Covidien). Two Kocher clamps were used to lift up the umbilical fundus in order to insert the port. After that, the skin in the sagittal section of the everted umbilicus was cut from its upper to lower base and next 2.5 cm incisions of the fascia and peritoneum were made. The SILS port was placed through the incision and three 10-5-5 mm Dexide trocars were inserted through its preplaced spaces. CO2 insufflation was performed via a special, separate channel and 12-mmHg pneumoperitoneum was established. Then the patient was placed in a 30° Trendelenburg position, which caused the small bowel loop to move up and allowed for complete visualization of the surgical field with 5 mm, 30° scope. After the portion of the greater omentum had been moved, oblique inguinal hernia on the right side was observed. Further procedure did not differ from classic TAPP surgery performed in classic laparoscopy. First, the peritoneal incision was made in an arc from the pubic tubercle towards the iliac spine in order to create a lower flap. Next, the hernia sac was dissected from the spermatic cord with monopolar diathermy scissors, and the hernia ring was covered with a 13 cm × 8 cm polypropylene mesh (Surgical Mesh, Grena LTD), placed in the peritoneal cavity through a 10 mm channel in the SILS port and attached with titanium screws of Protac by Covidien. Following that, the implanted mesh was covered with the previously created lower flap of the parietal peritoneum. After the haemostasis had been checked, the SILS port was removed from the umbilical incision and the fascia was sewn with a continuous no. 2 non-absorbable suture. Finally, the umbilicus was carefully, from the cosmetic point of view, closed with single 3-0 absorbable sutures. The total time of the procedure from the cutaneous incision to the last suture was 43 min. Ketoprofen was administered twice intravenously during postoperative care. The patient in good general condition was released on the 2nd postoperative day and the follow-up appointment in the surgical out-patient clinic was recommended. Two years after the procedure, the patient does not report any ailments. Painful sensations were present only on the 1st day after the procedure. During the physical examination 2 years after the procedure no hernia recurrence was observed and the cosmesis is exquisite; no scar is visible.