Laparoscopische extraperitoneale endoscopische stapler-baseierte sublay operation (LEESS) mit transversus abdominis release wie ich es mache

Aim To describe the novel LEESS technique with transversus-abdominis release with mesh augmentation in the category of “How I do it” in a specific case with a problematic clinical situation characterized by a challenging incisional hernia.

Material and methods Scientific case report.

Results (Kasuistik) A 61-years old male patient with multiple symptomatic incisional hernia M2M3W2 state after complicated small and large bowel resection with anastomosis insufficiency is presented. LEESS operation was performed under general anesthesia and took approximately 150 min. In detail, patient was positioned on the operating table in the “French position”. First entry port was placed at the left upper abdominal wall. The stapler was introduced under laparoscopy guidance. Transversus-abdominis release was executed to avoid tension on the posterior rectus sheath. UltraPro^® mesh (size, 30 x 25 cm; Ethicon, Norderstedt, Germany) was inserted into the sublay space. Postoperatively, there was no intra- or postoperative complication (hospital stay, 4 d).After a follow-up time period of 12 months, there were no further complaints or problems.In addition, there was a high level of satisfaction in the patient created by the operative success and further successful clinical course as reported.

Conclusion The LEESS technique with transversus-abdominis release with mesh augmentation is an innovative, minimally invasive, feasible and safe surgical procedure for treatment of patients with symptomatic large incisional hernia. Further experiences are needed to be obtained in systematic studies to assess finally the value of this specific technique.

Publication History

Article published online:
07 September 2021