This video demonstrates Forty patients with ventral hernias (VH) or incisional hernias (IH) underwent laparoscopic repair with a 2-port technique. The technique involves insertion of one 10-mm to 12-mm balloon port and one 5-mm port, usually on the left side as laterally as possible.

Incisional hernia is a common long-term complication following abdominal surgery, occurring when the previous surgical incision weakens and allows abdominal contents to protrude through the abdominal wall. With the advancement of minimally invasive surgery, laparoscopic repair has become a preferred option because of less postoperative pain, faster recovery, and reduced complications compared with open surgery.

World Laparoscopy Hospital (WLH), Gurugram, is known for teaching advanced minimal access surgical techniques, including the two-port laparoscopic repair of incisional hernia, which is designed to further minimize tissue trauma and improve patient outcomes.

Concept of Two-Port Laparoscopic Incisional Hernia Repair

The two-port technique is a refined laparoscopic approach where only two trocars are used instead of the conventional three or more. Typically, this involves:

• One 10–12 mm port (usually balloon or optical port)

• One 5 mm working port
  These ports are placed laterally (often left side) away from the hernia defect to allow better visualization and instrument handling.

The hernia contents are reduced, adhesions are released, and mesh is introduced through the larger port and fixed using sutures or fixation devices.

Technique Practiced at World Laparoscopy Hospital

At WLH, the two-port incisional hernia repair is performed as an intraperitoneal onlay mesh (IPOM) technique, which is minimally invasive and reliable. The procedure generally includes:

1. Creation of Pneumoperitoneum
   Access is usually obtained using a Veress needle to inflate the abdomen with CO₂.

2. Port Placement

   • One 10–12 mm port

   • One 5 mm port
     Positioned opposite the hernia defect for optimal ergonomics.

3. Adhesiolysis and Reduction of Hernia Content
   Adhesions are carefully released using energy devices or scissors.

4. Defect Preparation
   Hernia margins are cleared circumferentially (usually ~6 cm) for mesh overlap.

5. Mesh Placement
   Dual mesh or composite mesh is placed intraperitoneally and fixed using sutures and/or tacks.

This method aims to achieve strong abdominal wall reinforcement with minimal port trauma.

Clinical Outcomes and Evidence

Studies evaluating two-port laparoscopic hernia repair have shown encouraging outcomes:

• Operative time: ~15–70 minutes

• Low recurrence rates (very few recurrences in follow-up)

• Acceptable complication profile

• Good long-term patient satisfaction

More broadly, laparoscopic incisional hernia repair compared to open repair has shown:

• Less blood loss

• Lower postoperative pain

• Shorter hospital stay

• Faster return to normal activity

• Lower complication rates

These findings support minimally invasive repair as a patient-friendly and effective option.

Advantages of Two-Port Technique

1. Reduced Surgical Trauma
Fewer ports mean less tissue injury and smaller scars.

2. Less Postoperative Pain
Smaller incisions typically translate into lower pain scores.

3. Faster Recovery
Patients often resume normal activities earlier compared to open repair.

4. Cosmetic Benefit
Minimal scars improve cosmetic outcomes.

5. Cost Effectiveness
Fewer ports and instruments may reduce procedural cost in selected cases.

Indications

Two-port laparoscopic repair can be considered in:

• Small to moderate incisional hernias

• Recurrent hernias

• Patients requiring faster recovery

• Patients suitable for general anesthesia and pneumoperitoneum

Limitations

Despite advantages, some challenges remain:

• Risk of bowel injury during adhesiolysis (rare but possible)

• Requires advanced laparoscopic expertise

• Dense adhesions may require conversion to multi-port or open surgery

Role of WLH in Surgical Training

World Laparoscopy Hospital is globally recognized for training surgeons in advanced laparoscopic and minimal access techniques. The institution emphasizes:

• Hands-on simulation training

• Live surgery exposure

• Evidence-based surgical protocols

• Standardized mesh fixation and defect closure methods

The two-port technique taught at WLH reflects ongoing evolution toward less invasive yet effective abdominal wall reconstruction.

Conclusion

Laparoscopic repair of incisional hernia by two ports represents an advanced evolution of minimal access hernia surgery. By reducing the number of ports without compromising surgical effectiveness, this technique offers excellent clinical outcomes, faster recovery, and improved patient satisfaction. With structured training and standardized protocols, institutions like World Laparoscopy Hospital are helping surgeons adopt such innovative techniques safely and effectively.