Watch this detailed video on Laparoscopic Repair of Incisional Hernia using Two Ports. Learn the step-by-step minimally invasive technique, surgical tips, and key considerations for a successful hernia repair. This educational video is perfect for surgeons, trainees, and medical professionals interested in advanced laparoscopic procedures.

Various ventral and incisional hernia repair techniques exist and have largely replaced the open ones. The purpose of this video is to show the 2-port technique and demonstrate that it is feasible, efficient, and safe. Laparoscopic herniorrhaphy with the 2-port technique offers an efficient, safe, and effective repair for ventral and incisional hernias. We at Worls Laparoscopy Hospital started performing all the ventral hernia by two port in year 2002. Access to the abdomen and creation of pneumoperitoneum is obtained by placing a Veress needle in the left upper quadrant. One 10-mm to 12-mm balloon port and one 5-mm straight port are placed opposite the hernia as laterally as possible, preferably on the left side. The surgeon's nondominant hand compresses the abdominal wall to bring it down to the scissors tip or Harmonic scalpel for dissection or adhesiolysis. The hernia sac content is then reduced, and the margins of the hernia defect cleared circumferentially to a distance of at least 6 cm.

Incisional hernia is a common complication following abdominal surgery, occurring at the site of a previous surgical incision. Traditional open repair techniques often involve large incisions, prolonged recovery, and a higher risk of wound complications. Over the years, minimally invasive approaches like laparoscopic hernia repair have revolutionized treatment, offering patients faster recovery, less postoperative pain, and reduced hospital stays. Among these approaches, two-port laparoscopic repair has emerged as a safe and efficient technique for selected patients.

What is Two-Port Laparoscopic Repair?

Two-port laparoscopic repair is a minimally invasive technique for treating incisional hernias using only two small incisions (ports). Unlike conventional multi-port laparoscopic procedures that may use three or more ports, this method reduces surgical trauma while maintaining effectiveness. It is particularly suitable for small to medium-sized hernias and patients who seek faster recovery and better cosmetic results.

Indications

Two-port laparoscopic repair is indicated in patients with:

• Small to medium-sized incisional hernias (usually <10 cm in diameter)

• Hernias without significant loss of abdominal domain

• Patients without extensive intra-abdominal adhesions

• Individuals seeking minimally invasive surgery for faster recovery

Surgical Technique

1. Patient Preparation:
   The patient is placed in a supine position, under general anesthesia. Prophylactic antibiotics are administered to reduce the risk of infection.

2. Port Placement:
   A primary port is inserted, usually at a site distant from the hernia, for the laparoscope. A secondary working port is placed under direct vision to introduce surgical instruments.

3. Adhesiolysis:
   Any adhesions from previous surgeries are carefully dissected to expose the hernia defect.

4. Hernia Reduction:
   The hernia sac and its contents are reduced into the abdominal cavity.

5. Mesh Placement:
   A synthetic mesh is introduced through one of the ports and positioned over the defect. The mesh is usually fixed using tacks, sutures, or a combination of both to ensure stability.

6. Closure:
   The ports are removed, and the small incisions are closed with absorbable sutures or skin adhesive.

Advantages of Two-Port Technique

• Minimally Invasive: Smaller incisions lead to less postoperative pain and better cosmetic outcomes.

• Reduced Recovery Time: Most patients can resume daily activities within a few days.

• Lower Complication Rates: Fewer ports mean reduced risk of port-site hernias and infections.

• Enhanced Precision: Laparoscopic visualization allows accurate placement of the mesh.

Limitations

• Not ideal for very large or complex hernias.

• Requires advanced laparoscopic skills.

• Dense adhesions may necessitate conversion to a multi-port or open approach.

Postoperative Care

• Early mobilization is encouraged to prevent complications such as deep vein thrombosis.

• Pain is usually managed with oral analgesics.

• Patients are advised to avoid heavy lifting for at least 4–6 weeks.

• Follow-up imaging may be done to ensure proper mesh placement and healing.

Conclusion

The two-port laparoscopic repair of incisional hernia is an effective and patient-friendly technique that combines the benefits of minimally invasive surgery with excellent surgical outcomes. With proper patient selection and skilled surgical execution, this approach can significantly improve recovery, reduce complications, and enhance patient satisfaction. As laparoscopic expertise continues to evolve, the two-port technique is likely to become a preferred method for many incisional hernia repairs worldwide.