When American teenager, Johnny Stoch, was planning his summer vacation to Nassau, Bahamas in August 2016, he never could have imagined being confronted by a formidable force in the form of a large shark. While snorkeling with his family in the crystal clear and normally serene waters, the 15-year-old’s leg was grabbed by the shark and bitten into. With the help of the boat crew and his family, Johnny was immediately pulled in and rushed to the hospital; but, whether or not his leg, which now had a giant chunk missing from it and was bleeding severely, could be saved was unknown. Upon arrival at the hospital, Stoch was confronted by another formidable force—Dr. Ross Downes, a skilled and talented surgeon who immediately sprang into action to save Johnny’s life and his leg.
“I thought my whole leg was gone, but turns out it wasn’t,” Stoch said. “I really want to thank the doctor that saved my leg because without him I wouldn’t have one. [Thank you] Dr. Downes.” (ABC NEWS)
Stoch was not Dr. Downes’ first success story by any means. As a general surgeon and laparoscopic specialist, Dr. Downes has helped many patients with a variety of needs ranging from emergency appendectomies and cholecystectomies to gynecological procedures, hernia repair and many more procedures. Downes specializes in general surgery and laparoscopic surgery and is the managing director at The Surgi Centre, the Bahamas’ only outpatient surgery center using single port laparoscopic treatment to minimize a patient’s pain, recovery time and scarring. With this revolutionary technology, ONE single incision is made into the navel and through it, the entire surgery is both viewed and performed. Downes’ patients continually remark that they cannot believe just how quickly they’re able to resume normal activity post-surgery.
Downes was born in Barbados and received his medical degrees from the University of the West Indies in Jamaica as well as Grambling State University and the University of Southern California in the United States, but he now resides and practices in Nassau. In addition to his work at The Surgi Centre, he’s also the Director of Operations at the Centerville Medical Centre and a consultant at Doctors Hospital. He is a member of the Society of Gastrointestinal and Endoscopic Surgeons (SAGES), and was recently added to OPEN ACCESS journal’s editorial board of clinics in Surgery-General Surgery.
The consensus about whether the single port approach is advantageous remains controversial. As the ambulatory service becomes the standard of care, techniques are in evolution to augment the patient experience in this setting. This forms the basis for evaluating SILS (Single Incision Laparoscopic Surgery) prosthetic ventral hernia repair in the ambulatory setting. We report a SILS technique of ventral hernia repair using the Stryker Ideal-eyes articulating laparoscope and standard laparoscopic instruments in the day-case setting.
We report three cases of ventral hernias (one primary and two incisional). All were completed using single port techniques. They were done in the ambulatory setting and require no admission. Single incision laparoscopic repair of primary and incisional ventral hernias was completed successfully in all cases without conversion to standard laparoscopy. Median (range) operative time was 66 min (39–95 min). No intra- or postoperative complications were recorded. No episodes of prolonged postoperative pain were reported. We examine the literature and subsequently discuss the feasibility of ambulatory single port ventral hernia repair.