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Wang CY, Chien TH, Chien CY. The mentoring effects of learning curve of total extraperitoneal hernioplasty: the CUSUM analysis of the pioneer and second-generation surgeon. Surg Endosc 2025; 39:3337-3345. [PMID: 40240701 DOI: 10.1007/s00464-025-11729-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Accepted: 04/06/2025] [Indexed: 04/18/2025]
Abstract
BACKGROUND Most studies demonstrated that the learning curve of total extraperitoneal hernioplasty (TEP) is around 30-80 cases. All these studies were performed by a single surgeon who had little or no experience of TEP repair before. However, with mentoring by experienced surgeon, the second-generation surgeon may get more familiar with the anatomy and procedures of TEP than the pioneer surgeon. Besides, the surgical caveats would be further understood and pitfalls avoided by mentoring with the pioneer surgeon. The aims of this study were to investigate the effects of mentoring by pioneer surgeon to the second-generation surgeon in the TEP operation by comparing the learning curve and complications of pioneer and second-generation surgeon. METHODS We retrospectively reviewed our TEP cases performed by the two surgeons, the pioneer surgeon and the second-generation surgeon, in general surgery department in Chang Gung Memorial Hospital, Keelung division. The reviewed period was between January 2016 and December 2021. The pioneer surgeon performed the TEP surgery by himself. The second-generation surgeon attended 20-30 cases of TEP done by pioneer surgeon. Then, the pioneer surgeon mentored the second-generation surgeon's first 10 TEP cases. By comparing the operation time, the intraoperative and post-operative complications, cumulative sum (CUSUM) learning curve was used for analysis. RESULTS The CUSUM analysis reveals that the learning curve of TEP is around 45 procedures in the pioneer surgeon and 30 procedures in the second-generation surgeon. The median operation time in pioneer surgeon and second-generation surgeon is 103.5 vs 90 min (p = 0.03). The overall intraoperative and post-operative complications between pioneer and second-generation surgeon reveal no significant difference. After crossing the learning curve, the operation time of pioneer surgeon and the second-generation surgeon decreased significantly, from 114 to 93 min (p = 0.008) and from 103 to 87.2min (p = 0.032), respectively. However, there was no significant difference in the overall post-operative complications. CONCLUSIONS By mentoring with the pioneer surgeon, the second-generation surgeon may achieve the learning curve quicker than the pioneer surgeon in terms of operation time. After reaching the learning curve, the operation time before and after learning curve reveal significant different in both surgeons while the overall post-operative complications reveal no significant different.
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Affiliation(s)
- Chih-Yuan Wang
- Department of General Surgery, Keelung Chang Gung Memorial Hospital, No 222, Maijin Rd., Anle Dist., Keelung City, 204201, Taiwan.
| | - Ti-Hsuan Chien
- Department of General Surgery, Keelung Chang Gung Memorial Hospital, No 222, Maijin Rd., Anle Dist., Keelung City, 204201, Taiwan
| | - Chih-Ying Chien
- Department of General Surgery, Keelung Chang Gung Memorial Hospital, No 222, Maijin Rd., Anle Dist., Keelung City, 204201, Taiwan
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Ma R, Jiang H, Guo Y, Zhang X, Wang X, Zhang C. Retrograde puncture for trocar placement for the establishment of the preperitoneal space in laparoscopic totally extraperitoneal repair for groin hernias: 10 years of experience. Surg Endosc 2025; 39:2874-2881. [PMID: 40087181 PMCID: PMC12040974 DOI: 10.1007/s00464-025-11623-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 02/17/2025] [Indexed: 03/17/2025]
Abstract
OBJECTIVES The aim of this study was to investigate the feasibility and safety of retrograde puncture for trocar placement for the establishment of the preperitoneal space in laparoscopic total extraperitoneal repair (TEP) for groin hernias. METHODS A retrospective analysis of the clinical data of 1388 patients who underwent TEP surgery for a groin hernia at the General Hospital of Northern Theater Command of the Chinese People's Liberation Army (hereinafter referred to as the General Hospital of Northern Theater Command) from August 2013 to August 2023 was conducted. The feasibility and safety of retrograde puncture for trocar placement for the establishment of the preperitoneal space were examined. RESULTS All 1388 operations were successful, with no conversion to open surgery. The mean time for unilateral placement of the Trocars was 6.36 ± 2.32 min. The mean time for unilateral hernia surgery was 42.73 ± 10.33 min, and the mean time for bilateral hernia surgery was 73.11 ± 20.31 min. Peritoneal injuries were observed in 8 patients (0.58%), but there were no abdominal organ injuries. Two patients (0.14%) had inferior epigastric vascular injuries, and 16 patients (1.15%) experienced muscle hemorrhage during retrograde puncture. Twenty-five patients (1.80%) had postoperative local hematomas of the abdominal wall, and 37 patients (2.67%) had subcutaneous emphysema. Sixty-four patients (4.61%) experienced seroma retention, and 13 patients (0.94%) experienced urinary retention. The postoperative follow-up period ranged from 3 to 124 months, with a median follow-up time of 66 months. None of the patients experienced recurrence, persistent pain, localized foreign body sensation, mesh infection, or incision infection. CONCLUSIONS The retrograde puncture method for placing trocars to establish the preperitoneal space in laparoscopic TEP surgery for groin hernias is feasible and safe.
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Affiliation(s)
- Rui Ma
- Department of General Surgery, General Hospital of Northern Theater Command of Chinese People's Liberation Army, Shenyang, 110016, Liaoning, China
| | - Huiyong Jiang
- Department of General Surgery, Northeast International Hospital, Shenyang, 110016, Liaoning, China
| | - Yijun Guo
- Department of General Surgery, General Hospital of Northern Theater Command of Chinese People's Liberation Army, Shenyang, 110016, Liaoning, China
| | - Xuefeng Zhang
- Department of General Surgery, Northeast International Hospital, Shenyang, 110016, Liaoning, China
| | - Xize Wang
- Department of General Surgery, General Hospital of Northern Theater Command of Chinese People's Liberation Army, Shenyang, 110016, Liaoning, China
| | - Cheng Zhang
- Department of General Surgery, General Hospital of Northern Theater Command of Chinese People's Liberation Army, Shenyang, 110016, Liaoning, China.
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Trad KS, Thiru SS, Stirrat TP, Marino PJ, Prevou ER, Greer ME, Alimi YR. Balloon dissection for robotic totally extra-peritoneal (rTEP) inguinal herniorrhaphy: description of a modified technique and report on 97 consecutive patients. Hernia 2025; 29:115. [PMID: 40072628 DOI: 10.1007/s10029-025-03312-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Accepted: 03/01/2025] [Indexed: 03/14/2025]
Abstract
PURPOSE As the use of robotic platforms for inguinal hernia repairs continues to grow, the rTAPP (Robotic Trans-Abdominal Pre-Peritoneal) approach is being performed significantly more often than rTEP (Robotic Totally Extra-Peritoneal) and is predominantly taught to newly trained robotic surgeons. This study's primary objective was to evaluate the feasibility of a proposed modified rTEP technique that incorporates balloon dissection as a primary tool, enabling the horizontal placement of three trocars aligned with the umbilicus. Secondary objectives included evaluation of safety and effectiveness of this technique, and of the learning curve required to reach proficiency. METHODS From February 2023 to April 2024, a total of 97 consecutive patients (87 males, 10 females) with an average age of 61 years (range 17-89) and a mean body mass index of 26 kg/m2 (21-37) underwent rTEP for the repair of 122 inguinal and femoral hernias. All procedures were performed by a single surgeon following a standardized protocol detailed in this manuscript. Key metrics and events assessed included conversions to open or laparoscopic approaches, console operating times, postoperative narcotic usage, postoperative complications, serious adverse events, unplanned returns to the operating room within 30 days, and hernia recurrences. Cumulative sum (CUSUM)_sequential analysis was used for determination of the learning curve. RESULTS Repaired hernias included 57 indirect (46.7%), 48 direct (39.3%), 4 femoral (3.3%) and 13 mixed (10.7%). There were no conversions to open or laparoscopic surgery, and the average console time was 45 min for unilateral repairs and 68 min for bilateral repairs. 70% of patients elected not to use the narcotic prescribed for postoperative analgesia. There was one serious adverse event (1/97, 1.0%), and one unplanned return to the operating room within 30 days (1/97, 1.0%). Over an average follow-up period of 52 weeks (range 25-87 weeks), there was one recurrence (1/122, 0.8%). In our analysis of the learning curve, we found that proficiency was reached around the 24th non-complex unilateral case. CONCLUSION The modified rTEP technique utilizing balloon dissection is feasible, reproducible and time efficient. This study demonstrates its safety and effectiveness. The technique provides superior visualization of the extraperitoneal space, facilitates manipulation of robotic wristed instruments, and ensures proper mesh placement. Early postoperative outcomes suggest that rTEP could play an important role in the surgical management of inguinal and femoral hernias. Further studies are needed to provide data on short and long-term quality of life, and to compare rTEP to rTAPP.
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Affiliation(s)
- Karim S Trad
- Division of General Surgery, Georgetown University School of Medicine, Washington, DC, USA.
- Department of General Surgery, MedStar Georgetown University Hospital, Washington, DC, USA.
| | - Shankar S Thiru
- Georgetown University School of Medicine, Washington, DC, USA
| | | | - Paul J Marino
- Department of General Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Elizabeth R Prevou
- The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | | | - Yewande R Alimi
- Department of General Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
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Huerta S, Garza AM. A Systematic Review of Open, Laparoscopic, and Robotic Inguinal Hernia Repair: Management of Inguinal Hernias in the 21st Century. J Clin Med 2025; 14:990. [PMID: 39941661 PMCID: PMC11818799 DOI: 10.3390/jcm14030990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2024] [Revised: 01/28/2025] [Accepted: 02/03/2025] [Indexed: 02/16/2025] Open
Abstract
Background: In the 21st century, the management of groin hernias (GHs) has evolved from watchful waiting (WW) to robotic hernia repair (RHR). The present study interrogates the status of robotics in the context of current repairs and provides one author's perspectives. Methods: A systematic review was undertaken using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines for studies comparing open (OHR) to robotic hernia repair (RHR); RHR to laparoscopic hernia repair (LHR); or OHR vs. LHR vs. RHR. The historical context was extracted from previous reviews. Results: Fifty-four studies were included in the analysis. Three techniques have withstood the test of time: OHR (tissue and mesh repairs), laparo-endoscopic (TEP and TAPP), and RHR. The literature indicates that RHR is safe and effective for the management of groin hernias. Operative times and costs remain a concern when using this technique. While the number of overall complications with RHR is similar to OHR, in a minority of cases, complications are more consequential with the robotic platform. Conclusions: RHR has emerged as an unequivocally powerful technique for the management of GHs. OHR remains the technique of choice for local/regional anesthesia, posterior recurrences, and in centers that lack other platforms. In low- and middle-income countries, OHR is the most utilized technique. Centers of excellence should offer all techniques of repair including WW.
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Affiliation(s)
- Sergio Huerta
- VA North Texas Health Care System, Dallas, TX 75216, USA
| | - Amanda M. Garza
- University of Texas Southwestern Medical Center, Dallas, TX 75390, USA;
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Şenol Z. Evaluation of Surgical Results and Effectiveness of Laparoscopic Transabdominal Preperitoneal and Laparoscopic Totally Extraperitoneal Approaches in Bilateral Inguinal Hernia Repair: A Randomized Analysis. J Laparoendosc Adv Surg Tech A 2025; 35:152-155. [PMID: 39515379 DOI: 10.1089/lap.2024.0360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2024] Open
Abstract
Background: Laparoscopic surgery is recommended as the standard approach for bilateral inguinal hernia repair. There are few studies in the literature comparing laparoscopic transabdominal preperitoneal (TAPP) and laparoscopic total extraperitoneal (TEP) approaches for bilateral inguinal hernia repair. This study aimed to compare the surgical outcomes and effectiveness of laparoscopic TAPP and laparoscopic TEP methods applied in bilateral inguinal hernia repair. Methods: A total of 100 patients operated on for bilateral inguinal hernia by applying laparoscopic TAPP and laparoscopic TEP methods from January 2016 to March 2023 were included in the study. The patients were randomized equally in two groups. Postoperative follow-up results were statistically analyzed in terms of recurrence rate, swelling in the incisions, scrotal edema and swelling, suture dehiscence, and the average time to return to work. Results: In bilateral inguinal hernia patients operated with laparoscopic TAPP method compared with bilateral inguinal hernia patients operated with laparoscopic TEP method, postoperative recurrence rate was significantly lower (2% versus 16%), swelling in the incision sites was significantly less (4% versus 24%), and the average time to return to work was significantly shorter (3.6 ± 2.3 versus 6.3 ± 5.8) (P < .05). Scrotal edema and swelling and suture dehiscence results did not show significant differences between the two approaches (P > .05). Conclusions: Both methods are widely used in bilateral inguinal hernia repairs. Postoperative results revealed that the laparoscopic TAPP method with less postoperative recurrence rate and less swelling in the incision sites, and shorter average time of the patients to return to work appears to be superior to the laparoscopic TEP method.
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Affiliation(s)
- Zafer Şenol
- Department of General Surgery, Selimiye Mah., Tıbbiye Cad., Uskudar, Health Sciences University Sultan 2. Abdulhamid Han Training and Research Hospital, Istanbul, Turkiye
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Yang B, Xie CH, Lv YX, Wang YQ. Rare but important gastrointestinal complications after laparoscopic inguinal hernia repair: a single-center experience. Sci Rep 2025; 15:2593. [PMID: 39833488 PMCID: PMC11747373 DOI: 10.1038/s41598-025-87188-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Accepted: 01/16/2025] [Indexed: 01/22/2025] Open
Abstract
Transabdominal preperitoneal patch plasty (TAPP) versus total extraperitoneal patch plasty (TEP) are surgical techniques commonly used to treat inguinal hernia. However, studies indicate that both procedures may lead to significant complications, particularly gastrointestinal complications, some of which can be life-threatening. We statistically analyzed the complications caused by adult inguinal hernia patients admitted from 2018 to 2022. We focused on gastrointestinal complications and conducted a case-by-case analysis on their causes and treatment processes. A total of 1034 patients were included in the final analysis, with 783 patients receiving TAPP treatment and 251 patients undergoing TEP. The overall complication rate for the TAPP group was slightly higher at 4.72% compared to 3.58% in the TEP group, but the difference was not statistically significant (p = 0.446). The incidence of both common and gastrointestinal complications is similar between the two groups, with no significant difference observed. Five patients (0.48%) suffered gastrointestinal complications, one with gastric perforation after TEP surgery, and four during TAPP surgery. All five cases of gastrointestinal complications were Grade III or higher according to the Clavien-Dindo classification, and all required reoperation. Gastrointestinal complications, though rare in LIHR, often require readmission and reoperation. Attempting non-operative management of such complications may lead to disastrous consequences. The majority of these complications are attributed to improper use of surgical instruments, necessitating vigilance on the part of the surgical team in preventing them.
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Affiliation(s)
- Bo Yang
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, No. 99, Longcheng Street, Xiaodian District, Taiyuan, 030032, Shanxi Province, China
| | - Chang-Hu Xie
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, No. 99, Longcheng Street, Xiaodian District, Taiyuan, 030032, Shanxi Province, China
| | - Yu-Xing Lv
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, No. 99, Longcheng Street, Xiaodian District, Taiyuan, 030032, Shanxi Province, China
| | - Yin-Quan Wang
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, No. 99, Longcheng Street, Xiaodian District, Taiyuan, 030032, Shanxi Province, China.
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Park JY, Han SR, Song JY. Single-port Laparoscopic Bilateral Orchiectomy via Total Extraperitoneal Approach in Androgen Insensitivity Syndrome. J Minim Invasive Gynecol 2025:S1553-4650(24)01554-1. [PMID: 39761868 DOI: 10.1016/j.jmig.2024.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2024] [Revised: 12/06/2024] [Accepted: 12/09/2024] [Indexed: 03/16/2025]
Affiliation(s)
- Jung Yoon Park
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea (Drs. Park and Song)
| | - Seung-Rim Han
- Department of Surgery, Ain Hospital, Incheon, Korea (Dr. Han)
| | - Jae-Yen Song
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea (Drs. Park and Song).
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Chaoui AM, Rops JP, van Dijk WA, Loos MJA, Scheltinga MRM, Zwaans WAR, Slooter GD. Inguinal hernia recurrence after laparoscopic mesh removal for chronic pain: a single-center experience with 11 years of practice. Surg Endosc 2025; 39:300-306. [PMID: 39528657 DOI: 10.1007/s00464-024-11354-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 10/11/2024] [Indexed: 11/16/2024]
Abstract
INTRODUCTION Up to 12% of patients undergoing minimally invasive inguinal hernia repair may develop chronic postoperative inguinal pain (CPIP), possibly explained by the presence of mesh. Recent studies reported that laparoscopic mesh removal is feasible and safe. However, the risk of a hernia recurrence is unknown. This observational study describes the rate of hernia recurrence and evolution in pain score following laparoscopic mesh removal for CPIP after preperitoneal inguinal hernia repair. METHODS Prospectively collected questionnaires and operative notes of consecutive patients undergoing a laparoscopic mesh removal for CPIP in our center of expertise between November 2011 and July 2022 were studied. Pain scores were quantified using the Numeric Pain Rating Scale (NRS, 0-10). The presence of a hernia recurrence was based on patient history and clinical findings. RESULTS A total of 89 patients underwent laparoscopic mesh removal, and data of 83 patients (93% response rate) were available for analysis. Median decrease in pain score (NRS) after mesh removal was 4 (range + 2 to - 9). After a median 4.3 years follow up period, a hernia recurrence was present in 18 patients (21.7%). Of these, eight were symptomatic requiring correction using a Lichtenstein repair with a favorable outcome whereas a wait-and-see approach was successfully followed in the remaining 10 patients. CONCLUSION Laparoscopic mesh removal for CPIP following preperitoneal inguinal hernia repair resulted in an inguinal hernia recurrence in one of five patients requiring remedial surgery in one in ten patients. This knowledge may inform the preoperative counseling process.
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Affiliation(s)
- A M Chaoui
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands.
| | - J P Rops
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
| | - W A van Dijk
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
- SolviMáx, Center of Excellence for Abdominal Wall and Groin Pain, Máxima Medical Center, Eindhoven, The Netherlands
| | - M J A Loos
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
- SolviMáx, Center of Excellence for Abdominal Wall and Groin Pain, Máxima Medical Center, Eindhoven, The Netherlands
| | - M R M Scheltinga
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
- SolviMáx, Center of Excellence for Abdominal Wall and Groin Pain, Máxima Medical Center, Eindhoven, The Netherlands
| | - W A R Zwaans
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
- SolviMáx, Center of Excellence for Abdominal Wall and Groin Pain, Máxima Medical Center, Eindhoven, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - G D Slooter
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
- SolviMáx, Center of Excellence for Abdominal Wall and Groin Pain, Máxima Medical Center, Eindhoven, The Netherlands
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Dinçer B, Ömeroğlu S, Ethem Akgün İ. Telescopic Dissection as a Cost-Effective Alternative to Balloon Trocar for Preperitoneal Dissection in Total Extraperitoneal Inguinal Hernia Repair. J Laparoendosc Adv Surg Tech A 2024; 34:1084-1087. [PMID: 39235339 DOI: 10.1089/lap.2024.0223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2024] Open
Abstract
Background: Total extraperitoneal (TEP) approach is one of the commonly used minimally invasive method in inguinal hernia repair. There are limited data that compares the results of the telescopic dissection and balloon trocar for preperitoneal dissection. In our study, we aimed to retrospectively evaluate the TEP cases performed at our center and compare the results of these two techniques. Methods: TEP cases performed between 2020 and 2024 were evaluated. Strangulated and recurrent hernia cases were excluded. Telescopic dissection and balloon trocar techniques were compared in terms of conversion, postoperative pain, complications, and recurrence. Results: A total of 177 patients were included. Telescopic method was used in 122 cases, while a balloon trocar was used in 55 cases. The median age was 50 years (range: 20-86), and 163 patients (92%) were male. Bilateral inguinal hernia was present in 61 patients (35%). The median operative time was 100 minutes (IQR: 80-120 minutes). Conversion was required in a total of 3 cases (1.5%); specifically, the transabdominal preperitoneal method was employed in 2 cases, and Lichtenstein-style anterior approach hernia repair was performed in one case. Between the telescopic dissection and balloon trocar groups, no significant differences were observed in operation time (P = .407), conversion rates (P = .228), postoperative pain scores (P = .505, P = .264, P = .681, P = .743), complication rates (P = .205), or recurrence rates (P = .311). Conclusions: The results of using a balloon trocar and telescopic dissection in inguinal hernia repair with TEP are similar, and telescopic dissection could be a cost-effective alternative to the balloon trocar.
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Affiliation(s)
- Burak Dinçer
- Department of Surgical Oncology, Ankara Oncology Training and Research Hospital, Ankara, Turkiye
| | - Sinan Ömeroğlu
- Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkiye
| | - İsmail Ethem Akgün
- Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkiye
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Sharma K, Koul A, Puri G, Rathore YS, Chrungoo RK. Comparison of modified tumescent and conventional laparoscopic transabdominal pre-peritoneal repair in the patients of inguinal hernia: A randomised control trial. J Minim Access Surg 2024:01413045-990000000-00095. [PMID: 39611555 DOI: 10.4103/jmas.jmas_99_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 07/30/2024] [Indexed: 11/30/2024] Open
Abstract
INTRODUCTION Inguinal hernia surgery, a common procedure worldwide, continues to develop to achieve minimal access and tension-free repairs. However, a universally accepted technique has yet to be developed. Our study introduces a new approach, a modified tumescent transabdominal pre-peritoneal (TAPP), to a low-cost setting. We then compare its safety and efficacy with the conventional TAPP, providing a new perspective on hernia repair methods. PATIENTS AND METHODS The study was conducted between April 2016 and September 2017 at the department of surgery in a medical college in Jammu. Sixty patients were randomly assigned to either the conventional TAPP group or the tumescent TAPP group using computer-generated randomisation. In the tumescent group, we carefully administered a tumescent solution into the pre-peritoneal space after creating pneumoperitoneum and then compared the effectiveness and safety of the two procedures. RESULTS Our study revealed significant differences in various aspects between the two groups. In the conventional group, 16.7% of patients experienced challenging peritoneal flap dissection, while none in the tumescent group faced this issue. In addition, none of the patients in the tumescent group had an intraoperative haemorrhage. The conventional group had a mean operating time of 100.4 ± 11.21 min. On the other hand, the tumescent group had a significantly shorter mean operating time of 84 ± 13.47 min. The complication rates were 16.7% in the tumescent group and 30% in the conventional group. After the surgery, 13.3% of patients in the conventional group reported persistent pain, compared to only one patient in the tumescent group, which was statistically significant. CONCLUSION Our study demonstrates that tumescent TAPP can overcome the challenges of conventional TAPP surgery, offering practical benefits such as reduced bleeding, easier dissection, decreased post-operative pain and shorter operating time. Administering tumescent solution before TAPP repair of inguinal hernia provides technical and clinical advantages, suggesting the potential for shorter surgeries and a quicker learning curve.
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Affiliation(s)
- Kanika Sharma
- Department of Surgical Oncology, Indraprastha Apollo Hospital, New Delhi, India
| | - Avinash Koul
- Department of Surgery, Fortis Noida, Noida, Uttar Pradesh, India
| | - Gopal Puri
- Department of Surgery, All India Institute of Medical Sciences, New Delhi, India
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Sah VP, Sah BK, Sah N, Khanal B, Kumar A, Gupta RK. A comparative study on effects of defect closure versus non-closure in laparoscopic totally extraperitoneal repair of direct inguinal hernia. Ann Med Surg (Lond) 2024; 86:5034-5038. [PMID: 39239014 PMCID: PMC11374157 DOI: 10.1097/ms9.0000000000002408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 07/16/2024] [Indexed: 09/07/2024] Open
Abstract
Introduction Totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) repair are the principal techniques in laparoscopic hernia repair. Seroma formation and pain are frequent complications of moderate-large size laparoscopic direct inguinal hernia mesh repair. This study was conducted to evaluate the feasibility of defect closure in moderate-large direct inguinal hernias and its effect on various outcomes. Method This is a prospective cohort study from September 2020 to August 2021, where a total of 88 patients with uncomplicated direct inguinal hernia (M3 or more) were enrolled in the study and divided into two equal groups of TEP defect closure and non-closure, and various outcome measures were noted. Results The majority of patients were male (94.31%), with a mean age range of 18-85 years, and had right-sided inguinal hernia (46.5%). Seroma formation at 10th POD in the defect closure and non-closure were 24% and 33% (p value: 0.225), which reduced to 11% and 18%, respectively, at 1 month (p value: 1.000). All seromas resolved within 6 months. Pain in VAS at 10th POD in the defect closure and non-closure were 1.55±0.571 and 1.38±0.527, respectively (p value: 0.121), which gradually decreased to 1.20±0.524 and 1.16±0.420 at a 6-month interval (p value: 0.689). The mean operative time in the bilateral and unilateral defect closure groups was 72.3±4.1 and 56.5±4.3 min, respectively, whereas that in the bilateral and unilateral defect non-closure groups was 62.3±3.7 and 45.7±3.6 min, respectively. Conclusion The defect closure was found to have higher pain and less seroma formation at various intervals of time following TEP for moderate-large direct inguinal hernia. Although these findings were statistically insignificant, they may be clinically significant, and further studies with a larger sample size are suggested.
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Affiliation(s)
- Vijay Pratap Sah
- Department of Surgery, B.P. Koirala Institute of Health Science (BPKIHS), Dharan, Nepal
| | - Bikash Kumar Sah
- Department of Surgery, B.P. Koirala Institute of Health Science (BPKIHS), Dharan, Nepal
| | - Nishant Sah
- Department of Surgery, B.P. Koirala Institute of Health Science (BPKIHS), Dharan, Nepal
| | - Bhawani Khanal
- Department of Surgery, B.P. Koirala Institute of Health Science (BPKIHS), Dharan, Nepal
| | - Abhijeet Kumar
- Department of Surgery, B.P. Koirala Institute of Health Science (BPKIHS), Dharan, Nepal
| | - Rakesh Kumar Gupta
- Department of Surgery, B.P. Koirala Institute of Health Science (BPKIHS), Dharan, Nepal
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Pan G, Xu Y, Chen J, Pan G, He L, Weng J, Li J, Zhang W. Clinical application of the modified neck-shoulder technique based on membrane autopsy to laparoscopic totally extraperitoneal prosthesis for indirect inguinal hernia. Asian J Surg 2024; 47:938-945. [PMID: 38030491 DOI: 10.1016/j.asjsur.2023.11.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/01/2023] [Accepted: 11/17/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVE To investigate the anatomical basis and clinical application value of the modified neck-shoulder technique based on membrane autopsy in laparoscopic totally extraperitoneal prosthesis (TEP) for tension-free repairs of indirect inguinal hernia. METHODS In this retrospective cohort study, we analyzed the clinical data of 136 patients with indirect inguinal hernia who underwent laparoscopic TEP for tension-free repairs at the Department of Gastroenterological Surgery Unit 1, the First Hospital of Putian City, Fujian Province from June 2017 to June 2020. The patients were divided into the modified neck-shoulder technique group (68 cases) and the traditional surgery group (68 cases), according to the different surgical methods. The intraoperative and postoperative conditions of the two groups were compared. RESULTS Both the modified neck-shoulder technique group and the traditional surgery group completed the herniorrhaphy. Compared with the traditional surgery group, the modified neck-shoulder technique group had a shorter operation time [(37.15 ± 5.320) min vs. (54.04 ± 5.202) min, t = 18.472, p < 0.001], less intraoperative blood loss [(5.53 ± 1.634) ml vs. (16.21 ± 3.375) ml, t = 23.544, p < 0.001], lower incidence of intraoperative peritoneal injury [3 cases (4.41%) vs. 9 cases (13.26%), χ2 = 3.29, p = 0.07], lower intraoperative conversion rate [1 case (1.47%) vs. 8 cases (11.76%), χ2 = 5.83, p = 0.016], and lower incidence of postoperative chronic pain [1 case (1.47%) vs. 12 cases (17.65%), χ2 = 10.291, p = 0.001], all of which were statistically significant (p < 0.05). Both groups were followed up for 12 months after surgery. Relapse was not observed in any case. CONCLUSION Drawing upon the surgical principles of the open neck-shoulder technique and the understanding of the membrane autopsy in the inguinal region, our center has summarized a set of operation procedures called the "modified neck-shoulder technique" for laparoscopic TEP in the tension-free repairs of indirect inguinal hernias. This new surgical technique could expeditiously and precisely navigate the interlayer gap in the preperitoneal space under the enlarged view of the laparoscope. It facilitated the high ligation, disconnection, or repositioning of the hernia sac, enhancing the reliability of patch placement while minimizing collateral damage, reducing postoperative complications, and shortening operation time.
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Affiliation(s)
- Guofeng Pan
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350004, China; Department of Gastroenterological Surgery Unit 1, Teaching Hospital of Putian First Hospital, Fujian Medical University, Putian, 351100, China
| | - Yanchang Xu
- Department of Gastroenterological Surgery Unit 1, Teaching Hospital of Putian First Hospital, Fujian Medical University, Putian, 351100, China
| | - Jian Chen
- Department of Gastroenterological Surgery Unit 1, Teaching Hospital of Putian First Hospital, Fujian Medical University, Putian, 351100, China
| | - Guoyan Pan
- Department of Cardiology, Teaching Hospital of Putian First Hospital, Fujian Medical University, Putian, 351100, China
| | - Limei He
- Department of Oncology, Teaching Hospital of Putian First Hospital, Fujian Medical University, Putian, 351100, China
| | - Jianbin Weng
- Department of Gastroenterological Surgery Unit 1, Teaching Hospital of Putian First Hospital, Fujian Medical University, Putian, 351100, China
| | - Junpeng Li
- Department of Gastroenterological Surgery Unit 1, Teaching Hospital of Putian First Hospital, Fujian Medical University, Putian, 351100, China
| | - Weihong Zhang
- Department of Gastroenterological Surgery Unit 1, Teaching Hospital of Putian First Hospital, Fujian Medical University, Putian, 351100, China.
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Ukhanov AP, Zakharov DV, Zhilin SA, Bolshakov SV, Muminov KD, Aselderov YA. [Laparoscopic preperitoneal and Lichtenstein inguinal hernia repair. What method is preferable?]. Khirurgiia (Mosk) 2024:110-118. [PMID: 39268744 DOI: 10.17116/hirurgia2024091110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
This review is devoted to laparoscopic preperitoneal and open Lichtenstein unguinal hernia repair. Considering the PubMed, Google, the Springer Link online library and the Cochrane Systematic Review databases, we analyzed the reviews, prospective and retrospective studies devoted to comparison of these most common methods of treating inguinal hernias. Indications and contraindications for endoscopic hernia repair, features of laparoscopic surgeries, causes of conversion to open interventions, early and long-term results of laparoscopic and open operations were estimated.
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Affiliation(s)
- A P Ukhanov
- Central Clinical Hospital, Veliky Novgorod, Russia
- Jaroslav the Wise Novgorod State University, Veliky Novgorod, Russia
| | - D V Zakharov
- Central Clinical Hospital, Veliky Novgorod, Russia
- Jaroslav the Wise Novgorod State University, Veliky Novgorod, Russia
| | - S A Zhilin
- Central Clinical Hospital, Veliky Novgorod, Russia
- Jaroslav the Wise Novgorod State University, Veliky Novgorod, Russia
| | | | - K D Muminov
- Central Clinical Hospital, Veliky Novgorod, Russia
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Kakkilaya HB, Ganapathi SK, Christopher PJ, Pawar J, Maharaj R, Subbiah R, Rudhramoorthy S, Chinnusamy P. Robotic Totally Extraperitoneal Hernia Repair: An Initial Experience with Cambridge Medical Robotics Versius. J Laparoendosc Adv Surg Tech A 2023; 33:1167-1175. [PMID: 37906106 DOI: 10.1089/lap.2023.0282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023] Open
Abstract
Background: Total extraperitoneal approach for laparoscopic inguinal hernia repair (L-TEP) allows for better dissection, lesser chance of bowel injury, and quicker operating time. However robotic groin hernia repair is currently performed only through transabdominal route as it allows for more mobility of the arms. This study is aimed at studying the feasibility and outcomes of robotic totally extraperitoneal (R-TEP). Methods: A prospective nonrandomized comparative study was conducted to compare R-TEP with L-TEP. Out of a total of 88 patients with inguinal hernia, 44 patients underwent R-TEP and other 44 patients underwent L-TEP over a period of 15 months. All R-TEP were performed with Cambridge Medical Robotics (CMR) Versius. The outcomes were analyzed over a minimum follow-up period of 6 months. Results: All patients were males with a mean age of 45.9 years. Average body mass index was 28.7. Mean docking time for R-TEP was 12.7 minutes. Overall time taken for R-TEP (mean 60.47 minutes) was significantly higher (P < .001) than L-TEP (mean 38.45 minutes). When the console time of R-TEP and overall time of L-TEP were compared, there was no significant difference (P = .053). A RCT (RIVAL Trial) conducted by Prabhu et al. showed their robotic transabdominal preperitoneal (R-TAPP) time of median 75.5 (59.0-93.8) minutes. Kimberly et al. had their overall time of 77.5 minutes and Andre Luiz et al. had a console time of 58 minutes. When we compared the data, the overall time of R-TEP is lesser compared with R-TAPP. Postoperative pain on POD-1 showed that the robotic group had significantly lower pain. There were no recurrences noted in the study period. Conclusion: With our study, we have shown that R-TEP performed using the principle of laparoscopic triangulation technique with CMR Versius is feasible and reproducible. Although the overall time is significantly more in R-TEP when compared with L-TEP, console times of R-TEP and overall times of L-TEP were very similar. Console times of R-TEP are much lesser compared with other studies on R-TAPP. R-TEP can be a better alternative to R-TAPP and can be considered at par with L-TEP. A systematic RCT would provide a better picture.
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Affiliation(s)
| | - Senthil Kumar Ganapathi
- Department of Surgical Gastroenterology, GEM Hospital and Research Center, Coimbatore, India
| | | | - Jayadatt Pawar
- Department of Surgical Gastroenterology, GEM Hospital and Research Center, Coimbatore, India
| | - Rajiv Maharaj
- Department of Surgical Gastroenterology, GEM Hospital and Research Center, Coimbatore, India
| | - Rajapandian Subbiah
- Department of Surgical Gastroenterology, GEM Hospital and Research Center, Coimbatore, India
| | | | - Palanivelu Chinnusamy
- Department of Surgical Gastroenterology, GEM Hospital and Research Center, Coimbatore, India
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Hidalgo NJ, Guillaumes S, Bachero I, Butori E, Espert JJ, Ginestà C, Vidal Ó, Momblán D. Bilateral inguinal hernia repair by laparoscopic totally extraperitoneal (TEP) vs. laparoscopic transabdominal preperitoneal (TAPP). BMC Surg 2023; 23:270. [PMID: 37674142 PMCID: PMC10481522 DOI: 10.1186/s12893-023-02177-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/31/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND The guidelines recommend laparoscopic repair for bilateral inguinal hernia. However, few studies compare the totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) techniques in bilateral inguinal hernias. This study aimed to compare the outcomes of TEP and TAPP in bilateral inguinal hernia. METHODS We conducted a retrospective cohort study of patients operated on for bilateral inguinal hernia by TEP and TAPP repair from 2016 to 2020. Intraoperative complications, operative time, acute postoperative pain, hospital stay, postoperative complications, chronic inguinal pain, and recurrence were compared. RESULTS A total of 155 patients were included in the study. TEP was performed in 71 patients (46%) and TAPP in 84 patients (54%). The mean operative time was longer in the TAPP group than in the TEP group (107 min vs. 82 min, p < 0.001). The conversion rate to open surgery was higher in the TEP group than in the TAPP group (8.5% vs. 0%, p = 0.008). The mean hospital stay was longer in the TAPP group than in the TEP group (p < 0.001). We did not observe significant differences in the proportion of postoperative complications (p = 0.672), postoperative pain at 24 h (p = 0.851), chronic groin pain (p = 0.593), and recurrence (p = 0.471). We did not observe an association between the choice of surgical technique (TEP vs. TAPP) with conversion rate, operative time, hospital stay, postoperative complications, chronic inguinal pain, or hernia recurrence when performing a multivariable analysis adjusted for the male sex, age, BMI, ASA, recurrent hernia repair, surgeon, and hernia size > 3cm. CONCLUSIONS Bilateral inguinal hernia repair by TEP and TAP presented similar outcomes in our study.
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Affiliation(s)
- Nils Jimmy Hidalgo
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain.
| | - Salvador Guillaumes
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Irene Bachero
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Eugenia Butori
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Juan José Espert
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - César Ginestà
- Department of General and Digestive Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, Barcelona, Spain
| | - Óscar Vidal
- Department of General and Digestive Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, Barcelona, Spain
| | - Dulce Momblán
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
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Harvitkar RU, Gattupalli GB, Al-Hano H, Al-Kharouf KF, Joshi A. Laparoscopic Groin Hernia Repair Using the Totally Extraperitoneal Approach: A Retrospective Study and Our Experience. Cureus 2023; 15:e41151. [PMID: 37519581 PMCID: PMC10386888 DOI: 10.7759/cureus.41151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 08/01/2023] Open
Abstract
Background Recently, laparoscopic totally extraperitoneal (TEP) inguinal hernia repair has been considered one of the most effective and widely performed techniques for repairing inguinal hernias by avoiding entry into the peritoneal cavity. Its indications have evolved and expanded to almost encompass the entire range of groin hernias. This retrospective study aims to determine the outcomes and postoperative complications in patients undergoing TEP inguinal hernia repair performed by a single surgeon for groin hernias at a single center. Methodology We retrospectively evaluated the prospectively collected data of 900 patients who underwent elective TEP repair over 18 years at a single center performed by a single surgeon from April 2004 to February 2023. Patients were evaluated for age, sex, type of hernia, time taken for surgery, open from laparoscopy, intra and postoperative complications, hospital stay, and days taken to resume regular activity. Results The mean age of the 900 patients was 59 years (range = 21-83 years). The mean age of males and females was 59 and 56 years, respectively. The mean operative time was 40 and 55 minutes for a unilateral and bilateral hernia, respectively. In total, 369 (41%) patients had a right-sided groin hernia, 382 (42%) patients had a left-sided groin hernia, and 149 (16.5%) patients had bilateral groin hernias. A total of 121 (13%) patients had occult hernias, and 17 patients underwent concurrent TEP and transurethral resection of the prostate. Of the 900 patients, 20 (2.2%) had a recurrent hernia after a previous open inguinal hernia repair. Seven (0.8%) patients had a recurrence of hernias post-TEP and subsequently underwent open inguinal hernia repair. Seven (0.7%) patients needed conversion from TEP to the transabdominal pre-peritoneal approach. Only minor complications were noted intra and postoperatively. The average time of hospitalization was 24 hours. The time to resume normal activities was five (±1) days. Conclusions Our experience suggests that TEP repair with mesh fixation is a safe and effective procedure with a marginal recurrence rate. Apart from the obvious cosmetic benefits of minimal tissue invasion, a significant advantage of TEP is the visualization of the contralateral groin along with the surgical repair of a hernia, if required, in the same sitting and without the insertion of any extra trocars.
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Affiliation(s)
| | | | - Hashim Al-Hano
- General Surgery, Queen Alexandra Hospital, Portsmouth, GBR
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Nethaji K, Kumari R, Jaiswal P, Jha PK, Ranjan R, Akela A. Comparison of Extended Total Extraperitoneal (E-TEP) Repair and Trans-Abdominal Pre-Peritoneal (TAPP) Mesh Repair in Inguinal Hernia Repair. Cureus 2023; 15:e39420. [PMID: 37362494 PMCID: PMC10288329 DOI: 10.7759/cureus.39420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND AND AIM To find the superiority of extended total extraperitoneal (E-TEP) repair and trans-abdominal pre-peritoneal (TAPP) mesh repair in inguinal hernia repair. MATERIAL AND METHODS A total of 30 patients with a unilateral or bilateral inguinal hernia (IH), and recurrent IH, following open repair were studied. Out of 30 patients, laparoscopic TAPP or E-TEP mesh repair was performed in an equal number of inguinal hernia patients. The patient's demographic parameters, duration of surgery, postoperative hospital stay, and complications were compared. RESULTS In the E-TEP group, 33.33% of patients had left inguinal hernia (LIH), 60% of patients were diagnosed with right inguinal hernia (RIH) and 6.67% of patients had right inguinal and right direct hernia (RDH). In the TAPP group, 33.33% of patients had LIH and 53.33% of patients were suffering from RIH. Moreover, 6.67% of patients were diagnosed with a left inguinal direct hernia, and a similar proportion of patients had a right inguinal direct hernia. The mean duration of surgery was found to be significantly higher in the TAPP group (P<0.0000). The mean postoperative hospital stay was 2.07±0.59 and 2.80±1.32 days in E-TEP and TAPP groups, respectively (P=0.044). CONCLUSION In the present study, E-TEP mesh repair is a superior technique in the management of inguinal hernia as compared with TAPP repair.
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Affiliation(s)
- Kancham Nethaji
- General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Rinku Kumari
- General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Pradeep Jaiswal
- General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Pawan K Jha
- General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Rajeev Ranjan
- General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Ankur Akela
- Urology, Indira Gandhi Institute of Medical Sciences, Patna, IND
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Hidalgo NJ, Guillaumes S, Bachero I, Holguín V, Momblán D. Trends and predictors of laparoscopic bilateral inguinal hernia repair in Spain: a population-based study. Surg Endosc 2023:10.1007/s00464-023-09967-y. [PMID: 36914783 DOI: 10.1007/s00464-023-09967-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/18/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND International guidelines currently recommend laparoscopy for bilateral inguinal hernia repair (BIHR). Our study aims to evaluate the trends and factors associated with the choice of laparoscopy for BIHR in Spain. METHODS We performed a retrospective analysis of patients undergoing BIHR between 2016 and 2019. We used the national database of the Spanish Ministry of Health: RAE-CMBD. We performed a univariate and multivariable logistic regression analysis to identify the factors associated with the utilization of laparoscopy. We identified perioperative complications and the factors associated with their occurrence through multivariable logistic regression analysis. RESULTS A total of 21,795 BIHRs were performed: 84% by open approach and 16% by laparoscopic approach. Laparoscopic approach increased from 12% in 2016 to 23% in 2019 (p < 0.001). The 40% of hospitals did not use laparoscopy, and only 8% of the hospitals performed more than 50% of their BIHRs by laparoscopy. The utilization rate of laparoscopy was not related to the number of BIHRs performed per year (p = 0.145). The main factor associated with the choice of laparoscopy in multivariable logistic regression analysis was the patient's region of residence (OR 2.04, 95% CI 1.88-2.21). Other factors were age < 65 years (OR 1.65, 95% CI 1.52-1.79) and recurrent inguinal hernia (OR 1.31, 95% CI 1.15-1.49). The type of approach for BIHR was not independently associated with perioperative complications. CONCLUSIONS Despite a significant increase in recent years, laparoscopic BIHR in Spain remains low. The main factor associated with the utilization of laparoscopy was the patient's region of residence; this factor seems to be related to the presence of hospitals with a high rate of laparoscopic approaches where the patient lives. The type of approach was not independently associated with perioperative complications. More efforts are needed to increase laparoscopic use in patients with bilateral inguinal hernias.
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Affiliation(s)
- Nils Jimmy Hidalgo
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, C. de Villarroel, 170, 08036, Barcelona, Spain.
| | - Salvador Guillaumes
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Irene Bachero
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Victor Holguín
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Dulce Momblán
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, C. de Villarroel, 170, 08036, Barcelona, Spain
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Rade M, Jayaram A, Birkett R, Ford H, Birkett D, Nepomnayshy D. A randomized, double-blinded, placebo-controlled trial of the effects of infusing local analgesia on post-operative pain during laparoscopic inguinal hernia repair. Surg Endosc 2023; 37:1970-1975. [PMID: 36266481 DOI: 10.1007/s00464-022-09697-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/29/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE While it is widely accepted that laparoscopic total extraperitoneal (TEP) inguinal herniorrhaphy has decreased post-operative pain, there are conflicting data as to whether instillation of local anesthetic into the preperitoneal space improves post-operative pain in these patients. We designed a prospective study to evaluate this. Secondary outcomes include time spent in the PACU, need for narcotic pain medication, and total amount of narcotics required postoperatively. METHODS Prospective, randomized, double-blind, placebo-controlled study which enrolled 70 patients with unilateral non-recurrent inguinal hernia from 09/2013 to 03/2019 and included immediate and 2-week post-operative follow-up. All patients received unilateral laparoscopic TEP inguinal hernia repair with control patients receiving 10 ml of 0.9% saline instilled into preperitoneal space while treatment group received 10-ml 0.5% bupivacaine without epinephrine. RESULTS A total of 70 patients [67 (96%) men and 3 women; mean age (SD), 57 years (13.8)] were enrolled, 35 randomized into each group. Demographics between the two groups were similar. No differences were found in post-operative pain between the control and test groups at 1 h [mean (SD) of 3.15(2.5) vs 3.21(2.9); P = 0.92], 2 h [3.39 (1.55) vs 2.74 (1.85) P = 0.18], or 1 day [4.79 (2.19) vs 4.39 (2.37); P = 0.13] postoperatively. Likewise, no significant differences were observed in usage of narcotic pain medication postoperatively, as 17 control patients (50%) and 16 (46%) study patients required narcotics within 2 h of surgery (P = 0.72). CONCLUSION Instilling local anesthetic into the preperitoneal space during laparoscopic TEP inguinal hernia repair did not result in statistically significant difference in post-operative pain (Rade et al. in NESS Annual Meeting, 2021). Trial registry ClinicalTrials.gov Identifier: NCT02055053.
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Affiliation(s)
- Matthew Rade
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA.
- Umass Memorial Medical Group General Surgery, 91 Water Street, Milford, MA, 01757, USA.
| | | | - Richard Birkett
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Heather Ford
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Desmond Birkett
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Dmitry Nepomnayshy
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
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Ko H, Lee SM, Chang HK, Min SY, Cho K, Park MS. Laparoscopic total extra-peritoneal (TEP) inguinal hernia repair under local anesthesia by topical lidocaine injection. Hernia 2023; 27:113-118. [PMID: 35939245 DOI: 10.1007/s10029-022-02653-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/12/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Laparoscopic total extra-peritoneal (TEP) inguinal hernia repair is usually performed under general anesthesia (GA) for muscle relaxation. However, TEP hernia repair may be reluctant in high-risk patients of GA. The aim of this study was to compare the outcomes of the TEP under GA and local anesthesia (LA). METHODS We retrospectively analyzed patients with inguinal hernia who underwent TEP under GA or LA in a single center from December 2016 to May 2018. The outcomes, such as demographics, duration of surgery, length of hospital stay, visual analog scale (VAS), and postoperative complications, were compared in each group. RESULTS Seventy-six patients with inguinal hernia underwent TEP under GA (n = 52) or LA (n = 24). Total operation time (mean ± standard deviation; GA, 111.6 ± 23.0 min; LA, 76.3 ± 18.0 min; p < 0.001) and length of hospital stay (GA, 38.3 ± 11.6 min; LA, 30.3 ± 15.6 min; p < 0.014) were shorter in LA group compared to GA group. There were no significant differences in postoperative VAS (1 h, p = 0.247; 4 h, p = 0.086; 12 h, p = 0.469; 24 h, p = 0.411), postoperative adverse effects (vomiting, p = 0.570; urinary retention, p = 0.214; headache, p = 0.494), and postoperative complications (seroma, p = 0.348; scrotal edema, p = 0.178; recurrence, p = 0.822) between LA group and GA group. CONCLUSION Compared with GA, there were no differences in postoperative pain and complications in patients who underwent TEP hernia repair under LA. Furthermore, in LA group, total operation time and length of hospital stay were shortened.
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Affiliation(s)
- H Ko
- Department of Surgery, College of Medicine, Kyung Hee University, 23, Kyung Hee Dae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - S M Lee
- Department of Surgery, College of Medicine, Kyung Hee University, 23, Kyung Hee Dae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - H K Chang
- Department of Surgery, College of Medicine, Kyung Hee University, 23, Kyung Hee Dae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - S Y Min
- Department of Surgery, College of Medicine, Kyung Hee University, 23, Kyung Hee Dae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - K Cho
- Department of Surgery, College of Medicine, Kyung Hee University, 23, Kyung Hee Dae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - M-S Park
- Department of Surgery, College of Medicine, Kyung Hee University, 23, Kyung Hee Dae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea.
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Khan WF, Rathore YS, Aggarwal S, Chumber S, Arumugaswamy PR, Baig KAM, Patidar A, Rai SK. Endoscopic totally extraperitoneal repair for groin hernia: Experience from a tertiary care centre. J Minim Access Surg 2023; 19:107-111. [PMID: 36722535 PMCID: PMC10034794 DOI: 10.4103/jmas.jmas_364_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 04/27/2022] [Accepted: 09/05/2022] [Indexed: 01/20/2023] Open
Abstract
Background Totally extra-peritoneal (TEP) and transabdominal preperitoneal (TAPP) repair are two established minimal access techniques of groin hernia surgery. TEP offers the advantage of avoiding violation of the peritoneal cavity. Aim This study aims to describe the decade-long experience of TEP in groin hernia repair in a tertiary care teaching institute and the feasibility of the same in difficult scenarios. Materials and Methods Retrospective analysis of the database of patients undergoing TEP repair for inguinal hernia in a single surgical unit at a tertiary teaching hospital between January 2008 and December 2019 was performed. Detailed pre-operative clinical details, operative duration, intraoperative and post-operative complications, including pain, length of post-operative hospital stay and hernia recurrence data were analysed. Results Over 12 years' duration, 511 patients underwent endoscopic TEP mesh repair and the total number of hernias repaired was 614. Majority (97.45%) of patients were male. The mean age of the patient population was 51.3 years. Primary hernia was seen in 490 patients. The mean operating time for unilateral inguinal hernia repair was 56.8 ± 16 min and for bilateral repair 80.9 ± 25.2 min. TEP in previous lower abdominal/suprapubic surgical scars was attempted in 17 (3.3%) patients, with only one requiring conversion. The intraoperative peritoneal breach was the most common documented complication (34.8%). Seroma was seen in 9.4% of patients. Seventeen patients required conversion (14 TAPP and 3 open). Recurrence was seen in 4 (0.7) patients. Conclusion TEP repair is an effective method of groin hernia repair and can be attempted in the majority of patients groin hernia, including patients with previous lower abdominal incisions.
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Affiliation(s)
- Washim Firoz Khan
- Department of General Surgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Yashwant Singh Rathore
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Aggarwal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Sunil Chumber
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | | | - Khaja Abdul Moin Baig
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Patidar
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeet Kumar Rai
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
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22
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Hidalgo NJ, Bachero I, Hoyuela C, Juvany M, Ardid J, Martrat A, Guillaumes S. The transition from open to laparoscopic surgery for bilateral inguinal hernia repair: how we did it. Langenbecks Arch Surg 2022; 407:3701-3710. [PMID: 36070031 DOI: 10.1007/s00423-022-02671-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/29/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To describe the transition process from open repair (OR) to laparoscopic repair (LR) of bilateral inguinal hernia in a small basic general hospital METHODS: We describe the technical details and training strategy used to facilitate the transition to systematic LR of bilateral inguinal hernia. We conducted a retrospective analysis of prospectively collected data from all patients undergoing bilateral inguinal hernia repair between January 2017 and December 2020. We analysed the evolution of LR and compared the surgical outcomes: complications, acute pain (24 h), chronic pain (> 3 months), and recurrence (1 year) of the patients operated on by OR and LR. RESULTS We performed 132 bilateral inguinal hernia repairs, 55 (41.7%) ORs, and 77 (58.3%) LRs. A significant difference was observed in the choice of LR over time (2017: 9%, 2018: 32%, 2019: 75%, 2020: 91%, p < 0.001). The mean operative time was shorter in the OR group than in the LR group (56 min vs. 108 min, p < 0.001). However, the operative time of the LR decreased over the years. No significant differences were observed in complications or recurrence. LR was associated with lower acute postoperative pain at 24 h (2.2 vs. 3.1 points, p = 0.021) and lower chronic groin pain than OR (1.3% vs. 12.7%, p = 0.009). CONCLUSION A structured and systematized training process made the transition from OR to LR of bilateral inguinal hernias feasible and safe in a small basic general hospital. This transition did not increase complications or recurrence. Additionally, LR was associated with a decrease in postoperative pain and chronic groin pain.
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Affiliation(s)
- Nils Jimmy Hidalgo
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, C. de Villarroel, 170, 08036, Barcelona, Spain.
| | - Irene Bachero
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, C. de Villarroel, 170, 08036, Barcelona, Spain
- Universitat Internacional de Catalunya, Barcelona, Spain
| | - Carlos Hoyuela
- Department of Surgery, Hospital de Mollet, Mollet, Spain
| | - Montserrat Juvany
- Department of Surgery, Hospital General Granollers, Granollers, Spain
| | - Jordi Ardid
- Department of General and Digestive Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, Barcelona, Spain
| | - Antoni Martrat
- Department of General and Digestive Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, Barcelona, Spain
| | - Salvador Guillaumes
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, C. de Villarroel, 170, 08036, Barcelona, Spain
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23
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Ng K, Coleman L, Titcomb D, Crouch N. 053 Totally extraperitoneal approach (TEP) for gonadectomy for differences in sex development (DSD): Report of 2 cases. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2022.02.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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24
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Tarasov EE, Nishnevich EV, Prudkov MI, Bagin VA, Salemyanov AZ, Korishch YA, Korishch DA, Anferov ID. [Laparoscopic totally extraperitoneal repair of strangulated groin hernia]. Khirurgiia (Mosk) 2022:42-47. [PMID: 35477199 DOI: 10.17116/hirurgia202204142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To study the possibility of totally extraperitoneal repair combined with diagnostic laparoscopy in the treatment of strangulated groin hernias (Laparoscopy-Assisted Totally Extraperitoneal Plasty, LATEP). MATERIAL AND METHODS We analyzed the results of laparoscopic totally extraperitoneal hernia repair. The trocar placement technique was modified. There were 38 patients with strangulated groin hernia. The sample included 26 patients with strangulated inguinal hernia, 9 ones with strangulated femoral hernia and 3 patients with recurrent strangulated inguinal hernia. RESULTS LATEP was attempted in 38 patients and successful in 37 (97.3%) cases. In 1 (2.6%) patient, correction of small bowel strangulation was failed and conversion to open surgery was required. In 29 patients (76.3%), correction of strangulation was performed after laparoscopy-assisted external manipulations and careful traction from abdominal cavity. In 8 (21%) cases, strangulation spontaneously regressed before laparoscopy. Laparoscopy confirmed viability of strangulated organs in 36 patients. One (2.6%) patient required bowel resection due to small intestine wall necrosis. Later, all patients underwent totally extraperitoneal repair. We were able to prevent the contact of hernia sac fluid with the implant in all cases. At the stage of preperitoneal repair, local damage to peritoneum occurred in 9 patients. Nevertheless, sealing was not required since hernia fluid was previously removed from abdominal cavity. There were no signs of implant infection and hernia recurrence within 6-14 months. CONCLUSION Totally extraperitoneal repair combined with diagnostic laparoscopy is possible for strangulated groin hernias.
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Affiliation(s)
- E E Tarasov
- Ural State Medical University, Yekaterinburg, Russia.,City Clinical Hospital No. 40, Yekaterinburg, Russia
| | - E V Nishnevich
- Ural State Medical University, Yekaterinburg, Russia.,City Clinical Hospital No. 40, Yekaterinburg, Russia
| | - M I Prudkov
- Ural State Medical University, Yekaterinburg, Russia.,City Clinical Hospital No. 40, Yekaterinburg, Russia
| | - V A Bagin
- Ural State Medical University, Yekaterinburg, Russia.,City Clinical Hospital No. 40, Yekaterinburg, Russia
| | | | - Ya A Korishch
- Ural State Medical University, Yekaterinburg, Russia.,City Clinical Hospital No. 40, Yekaterinburg, Russia
| | - D A Korishch
- Ural State Medical University, Yekaterinburg, Russia
| | - I D Anferov
- Ural State Medical University, Yekaterinburg, Russia.,City Clinical Hospital No. 40, Yekaterinburg, Russia
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25
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Laparoscopic transabdominal preperitoneal and totally extraperitoneal in inguinal hernia surgery: comparison of intraoperative and postoperative early complications of two techniques. JOURNAL OF MINIMALLY INVASIVE SURGERY 2022; 25:18-23. [PMID: 35603345 PMCID: PMC8977503 DOI: 10.7602/jmis.2022.25.1.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/19/2022] [Accepted: 02/20/2022] [Indexed: 11/08/2022]
Abstract
Purpose Methods Results Conclusion
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26
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Comparison of Systemic Inflammatory Response After Total Extraperitoneal Repair and Lichtenstein Repair of Inguinal Hernia. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03278-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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27
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Gudigopuram SVR, Raguthu CC, Gajjela H, Kela I, Kakarala CL, Hassan M, Belavadi R, Sange I. Inguinal Hernia Mesh Repair: The Factors to Consider When Deciding Between Open Versus Laparoscopic Repair. Cureus 2021; 13:e19628. [PMID: 34956756 PMCID: PMC8675396 DOI: 10.7759/cureus.19628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 11/23/2022] Open
Abstract
Inguinal hernia repair is one of the most commonly performed surgical procedures worldwide. An inguinal hernia occurs due to a defect in the abdominal wall, which allows the abdominal contents to pass through it. Although the placement of mesh over the defect is the gold standard to close the defect, there are various approaches to achieving it, out of which two of the most widely accepted techniques are laparoscopic inguinal hernia repair (LIHR) and open inguinal hernia repair (OIHR). However, the approach of choice widely fluctuates with regards to various factors such as patient history, type of hernias, and surgeons' preference. It is imperative to understand the variations in outcomes of different approaches and how best they fit an individual patient in deciding the technique to be undertaken. This article has reviewed many studies and compared the two techniques in terms of chronic pain, the time required to return to activity, rate of recurrence, and cost-effectiveness.
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Affiliation(s)
| | | | - Harini Gajjela
- Research, Our Lady of Fatima University College of Medicine, Metro Manila, PHL
| | - Iljena Kela
- Family Medicine, Jagiellonian University Medical College, Krakow, POL
| | - Chandra L Kakarala
- Internal Medicine, Jawaharlal Institute of Post-Graduate Medical Education and Research (JIPMER), Pondicherry, IND
| | - Mohammad Hassan
- Internal Medicine, Mohiuddin Islamic Medical College, Mirpur, PAK
| | - Rishab Belavadi
- Surgery, Jawaharlal Institute of Post-Graduate Medical Education and Research (JIPMER), Pondicherry, IND
| | - Ibrahim Sange
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.,Research, K. J. Somaiya Medical College, Mumbai, IND
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28
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Laparoscopic repair of inguinal hernias: Risk factors for urinary retention and chronic pain after totally extraperitoneal repair and transabdominal preperitoneal repair. JOURNAL OF MINIMALLY INVASIVE SURGERY 2021; 24:215-222. [PMID: 35602856 PMCID: PMC8965974 DOI: 10.7602/jmis.2021.24.4.215] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/29/2021] [Accepted: 10/30/2021] [Indexed: 11/28/2022]
Abstract
Purpose There are various opinions about the postoperative complications of the two methods for laparoscopic inguinal hernia surgery; totally extraperitoneal repair (TEP) and transabdominal preperitoneal repair (TAPP). The aim of this study was to compare the postoperative course after TAPP and TEP, focusing on immediate postoperative pain, incidence of postoperative urinary retention (POUR), and chronic pain. Methods This study retrospectively analyzed a consecutive series of 344 inguinal hernia patients who were treated with laparoscopic surgery between November 2016 and December 2019 at a single tertiary referral center. Results Patient demographics did not differ significantly between the groups. The operation time was significantly shorter in the TEP group than in the TAPP group (43.1 ± 14.9 minutes vs. 63.5 ± 16.5 minutes, p < 0.001). The postoperative pain scores were significantly lower in the TEP group than in the TAPP group immediately (3.6 ± 1.3 vs. 4.4 ± 1.1, p < 0.001) and 6 hours (1.5 ± 1.4 vs. 2.3 ± 1.8, p < 0.001) after the operation. The other complications did not differ significantly between the groups. Age was a significant risk factor for POUR (odds ratio [OR], 1.083; 95% confidence interval [CI], 1.018–1.151; p = 0.011), and history of benign prostate hyperplasia (BPH) was a significant risk factor for chronic pain (OR, 5.363; 95% CI, 1.028–27.962; p = 0.046). Conclusion TEP and TAPP seem to be safe and effective for laparoscopic inguinal hernia repair and have similar postoperative outcomes. Age was a significant risk factor for POUR, and BPH history was a significant risk factor for chronic pain.
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29
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Vuille-Dit-Bille RN, Muff JL, Sommer V, Holland-Cunz SG, Frech-Dörfler M. Minimally Invasive Total Extraperitoneal Varicocele Repair: First Description in Children. J Laparoendosc Adv Surg Tech A 2021; 31:1496-1500. [PMID: 34748421 DOI: 10.1089/lap.2021.0306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: The aim of this study was to report the first pediatric case series treated with minimally invasive total extraperitoneal varicocele (MITEV) repair using the total extraperitoneal (TEP) approach. Materials and Methods: Five male adolescents (12-17 years) were included in this study, all with left-sided Grade III varicoceles. A 5 mm camera port was inserted just below the umbilicus and two 5 mm working ports were used, one above the symphysis in the midline and the other in the left lateral hemiabdomen just below the arcuate line. Results: Operation time ranged from 47 to 61 minutes (mean: 53 minutes). There were no intra- or postoperative complications. The peritoneum was not perforated, and the abdominal cavity was not entered. Two patients had resolution from varicoceles on follow-up clinical examination and ultrasonography was performed 6 months after surgery. In 3 patients, long-term follow-up was pending. Conclusion: MITEV repair reflects a new minimally invasive access to the retroperitoneum in children with varicocele.
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Affiliation(s)
| | - Julian L Muff
- Department of Pediatric Surgery, University Children's Hospital of Basel, Basel, Switzerland
| | - Vivienne Sommer
- Department of Pediatric Surgery, University Children's Hospital of Basel, Basel, Switzerland
| | - Stefan G Holland-Cunz
- Department of Pediatric Surgery, University Children's Hospital of Basel, Basel, Switzerland
| | - Martina Frech-Dörfler
- Department of Pediatric Surgery, University Children's Hospital of Basel, Basel, Switzerland
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30
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Hori T, Yasukawa D. Fascinating history of groin hernias: Comprehensive recognition of anatomy, classic considerations for herniorrhaphy, and current controversies in hernioplasty. World J Methodol 2021; 11:160-186. [PMID: 34322367 PMCID: PMC8299909 DOI: 10.5662/wjm.v11.i4.160] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/02/2021] [Accepted: 05/15/2021] [Indexed: 02/06/2023] Open
Abstract
Groin hernias include indirect inguinal, direct inguinal, femoral, obturator, and supravesical hernias. Here, we summarize historical turning points, anatomical recognition and surgical repairs. Groin hernias have a fascinating history in the fields of anatomy and surgery. The concept of tension-free repair is generally accepted among clinicians. Surgical repair with mesh is categorized as hernioplasty, while classic repair without mesh is considered herniorrhaphy. Although various surgical approaches have been developed, the surgical technique should be carefully chosen for each patient. Regarding as interesting history, crucial anatomy and important surgeries in the field of groin hernia, we here summarized them in detail, respectively. Points of debate are also reviewed; important points are shown using illustrations and schemas. We hope this systematic review is surgical guide for general surgeons including residents. Both a skillful technique and anatomical knowledge are indispensable for successful hernia surgery in the groin.
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Affiliation(s)
- Tomohide Hori
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Daiki Yasukawa
- Department of Surgery, Shiga University of Medical Science, Otsu 520-2192, Japan
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31
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Fukuhara M, Onishi S, Yonemura Y, Sato T, Tsutsumi S, Bandoh T, Utsunomiya T, Esumi G. A totally extraperitoneal approach for endoscopic resection of a congenital prepubic sinus through the pubic symphysis. Surg Case Rep 2021; 7:165. [PMID: 34264431 PMCID: PMC8282886 DOI: 10.1186/s40792-021-01245-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 07/04/2021] [Indexed: 11/15/2022] Open
Abstract
Background A congenital prepubic sinus (CPS) is a rare congenital anomaly in which a duct remnant extends from the skin opening near the pubic symphysis to various parts and the lesions are mostly located in the preperitoneal space. The totally extraperitoneal (TEP) approach is an operational method that provides a good field of view for the preperitoneal space. We report the CPS through the pubic symphysis in which complete resection was achieved by a TEP approach. TEP approach was minimally invasive and achieved satisfactory cosmetic outcome. Case presentation We herein report the case of a 13-year-old boy with a fistula opening near the dorsal penis. He was admitted to our hospital due to fever and lower abdominal pain. Abdominal ultrasonography and computed tomography revealed an abscess inside a fistula lumen on the posterior surface of the rectus abdominis muscles in the midline of the lower abdomen. Under a diagnosis of CPS, which was located in the preperitoneal space, endoscopic resection was performed by a totally extraperitoneal approach. After making an umbilical incision, the rectus abdominis muscle was excised outward to expose the preperitoneal space. A single-port system was placed in the preperitoneal space. Three 5-mm-port trocars were inserted. As the preperitoneal cavity was expanded, a sinus connecting to the pubic symphysis was confirmed. The pubic symphysis did not connect with the bladder. Because the fistula was penetrated with the pubic symphysis, the remaining caudal fistula was removed from the body surface with a small spindle-shaped incision around the fistula opening. Finally, the sinus was completely resected, with confirmation from both the cranial side and dorsal side of the pubic symphysis. We were able to perform complete resection of the CPS with good visibility and without any peritoneal damage. There were no intraoperative complications. His postoperative course was uneventful during the 1-year follow-up. Conclusions The TEP approach may be feasible for the resection of a CPS and may allow safe and secure resection due to good visibility, even in pediatric patients. Supplementary Information The online version contains supplementary material available at 10.1186/s40792-021-01245-0.
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Affiliation(s)
- Masahiro Fukuhara
- Department of Pediatric Surgery, Oita Prefectural Hospital, 8-1, Bunyo 2-chome, Oita, 870-8511, Japan.
| | - Shun Onishi
- Department of Pediatric Surgery, Oita Prefectural Hospital, 8-1, Bunyo 2-chome, Oita, 870-8511, Japan.,Department of Pediatric Surgery, Kagoshima University, Kagoshima, Japan
| | - Yusuke Yonemura
- Department of Surgery, Kyushu University Beppu Hospital, Beppu, Japan
| | - Tomoe Sato
- Department of Pediatric Surgery, Oita Prefectural Hospital, 8-1, Bunyo 2-chome, Oita, 870-8511, Japan
| | - Satoshi Tsutsumi
- Department of Gastroenterological Surgery, Oita Prefectural Hospital, Oita, Japan
| | - Toshio Bandoh
- Department of Gastroenterological Surgery, Oita Prefectural Hospital, Oita, Japan
| | - Tohru Utsunomiya
- Department of Gastroenterological Surgery, Oita Prefectural Hospital, Oita, Japan
| | - Genshiro Esumi
- Department of Pediatric Surgery, Oita Prefectural Hospital, 8-1, Bunyo 2-chome, Oita, 870-8511, Japan.,Department of Pediatric Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
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Takeuchi Y, Etoh T, Suzuki K, Ohyama T, Hiratsuka T, Ishio T, Kugimiya M, Matsumoto T, Kai S, Bandoh T, Shibata K, Iwaki K, Tahara K, Shigemitsu Y, Inomata M. Surgical outcomes of totally extraperitoneal repair for inguinal hernia: A retrospective multicenter propensity score-matched study. Ann Gastroenterol Surg 2021; 5:502-509. [PMID: 34337299 PMCID: PMC8316736 DOI: 10.1002/ags3.12443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/28/2020] [Accepted: 01/26/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Laparoscopic surgical approaches, including total extraperitoneal repair (TEP), have been widely accepted for inguinal hernia repair in Japan. However, there are limited data regarding recurrence after TEP in Japan, given the limited versatility of this procedure. This study retrospectively evaluated the rates of hernia recurrence after TEP and open mesh repair at multiple Japanese centers. METHODS This retrospective study evaluated 1917 patients who underwent inguinal hernia repair at 32 institutions in the Oita prefecture between January 2014 and December 2015. Eligible patients were grouped according to whether they underwent TEP (1011 patients) or open mesh repair (636 patients). Propensity score matching was performed 1:1 (total: 1076 patients, 538 patients from each group). The outcomes of interest were recurrence, morbidity, and postoperative recovery. RESULTS The TEP and open mesh repair groups had similar baseline characteristics. After propensity score matching, there was no significant difference between the two groups in terms of recurrence rate (TEP: 0.5% vs open mesh repair: 1.0%, P = .375). However, the TEP group had significantly longer operating times (median: 70.2 min vs 65.0 min, P < .001), significantly less blood loss (0-5.1 mL vs 0-20.4 mL, P < .001), and significantly shorter postoperative hospital stays (median: 5.0 days vs 6.4 days, P < .001). The overall incidences of morbidity were 6.2% in the TEP group and 7.2% in the open mesh repair group (P = .535). CONCLUSION This multicenter retrospective study with propensity score matching revealed that the recurrence rates were similarly low for TEP and open mesh repair of inguinal hernia. Thus, a well-trained surgical team could use TEP as a standard procedure.
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Affiliation(s)
- Yu Takeuchi
- Department of SurgeryJCHO Nankai Medical CenterOitaJapan
| | - Tsuyoshi Etoh
- Department of Gastroenterological and Pediatric SurgeryOita University Faculty of MedicineOitaJapan
| | - Kosuke Suzuki
- Department of Gastroenterological and Pediatric SurgeryOita University Faculty of MedicineOitaJapan
| | | | | | - Tetsuya Ishio
- Department of SurgeryKitsuki City Yamaga HospitalOitaJapan
| | | | - Toshifumi Matsumoto
- Department of SurgeryNational Hospital Organization Beppu Medical CenterOitaJapan
| | - Seiichiro Kai
- Department of SurgeryNakatsu Municipal HospitalOitaJapan
| | - Toshio Bandoh
- Department of SurgeryOita Prefectural HospitalOitaJapan
| | - Kohei Shibata
- Department of Gastrointestinal SurgeryOitaken Kouseiren Tsurumi HospitalOitaJapan
| | - Kentaro Iwaki
- Department of SurgeryOita Red Cross HospitalOitaJapan
| | | | | | - Masafumi Inomata
- Department of Gastroenterological and Pediatric SurgeryOita University Faculty of MedicineOitaJapan
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Outcomes of 207 totally extraperitoneal hernia repairs using self-fixation mesh. Sci Rep 2021; 11:12507. [PMID: 34131236 PMCID: PMC8206339 DOI: 10.1038/s41598-021-92063-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/26/2021] [Indexed: 11/08/2022] Open
Abstract
Inguinal hernia (IH) repair is one of the most common procedures in general surgery around the world. Minimizing postoperative acute and chronic pain without increasing recurrence has been a critical point, giving place to different strategies like self-fixation mesh. The current study aimed to describe a group of patients who underwent IH repair by Totally Extraperitoneal (TEP) technique with self-gripping mesh at a fourth level hospital between 2012 and 2019. Retrospective review of a prospectively collected database including patients who underwent laparoscopic TEP approach with self-fixation mesh for IH repair. Follow up data was obtained at 12, 24, 36, 48, and 60 months post surgical intervention. 207 hernia repairs were performed in 142 patients, with a total of 66 patients with bilateral IH. 10.6% required hospitalization due to either concomitant procedure performed or cardiovascular comorbidities, with a mean hospital stay of 1.6 days. Median and late follow up was up to 5 years. 88.9% of patients complete a year, 86% two years, and 36.7% with a 5 year follow-up. IH repair using the TEP technique and self-fixation mesh showed to be an excellent approach, demonstrating satisfactory results in follow up and complications.
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Short-term comparative study of three-dimensional and two-dimensional laparoscopic surgery for total extraperitoneal primary inguinal hernia repair. JOURNAL OF MINIMALLY INVASIVE SURGERY 2021; 24:98-103. [PMID: 35600788 PMCID: PMC8965998 DOI: 10.7602/jmis.2021.24.2.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/21/2021] [Accepted: 05/23/2021] [Indexed: 11/18/2022]
Abstract
Purpose The aim of this study was to compare the short-term outcomes of two-dimensional (2D) and three-dimensional (3D) laparoscopic surgery for total extraperitoneal (TEP) primary inguinal hernia repair. Methods This was a single-center, retrospective, observational database study of 38 patients who underwent laparoscopic TEP inguinal hernia repair from March 1, 2019 to August 30, 2019 at Kyung Hee University Hospital at Gangdong in Seoul, Korea. Results There was no significant difference in sex ratio, age, or body mass index between the two groups. The 2D group had two patients with direct hernia and 18 patients with indirect hernia. The 3D group had five patients with direct hernia, 11 patients with indirect hernia, and two patients with femoral hernia. The mean operation time was 38.2 minutes in the 2D group compared with 37.2 minutes in the 3D group. There was no severe intraoperative bleeding in either group. During the operation, peritoneal tearing occurred in 12 out of 20 patients in the 2D group compared with five out of 18 patients in the 3D group (p = 0.02). The average length of hospital stay was 1.3 days in both groups. The numeric rating scale score was 3.3 and 3 in the 2D group and the 3D group, respectively. In the 2D group, two patients revisited the outpatient clinic because of the postoperative occurrence of seroma and varicocele. Conclusion A 3D laparoscopic surgery is feasible and safe for inguinal hernia repair and showed less peritoneal tearing compared with 2D laparoscopic surgery for primary inguinal hernia repair.
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Laparoscopic totally extraperitoneal ligation for pediatric inguinal hernia: a novel surgical treatment. Surg Endosc 2021; 36:1320-1325. [PMID: 33625591 DOI: 10.1007/s00464-021-08408-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/15/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Laparoscopic repair is widely performed for the management of pediatric inguinal hernia (PIH), and different laparoscopic surgical methods are used. Herein, we present the application of laparoscopic totally extraperitoneal ligation (TEPL), which is a novel surgical method for PIH repair and is similar to traditional high ligation. METHODS In this study, 103 pediatric patients underwent laparoscopic TEPL for inguinal hernia. Data including demographic characteristics, clinical presentation, time of surgery, length of hospital stay, and postoperative complications were analyzed retrospectively. RESULTS The patient's median age at surgery was 4.3 years, and the median body weight at surgery was 18 kg. The preoperative diagnoses were as follows: n = 53, right inguinal hernia; n = 45, left inguinal hernia; and n = 5, bilateral inguinal hernia. All patients were discharged on the day of surgery. The operative times were 27.2 min for unilateral inguinal hernia and 28.8 min for bilateral inguinal hernia. All patients, except one who had scrotal bruise, did not present with postoperative complications. CONCLUSIONS Laparoscopic TEPL, which is similar to traditional high ligation, is used for the treatment of PIH. Moreover, it is safe, beneficial, and feasible. Double ligation is performed on the extraperitoneal space, and the assessment of contralateral patent processus vaginalis is not complex. However, further studies should be conducted to assess for long-term outcomes.
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Laparoscopic Totally Extraperitoneal Hernia Repairs: a Case Series Analysis. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02416-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Kumar A, Dandey A, Pal A, Agrawal M, Anand A, Pahwa H, Singh K, Sonkar A. Comparative evaluation of outcomes in different techniques of mesh fixation in totally extraperitoneal hernioplasty. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2021. [DOI: 10.4103/ijawhs.ijawhs_11_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ortenzi M, Williams S, Solanki N, Guerrieri M, Haji A. Laparoscopic repair of inguinal hernia: retrospective comparison of TEP and TAPP procedures in a tertiary referral center. MINERVA CHIR 2020; 75:279-285. [PMID: 33210522 DOI: 10.23736/s0026-4733.20.08518-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The technical evolution of hernia repair has brought to the introduction of laparoscopy in this field. The most common laparoscopic techniques are transabdominal preperitoneal (TAPP) repair and totally extraperitoneal (TEP) repair. Indirect comparisons between TAPP and TEP have raised questions as to which is the superior approach in improving patient outcomes; however, there is still a scarcity of data directly comparing these laparoscopic approaches. The aim of this report is to offer a retrospective comparison between the two techniques with a long-term follow-up. METHODS This study is a retrospective comparative study, comparing TEP and TAPP in the treatment of groin hernias. All patients undergoing laparoscopic hernia repair from 2015 and 2020 at a large UK Hospital Trust with tertiary referral center, were considered as eligible for inclusion. The primary endpoint was rate of successful surgery defined as absence of recurrence and chronic pain at the end of the follow-up. Secondary endpoints were conversion rate (the switch from TEP to TAPP was considered as a conversion for the index procedure), need for admission, readmission rate, serious adverse events (including visceral injuries and vascular injuries), rate of persisting pain at the end of follow-up, operative time and overall complications rate (hematoma, seroma, wound/superficial infection, mesh/deep infection, port site hernia). RESULTS Of the patients included in the study who underwent laparoscopic repair of inguinal hernia between 2015 and 2020, 140 (55.1%) underwent TEP and 114 (44.9%) had TAPP repair. The mean operative time did not differ between the two groups (P=0.202). The conversion rate was nil. The two procedures did not differ for intraoperative and postoperative complications. The length of hospital stay was significantly longer in the TAPP group (P<0.0001). The overall recurrence rate was 2.4%. and did not differ between the two groups. Costs were acquired from the clinical coding department. Mean costs were measured in pounds sterling and a significant difference was noted between the two groups (P=0.083). In the short term, the most common complication was seroma formation and was significantly more frequent in the TAPP group (P<0.001). In the long term, chronic pain was the most frequent complication in both groups and significant correlated when the operation performed for recurrent hernia, whereas the hernia Type 3 was a factor that which influenced recurrence. CONCLUSIONS In conclusion, TAPP and TEP have similar, overall complication risks, postoperative acute and chronic pain incidence and recurrence rates. Since TAPP and TEP have comparable outcomes it is recommended that the choice of the technique should be based on the surgeon's skills, education, and experience.
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Affiliation(s)
- Monica Ortenzi
- Department of General and Emergency Surgery, Polytechnic University of Marche, Ancona, Italy -
| | - Sophie Williams
- Department of Colorectal Surgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Nidaa Solanki
- Department of Colorectal Surgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Mario Guerrieri
- Department of General and Emergency Surgery, Polytechnic University of Marche, Ancona, Italy
| | - Amyn Haji
- Department of Colorectal Surgery, King's College Hospital NHS Foundation Trust, London, UK
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Hee RV, Goverde P, Hendrickx L, Schelling GVD, Totté E. Laparoscopic Transperitoneal versus Extraperitoneal Inguinal Hernia Repair: a Prospective Clinical Trial. Acta Chir Belg 2020. [DOI: 10.1080/00015458.1998.12098398] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- R. Van Hee
- Academic Surgical Center Stuivenberg, University of Antwerp-UIA
| | - P. Goverde
- Department of Surgery, Hoge Beuken Hospital, Antwerp, Belgium
| | - L. Hendrickx
- Academic Surgical Center Stuivenberg, University of Antwerp-UIA
| | | | - E. Totté
- Academic Surgical Center Stuivenberg, University of Antwerp-UIA
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Vanclooster P, Smet B, Gheldere CD, Segers K. Laparoscopic Inguinal Hernia Repair : Review of 6 Years Experience. Acta Chir Belg 2020. [DOI: 10.1080/00015458.2001.12098603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- P. Vanclooster
- Department of general and abdominal surgery, Hospital H. Hart, Kolveniersvest 20, 2500 Lier, Belgium
| | - B. Smet
- Department of general and abdominal surgery, Hospital H. Hart, Kolveniersvest 20, 2500 Lier, Belgium
| | - C. de Gheldere
- Department of general and abdominal surgery, Hospital H. Hart, Kolveniersvest 20, 2500 Lier, Belgium
| | - K. Segers
- Department of general and abdominal surgery, Hospital H. Hart, Kolveniersvest 20, 2500 Lier, Belgium
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Rajbhandari N, Karki B, Guglielmetti LC, Vuille-Dit-Bille RN. Establishment of Single-Port, Laparoscopic, Pediatric Hernia Repair in a Developing Country. J Laparoendosc Adv Surg Tech A 2020; 31:124-129. [PMID: 32990497 DOI: 10.1089/lap.2020.0547] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Single-port, laparoscopic, needle-assisted, inguinal hernia repair (LNAR) in children intends to reduce surgical trauma and enables contralateral assessment and closure of contralateral patent processus vaginalis if necessary. The aim of the present study was to demonstrate that laparoscopic inguinal repair can be performed safely and cost-effectively in a developing country where laparoscopy is not yet commonly used. Methods: In this single-center study, we included all children undergoing LNAR between January 2017 and December 2018. Intraoperative and postoperative complications and hospital costs were assessed. Results: We performed 148 hernia repair operations in 117 children (age range 1 month to 15 years). Mean operative time was 20.8 ± 9.4 minutes. Mean length of hospital stay amounted to 10 ± 7.6 hours, with 77.7% of patients discharged within 6 hours. No intraoperative complications occurred in any patient. Complications occurred in six (5.1%) patients. Three (2.5%) patients experienced residual hydrocele, two (1.4%) patients suffered wound site seroma, and one (0.67%) patient experienced recurrent inguinal hernia 6 months after the initial repair. All complications occurred during the first year of the study period. Likewise, operative time (P < .0001) as well as duration of hospital stay (P < .0001) was significantly shorter in the second year. Total costs for complete treatment were below USD 80 per patient, which is comparable with the costs associated with open herniotomy at the same institution. Conclusion: Single-port LNAR and hydrocele repair in children were established safely and cost-effectively in a developing country. Nevertheless, the procedure was associated with a steep learning curve.
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Affiliation(s)
- Nripesh Rajbhandari
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Banira Karki
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Laura C Guglielmetti
- Department of Visceral and Thoracic Surgery, Cantonal Hospital of Winterthur, Winterthur, Switzerland
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Affiliation(s)
- John F Sweeney
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
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Yasukawa D, Aisu Y, Hori T. Crucial anatomy and technical cues for laparoscopic transabdominal preperitoneal repair: Advanced manipulation for groin hernias in adults. World J Gastrointest Surg 2020; 12:307-325. [PMID: 32821340 PMCID: PMC7407845 DOI: 10.4240/wjgs.v12.i7.307] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 04/08/2020] [Accepted: 05/12/2020] [Indexed: 02/06/2023] Open
Abstract
Groin hernias include indirect inguinal, direct inguinal, and femoral hernias. Obturator and supravesical hernias appear very close to the groin. High-quality repairs are required for groin hernias. The concept of "tension-free repair" is generally accepted, and surgical repairs with mesh are categorized as "hernioplasties". Surgeons should have good knowledge of the relevant anatomy. Physicians generally focus on the preperitoneal space, myopectineal orifice, topographic nerves, and regional vessels. Currently, laparoscopic surgery has therapeutic potential in the surgical setting for hernioplasty, with laparoscopic transabdominal preperitoneal (TAPP) repair appearing to be a powerful tool for use in adult hernia patients. TAPP offers the advantages of accurate diagnoses, repair of bilateral and recurrent hernias, less postoperative pain, early recovery allowing work and activities, tension-free repair of the preperitoneal (posterior) space, ability to cover obturator hernias, and avoidance of potential injury to the spermatic cord. The disadvantages of TAPP are the need for general anesthesia, adhering to a learning curve, higher cost, unexpected complications related to abdominal organs, adhesion to the mesh, unexpected injuries to vessels, prolonged operative time, and as-yet-unknown long-term outcomes. Both technical skill and anatomical familiarity are important for safe, reliable surgery. With increasing awareness of the importance of anatomy during TAPP repair, we address the skills and pitfalls during laparoscopic TAPP repair in adult patients using illustrations and schemas. We also address debatable points on this subject.
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Affiliation(s)
- Daiki Yasukawa
- Department of Surgery, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Yuki Aisu
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Tomohide Hori
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
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Tiwary SK, Kumar S, More R, Shankar V, Kumar S, Dwivedi AND. A study of contralateral occult inguinal hernia in adult male patients undergoing total extraperitoneal herniorraphy. J Family Med Prim Care 2020; 9:2975-2979. [PMID: 32984158 PMCID: PMC7491803 DOI: 10.4103/jfmpc.jfmpc_207_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/13/2020] [Accepted: 03/23/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The incidence of contralateral occult hernia (COH) varies from 4.2% to 57.5%. Total extraperitoneal (TEP) gives us opportunity to visualize contralateral groin for occult hernia and its simultaneous repair. Ultrasonography (USG) helps to diagnose occult hernia preoperatively with detection rate of 96.6% with specificity 84.4%. OBJECTIVE The aims of this study were to identify the incidence of contralateral occult inguinal hernia in clinically diagnosed unilateral inguinal hernia patients using USG as diagnostic modality and to compare the clinical outcomes of unilateral TEP vs. bilateral TEP with respect to pain, duration of hospital stay, time for return to normal work, and postoperative complications. SETTING AND DESIGN This was a prospective observational, single-center study. MATERIALS AND METHODS A total of 30 male patients were included in the study who was having clinically diagnosed unilateral hernia. All patients were assessed by USG for contralateral occult inguinal hernia. RESULTS Incidence of COH was 10%, two (6.7%) had indirect defect, and 1 (3.3%) had direct defect. Two (6.7%) patients underwent bilateral TEP and 28 (93.3%) underwent unilateral TEP. No significant difference was observed in terms of mean duration of hospital stay, duration of surgery, and visual analog scale score for pain in both unilateral and bilateral TEP. The mean for resuming daily work in unilateral TEP was 4.86 ± 0.833 days and in bilateral TEP the mean was 7.50 ± 0.70 days and this showed statistically significant difference (P < 0.001). CONCLUSION Patients with COH should be counselled for synchronous repair as there is no significant difference in clinical outcomes of unilateral and bilateral TEP. On the basis of this pilot study, it can be concluded that preoperative USG is mandatory for diagnosis and simultaneous management of preexisting contralateral hernia.
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Affiliation(s)
- S. K. Tiwary
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Satendra Kumar
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Raghunath More
- Department of Anatomy, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Vijay Shankar
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Sandip Kumar
- Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - A. N. D. Dwivedi
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Keskinkılıç Yağız B, Yalaza M, Sapmaz A. Is Youtube a potential training source for total extraperitoneal laparoscopic inguinal hernia repair? Surg Endosc 2020; 35:2014-2020. [PMID: 32367448 DOI: 10.1007/s00464-020-07596-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 04/22/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of this study is to evaluate the quality of the most commonly viewed total extraperitoneal laparoscopic inguinal hernia repair (TEP) videos on Youtube, which is the largest social and medical media broadcasting service, concerning educational purposes. METHOD A search with the keyword "total extraperitoneal laparoscopic inguinal hernia repair" was performed on Youtube. The first 120 videos among the search results were downloaded and 55 of them were included in the study. A scoring system developed by the authors according to the recent literature was utilized for evaluation of the videos. Video demographics were evaluated for the quality and upload source. RESULTS Among the enrolled videos, video quality was rated as good in 13 (23.6%), as moderate in 22 (40%), and as poor in 20 (36.4%). Video length, presence of narration, number of likes, and comments were significantly higher in the good group. Upload source was an academic center in 14 (25.5%), a community hospital in 22 (40.0%), and a physician in 19 (34.5%). The mean video score of the academic center group (8 ± 4.095) and community hospital group (8.64 ± 3.259) was significantly higher than the physician group (5.47 ± 2.632) (p = 0.010). Video quality was not correlated with total views or views per day. CONCLUSION Total extraperitoneal laparoscopic inguinal hernia repair procedure videos uploaded to Youtube demonstrate considerable heterogeneity in terms of educational quality and the number of good quality videos is significantly low. This heterogeneity is attributed to the lack of peer review process for the evaluation of educational quality of the videos. Therefore, a physician intending to learn and practice a surgical procedure properly (TEP repair in this situation) should not consider a broadcasting service without a peer review process as a reliable training source.
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Affiliation(s)
- Betül Keskinkılıç Yağız
- Department of General Surgery, Ministry of Health Ankara City Hospital, Üniversiteliler caddesi Bilkent bulvarı no:1, Çankaya, Ankara, Turkey.
| | - Metin Yalaza
- Department of General Surgery, Subdivision of Surgical Oncology, Ministry of Health Ankara City Hospital, Üniversiteliler caddesi Bilkent bulvarı no:1, Çankaya, Ankara, Turkey
| | - Ali Sapmaz
- Department of General Surgery, Ministry of Health Ankara City Hospital, Üniversiteliler caddesi Bilkent bulvarı no:1, Çankaya, Ankara, Turkey
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Aghayeva A, Benlice C, Bilgin IA, Bengur FB, Bas M, Kirbiyik E, Aytac E, Baca B. Laparoscopic totally extraperitoneal vs robotic transabdominal preperitoneal inguinal hernia repair: Assessment of short‐ and long‐term outcomes. Int J Med Robot 2020; 16:e2111. [DOI: 10.1002/rcs.2111] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/04/2020] [Accepted: 04/07/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Afag Aghayeva
- Department of General SurgeryAcibadem Mehmet Ali Aydinlar University School of Medicine Istanbul Turkey
| | - Cigdem Benlice
- Department of General SurgeryAcibadem Mehmet Ali Aydinlar University School of Medicine Istanbul Turkey
| | - Ismail A. Bilgin
- Department of General SurgeryAcibadem Mehmet Ali Aydinlar University School of Medicine Istanbul Turkey
| | - Fuat B. Bengur
- Acibadem Mehmet Ali Aydinlar University School of Medicine Istanbul Turkey
| | - Mustafa Bas
- Acibadem Mehmet Ali Aydinlar University School of Medicine Istanbul Turkey
| | - Ebru Kirbiyik
- Department of General SurgeryAcibadem Mehmet Ali Aydinlar University School of Medicine Istanbul Turkey
| | - Erman Aytac
- Department of General SurgeryAcibadem Mehmet Ali Aydinlar University School of Medicine Istanbul Turkey
| | - Bilgi Baca
- Department of General SurgeryAcibadem Mehmet Ali Aydinlar University School of Medicine Istanbul Turkey
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Totally Extraperitoneal Repair in Inguinal Hernia: More Than a Decade's Experience at a Tertiary Care Hospital. Surg Laparosc Endosc Percutan Tech 2020; 29:247-251. [PMID: 31135709 DOI: 10.1097/sle.0000000000000682] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION There are 2 standard techniques of laparoscopic groin hernia repair, totally extraperitoneal repair (TEP) and transabdominal preperitoneal repair (TAPP). TEP has the advantage that the peritoneal cavity is not breached but is, however, considered to be more difficult to master when compared with TAPP. We describe herein our experience of TEP repair of inguinal hernia over the last 14 years. MATERIALS AND METHODS This study is a retrospective analysis of a prospectively maintained database of all patients with groin hernia who underwent TEP repair in a single surgical unit between January 2004 and January 2018. Patients' demographic profile and hernia characteristics (duration, side, extent, content, and reducibility) were noted in the prestructured proforma. Clinical outcomes included the operation time, intraoperative and postoperative complications, length of postoperative hospital stay, hernia recurrence, chronic pain, recurrence, seroma, and wound infections. Long-term follow-up was carried out in the outpatient department. RESULTS Over the last 14 years, TEP repair was performed in 841 patients and a total of 1249 hernias were repaired. The mean age of patients was 50.7 years. There were 748 primary and 345 unilateral hernias. The majority were direct (61%) inguinal hernias. Telescopic dissection was the commonest method of space creation. The average operating time was 54.8 and 77.9 minutes for unilateral and bilateral hernias, respectively. With 81 conversions, the success rate for TEP was 93.5%. Seroma was the most common postoperative complication seen in 81 patients. The incidence of chronic groin pain was 1.4%. The follow-up ranged from 3 months to 10 years, and there were only 3 recurrences (<1%). CONCLUSION In conclusion, TEP repair is an excellent technique of laparoscopic inguinal hernia repair with acceptable complications after long-term follow-up.
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Stodolski M, Zirngibl H, Ambe PC. Gender discrimination in endoscopic groin hernia repair. Minimal invasive groin hernia repair is offered less often to female patients compared to male patients. J Visc Surg 2019; 157:271-276. [PMID: 31870628 DOI: 10.1016/j.jviscsurg.2019.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Groin hernia repair constitutes a very common procedure in general surgery. Minimal invasive closure of groin hernia has evolved to become the standard means of closure. However, there seems to be a gender-associated discrimination with regard to endoscopic groin hernia repair. We investigated the rate of endoscopic closure in female patients undergoing groin hernia closure. MATERIALS AND METHODS A retrospective analysis of the data of patients undergoing elective groin hernia repair within a four-year period from 2013 to 2016 was performed. The rate of endoscopic hernia repair was calculated for both genders. RESULTS Eight hundred and forty-six patients including 94 females and 752 males were included for analysis. The female group was significantly older compared to the male group (68.0 vs. 61.0 yrs, P=0.02). The rate of endoscopic groin hernia repair was significantly lower in the female group compared to in the male cohort (30% vs. 60%, P=0.001). The overall duration of surgery was 74.0min in the female cohort and 93.0min in the male group, P=0.001. However, there was no statistically significant difference amongst both groups with regard to the duration of surgery for endoscopic repair: 78.0min in the female group and 89.0min in the male group, P=0.67. CONCLUSION Findings from this retrospective collective suggests that, there might be some degree of sex discrimination with regard to endoscopic groin hernia repair in favor of the male population.
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Affiliation(s)
- M Stodolski
- Department of Surgery, Helios Universitätsklinikum Wuppertal, Witten/Herdecke University, Wuppertal, Germany
| | - H Zirngibl
- Department of Surgery, Helios Universitätsklinikum Wuppertal, Witten/Herdecke University, Wuppertal, Germany
| | - P C Ambe
- Department of Surgery, Helios Universitätsklinikum Wuppertal, Witten/Herdecke University, Wuppertal, Germany; Department of General, Visceral and Transplantation Surgery, University Hospital Münster Albert-Schweitzer-Campus 1, Gebäude W1 Waldeyerstraße 1, 48149 Münster, Germany.
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Steinke H, Wiersbicki D, Völker A, Pieroh P, Kulow C, Wolf B, Osterhoff G. The fascial connections of the pectineal ligament. Clin Anat 2019; 32:961-969. [PMID: 31381189 DOI: 10.1002/ca.23445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 11/11/2022]
Abstract
In clinical settings, the pectineal ligament forms a basic landmark for surgical approaches. However, to date, the detailed fascial topography of this ligament is not well understood. The aim of this study was to describe the morphology of the pectineal ligament including its fascial connections to surrounding structures. The spatial-topographical relations of 10 fresh and embalmed specimens were dissected, stained, slice plastinated, and analyzed macroscopically, and in three cases histological approaches were also used. The pectineal ligament is attached ventrally and superiorly to the pectineus muscle, connected to the inguinal ligament by the lacunar ligament and to the tendinous origin of rectus abdominis muscle and the iliopubic tract. It forms a site of origin for the internal obturator muscle, and throughout its curved course, the ligament attaches to both the fasciae of iliopsoas and the internal obturator muscle. However, dorsally, these fasciae pass free from the bone, while the pectineal ligament itself is adhered to it. The organ fasciae are seen apart from the pectineal ligament and its connections. The pectineal ligament seems to form a connective tissue junction between the anterior and medial compartment of the thigh. This ligament, however, is free to other compartments arisen from the embryonal gut and to the urogenital ridge. These features of the pectineal ligament are important to consider during orthopedic and trauma surgical approaches, in gynecology, hernia and incontinence surgery, and in operations for pelvic floor and neovaginal reconstructions. Clin. Anat. 32:961-969, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Hanno Steinke
- Institute of Anatomy, Leipzig University, Leipzig, Germany
| | | | - Anna Völker
- Orthopedics, Trauma Surgery and Plastic Surgery, Spine Center, University Hospital Leipzig, Leipzig, Germany
| | - Philipp Pieroh
- Orthopedics, Trauma Surgery and Plastic Surgery, Spine Center, University Hospital Leipzig, Leipzig, Germany
| | | | - Benjamin Wolf
- Department for Gynecology, University Hospital Leipzig, Leipzig, Germany
| | - Georg Osterhoff
- Orthopedics, Trauma Surgery and Plastic Surgery, Spine Center, University Hospital Leipzig, Leipzig, Germany
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Huerta S, Timmerman C, Argo M, Favela J, Pham T, Kukreja S, Yan J, Zhu H. Open, Laparoscopic, and Robotic Inguinal Hernia Repair: Outcomes and Predictors of Complications. J Surg Res 2019; 241:119-127. [PMID: 31022677 DOI: 10.1016/j.jss.2019.03.046] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 02/20/2019] [Accepted: 03/22/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The robotic approach to an inguinal hernia has not been compared head to head with the open and laparoscopic techniques in randomized controlled trials. Furthermore, long-term outcomes for robotic inguinal hernia repair (RHR) are lacking. In this study, we compared laparoscopic inguinal hernia repair (LHR) and RHR with open inguinal hernia repair (OHR) in veteran patients performed by surgeons most familiar with each approach. METHODS A retrospective single-institution analysis of 1299 inguinal hernia repairs performed at the VA North Texas Health Care System between 2005 and 2017 was undertaken. Three surgeons performed the operations, each an expert in one approach, and there was no crossover in techniques. A total of 1100 OHRs, 128 LHRs, and 71 RHRs were performed. Univariable analysis was undertaken to determine associations between techniques and outcomes (OHR versus LHR; OHR versus RHR; LHR versus RHR). Setting complications as a dependent variable, multivariable analyses were undertaken to determine an association with complications as well as independent predictors of complications. RESULTS Patient demographics were similar among groups except for age that was higher in the OHR cohort. The average follow-up was 5.2 ± 3.4 y. In the present report, recurrence was associated with a higher rate in the RHR versus OHR (5.6% versus 1.7%; P < 0.02), but not in the LHR versus OHR (3.9% versus 1.9%; P = 0.09). Inguinodynia was more likely to occur in both the LHR and RHR compared with the OHR (9.4% and 14.1 versus 1.5%; both P's < 0.001). Urinary retention was also more common in the LHR and RHR than in the OHR (5.5% and 5.6% versus 1.8%, both P's < 0.05) as was the rate of overall complications (34.4% and 38.0% versus 11.2%, both P's < 0.001). Multivariable regression analysis showed femoral hernias, ASA, serum albumin, operative room time, a recurrent hernia, and the minimally invasive approaches were independent predictors of overall complications. CONCLUSIONS Outcomes in the OHR cohort were, in general, superior compared with both the LHR and RHR. However, these strategies should be viewed as complementary. The best approach to an inguinal hernia repair rests on the specific expertise of the surgeon.
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Affiliation(s)
- Sergio Huerta
- Department of Surgery, University of Texas Southwestern, Medical Center, Dallas, Texas; Department of Surgery, VA North Texas Health Care System, Dallas, Texas.
| | - Corey Timmerman
- Department of Surgery, University of Texas Southwestern, Medical Center, Dallas, Texas
| | - Madison Argo
- Department of Surgery, University of Texas Southwestern, Medical Center, Dallas, Texas
| | - Juan Favela
- Department of Surgery, University of Texas Southwestern, Medical Center, Dallas, Texas
| | - Thai Pham
- Department of Surgery, University of Texas Southwestern, Medical Center, Dallas, Texas; Department of Surgery, VA North Texas Health Care System, Dallas, Texas
| | - Sachin Kukreja
- Department of Surgery, VA North Texas Health Care System, Dallas, Texas
| | - Jingsheng Yan
- Department of Surgery, University of Texas Southwestern Medical Center, Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
| | - Hong Zhu
- Department of Surgery, University of Texas Southwestern Medical Center, Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
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