Abstract
Purpose. To evaluate the feasibility, safety, and effectiveness of laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair using a memory-ring patch (Polysoft™ mesh). Patients and Methods. Between April 2010 and March 2013, a total of 76 inguinal hernias underwent TAPP repair using Polysoft mesh in 67 adults under general anesthesia. Three different senior resident surgeons performed TAPP repair under the instruction of a specialist surgeon. Nine patients had bilateral hernias. The 76 hernias included 37 indirect inguinal hernias, 29 direct hernias, 1 femoral hernia, 1 pantaloon hernia (combined direct/indirect inguinal hernia), and 8 recurrent hernias after open anterior hernia repair. The immediate postoperative outcomes as well as the short-term outcomes (mainly recurrence and incidence of chronic pain) were studied. Results. There was no conversion from TAPP repair to anterior open repair. The mean operation time was 109 minutes (range, 40–132) for unilateral hernia repair. Scrotal seroma was diagnosed at the operation site in 5 patients. No patient had operation-related orchitis, testicle edema, trocar site infection, or chronic pain during follow-up. Conclusions. The use of Polysoft mesh for TAPP inguinal hernia repair does not seem to adversely affect the quality of repair. The use of this mesh is therefore feasible and safe and may reduce postoperative pain.
Highlights
Prosthetic mesh has recently been used in the operative management of inguinal hernia and has been shown to significantly reduce recurrence as compared with traditional anterior hernia repair [1]
We report the results of a study evaluating the feasibility, safety, and effectiveness of transabdominal preperitoneal (TAPP) inguinal hernia repair using Polysoft mesh
The eight recurrent hernias developed after open anterior hernia repair
Summary
Prosthetic mesh has recently been used in the operative management of inguinal hernia and has been shown to significantly reduce recurrence as compared with traditional anterior hernia repair [1]. Discussions on inguinal hernia repair focus more on chronic pain, rather than the rate of recurrence. The number of studies reporting high incidences of postoperative chronic pain after open anterior mesh repair is increasing [2, 3]. Pelissier reported that the preperitoneal placement of Polysoft mesh (C.R. Bard, Inc., Puerto Rico, USA) via an open anterior approach reduces postoperative disabling pain [4,5,6]. Preperitoneal placement of the mesh has the advantage of using the intra-abdominal pressure to push the mesh against the overlying fascia in a more natural type of repair and decreases postoperative chronic pain because it prevents contact with the inguinal sensory nerves (ilioinguinal, iliohypogastric, and genital branch of the genitofemoral nerve) running in the inguinal canal [7,8,9]. The memory-ring offers easy deployment of the patch in the preperitoneal space during open anterior mesh repair
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