Patients Satisfaction Post Laparoscopic Transabdominal Preperitoneal Inguinal Hernia Repair with External Fixation Versus Post Internal Fixation

Mohamed Salah Abdelhamid

doi:10.11648/j.js.20160402.13

Abstract

Laparoscopic transabdominal preperitoneal inguinal hernia repair wth external fixation is a new technique in which there is a marked reduction in the cost without affecting the outcome The issue of mesh fixation in laparoscopic repair of inguinal hernia repairs remains unsolved. The need for fixing the mesh arises from the fear of increasing recurrence rates. However, specific complications have emerged as a result of mesh fixation. The aim was to find out which is more satisfactory to the patients external fixation or internal fixation. In 80 patients the mesh were fixed from the interior using staples while in the other 80 patients it is fixed to the exterior using prolene threads (Abdelhamid Technique). We conducted A prospective study for laparoscopic TAPP inguinal hernia repair on 160 patients between September 2008 until May 2014 and we follow the patients till May 2015. In 80 we fixed the mesh to the exterior and in another 80 from the interior. There were 90 patients with direct inguinal hernia 45 done through external fixation (gp1) another 45 through internal fixation of the mesh (gp2), 70 patients with indirect inguinal hernia 35 external fixation (gp3) 35 internal fixation (gp4). We follow the patients for recurrence, impulse on cough, inguinal pain and sense of discomfort. The operative time ranged from 35 – 70minutes for external fixation, 30 -60 minutes for internal fixation. During this period we did not encounter any recurrence, but in group 1 there is one patient complained of impulse on cough and in group 2 there were three had the same complain. Regarding pain non of the external fixation patients complained of groin pain while in group 2 there were two and in group 4 there were two patients complained of groin pain. We concluded that in addition to much reduction in the cost as we did not use stapler nor tucker, external fixation is safe easy to learn, external fixation is associated with no groin pain compared to internal fixation and much less incidence of impulse of cough making this technique more acceptable to the patients.

Highlights

3500yrs ago, Egyptian physicians reported the management of hernia by conservative means that included the snuggly fitting bandage for reduction and support
There were 90 patients with direct inguinal hernia 45 done through external fixation (g1) another 45(gp2) done through internal fixation of the mesh. 70 patients with indirect inguinal hernia 35 done through external fixation and 35 done with internal fixation
The time of surgery ranged from 35minutes to 70 minutes from the first incision until the last suture in the external fixation group of patients, on the stapled mesh group of patients ranged from 30-60 minutes

Summary

Introduction

3500yrs ago, Egyptian physicians reported the management of hernia by conservative means that included the snuggly fitting bandage for reduction and support. Several studies have demonstrated a definite advantage over open repair with regard to reduced post-operative pain [3, 4, 5] and earlier return to work and normal activities [6, 7, 8]. It is unknown at present what the best method is among mesh implantation, central incision, reconstructing the deep inguinal ring, or a non-incised mesh implant in laparoscopic hernia surgery [9]. The incision is extended from the lateral aspect of the inguinal region to the Lateral Umbilical Ligament as high as possible to maximize the exposure of the region

Methods

Results

Conclusion