Extraperitoneal Inguinal Hernia Repair Research Articles

Comparative Review of Outcomes of Totally Extraperitoneal (TEP) and Transabdominal Preperitoneal (TAPP) Primary Inguinal Hernia Repair.

There is an ongoing debate about the efficacy and postoperative outcomes of transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) inguinal hernia repair. Our aim is to assess the surgical outcomes of each technique, focusing predominantly on postoperative components to determine if establishing a policy to advocate for a single technique is warranted. A literary review of randomized control trials and cohort studies to delineate recurrent concerns or points of contention was undertaken. A retrospective, comparative analysis was performed of TEP and TAPP primary inguinal hernia repairs performed by surgeons with more than five-yearexperience with their preferred technique over a three-year period (January 2020 to December 2022) at three separate institutions. A total of 279 applicable cases were reviewed of which 38% (n=106) were performed as TEP and 62% (n=173) performed as TAPP. The demographic of the cohort was heavily skewed towards the male population as expected; however, there were no differences between each subgroup. TEP hernia repair showed a significantly improved postoperative pain score at one and 24 hours, respectively(1.67 ± 0.45, p < 0.05 and 1.97 ± 0.31, p < 0.05). No discernible difference was noted in the categories of length of hospital stay, recurrence rate, and overall patient satisfaction. The study showed overall improved results using the TEP inguinal hernia repair technique; however, no statistically significant results were demonstrated in the long term to advocate for changes to pre-existing surgeon preferences.

Safety of unfixed mesh in laparoscopic total extraperitoneal inguinal hernia repair: A meta-analysis of randomized controlled trials

BackgroundWhether the effect of the unfixed mesh during laparoscopic total extraperitoneal (TEP) inguinal hernia repair can lead to hernia recurrence remains controversial. MethodsThe PubMed, Cochrane Library, and EMBASE databases were searched to retrieve clinical randomized controlled trials (RCTs) comparing nonfixation of mesh and fixation of mesh in TEP inguinal hernia repair, and we performed a metaanalysis with RevMan 5.3 software. ResultsFifteen RCTs were included in the metaanalysis, which showed that the operation time (P = 0.001) of the unfixed mesh group was shorter than that of the fixed mesh group; additionally, the postoperative 24-h pain score (P = 0.04) and incidence of urinary retention (P = 0.001) were lower in the unfixed mesh group. There was no significant difference between the unfixed mesh group and the fixed mesh group in terms of hospital stay (P = 0.47), time to resume normal activities (P = 0.51), incidence of haematoma (P = 0.96), incidence of chronic pain (P = 0.20), and recurrence rate (P = 0.09). ConclusionUnfixed mesh in TEP inguinal hernia repair shows no elevated recurrence rates compared to fixed mesh and is clinically safe.

The Effect of Mesh Fixation Methods on Pain Sensation After Laparoscopic Inguinal Hernia Repair

Aim: Groin hernia repair is one of the most common surgical procedure in general surgery. The use of prosthetic meshs has reduced the recurrence rate after inguinal hernia repair to less than 5%. Chronic pain is thought to be multi-factorial. Among these, surgical-related factors are the types of mesh used and fixation methods. It was aimed to evaluate the effect of the use of absorbable and non-absorbable screws for mesh fixation on post-operative pain during TEP repair.&#x0D; Material and Methods: The data of patients who were operated on by a single surgeon and who underwent TEP repair for unilateral or bilateral inguinal hernia were reviewed retrospectively. Post-operative first-week pain sensations were compared between patient groups in which absorbable and non-absorbable screws were used for patch fixation.&#x0D; Results: A total of 35 patients who were operated by a single surgeon and who underwent laparoscopic total extraperitoneal (TEP) repair for unilateral or bilateral inguinal hernia were included in the study. It was found that patients in the absorbable screw group felt statistically significantly less pain [VAS: 3 (2-7) vs. 4 (2-8); p=0.03].&#x0D; Conclusion: Chronic pain after patchy hernia repair is also seen as a late complication that can last up to 6 months. This study, which proves that the use of absorbable stabilizers leads to less pain in the early period, reveals that this method may also be a suitable method for preventing the development of possible chronic pain.

Feasibility of totally extraperitoneal inguinal hernia repair in patients with previous prostatectomy.

Laparoscopic totally extraperitoneal inguinal hernia repair (TEP) surgery technique includes three key steps: reaching the preperitoneal space, reducing hernias, and placement of mesh. However, reaching the preperitoneal space can be complicated in patients with previous lower abdominal surgeries. This study aimed to assess the feasibility of laparoscopic inguinal TEP in patients with previous prostatectomies. Inguinal hernia patients who underwent laparoscopic TEP between January 2015 and February 2021 at Koç University Faculty of Medicine, Department of General Surgery, were included in this retrospective study. The operations were performed by five senior surgeons experienced in laparoscopy. Patients were divided into two study groups, as the radical prostatectomy (RP) group which included patients with previous prostatectomy non-RP which included patients without previous radical prostatectomy. Operative time (OT), length of hospital stay (LOS), and postoperative complications were compared within two groups. Three hundred and forty-nine patients underwent laparoscopic TEP, and 27 had previous prostatectomies. Among them, 190 patients had unilateral inguinal hernias, and 159 had bilateral inguinal hernias. Mean age of the patients in the non-RP and RP groups was 58.1 ± 14.7 and 73.9 ± 9.6 years, respectively. Only one (3.7%) case was complicated with urinary tract infection in the RP group, and 10 (3.1%) were complicated in the non-RP group. Complications for the non-RP group include hematomas in six cases, urinary tract infection in three cases, and urinary retention in one case. No significant difference in mean operative time was seen between non-RP and RP groups (p= 0.43). There was no significant difference in the means of the length of hospital stay between the two groups (p= 0.7). Laparoscopic TEP in patients with a previous prostatectomy can be performed safely without prolonging the operative time and increasing the length of hospital stay.

Meta‑analysis of single-incision laparoscopic versus multi-trocar laparoscopic totally extraperitoneal inguinal hernia repair.

Whether single-incision laparoscopic totally extraperitoneal (SIL-TEP) inguinal hernia repair is similar or superior to multi-trocar laparoscopic totally extraperitoneal (MTL-TEP) inguinal hernia repair is controversial. We conducted this meta-analysis to compare the safety, efficacy and cosmetic effect of the two surgical methods. We systematically searched the Cochrane Library, Embase database and PubMed database for published studies on SIL-TEP and MTL-TEP inguinal hernia repair. The studies were screened and evaluated for quality according to the inclusion and exclusion criteria, and RevMan 5.3 software was used for meta-analysis. Twenty studies were included, including 7 randomized controlled studies and 13 nonrandomized controlled studies. Meta-analysis revealed no significant difference between SIL-TEP and MTL-TEP inguinal hernia repair in terms of unilateral operation time (P = 0.12), bilateral operation time (P = 0.72), pain score on the first day after operation (P = 0.61], chronic pain rate (P = 0.61), total complication rate (P = 0.26), hospital stay (P = 0.72), and recurrence rate (P = 0.83), but the cosmetic effect score (P = 0.002) was higher in the former. These findings demonstratethat SIL-TEP inguinal hernia repair is safe, reliable and feasible. In addition, it can result in a better cosmetic effect of the incision than MTL-TEP inguinal hernia repair. SIL-TEP inguinal hernia repair should be considered for patients with stricter cosmetic requirements.Clinical trial registration: INPLASY2022110085.

A novel high accuracy model for automatic surgical workflow recognition using artificial intelligence in laparoscopic totally extraperitoneal inguinal hernia repair (TEP)

IntroductionArtificial intelligence and computer vision are revolutionizing the way we perceive video analysis in minimally invasive surgery. This emerging technology has increasingly been leveraged successfully for video segmentation, documentation, education, and formative assessment. New, sophisticated platforms allow pre-determined segments chosen by surgeons to be automatically presented without the need to review entire videos. This study aimed to validate and demonstrate the accuracy of the first reported AI-based computer vision algorithm that automatically recognizes surgical steps in videos of totally extraperitoneal (TEP) inguinal hernia repair.MethodsVideos of TEP procedures were manually labeled by a team of annotators trained to identify and label surgical workflow according to six major steps. For bilateral hernias, an additional change of focus step was also included. The videos were then used to train a computer vision AI algorithm. Performance accuracy was assessed in comparison to the manual annotations.ResultsA total of 619 full-length TEP videos were analyzed: 371 were used to train the model, 93 for internal validation, and the remaining 155 as a test set to evaluate algorithm accuracy. The overall accuracy for the complete procedure was 88.8%. Per-step accuracy reached the highest value for the hernia sac reduction step (94.3%) and the lowest for the preperitoneal dissection step (72.2%).ConclusionsThese results indicate that the novel AI model was able to provide fully automated video analysis with a high accuracy level. High-accuracy models leveraging AI to enable automation of surgical video analysis allow us to identify and monitor surgical performance, providing mathematical metrics that can be stored, evaluated, and compared. As such, the proposed model is capable of enabling data-driven insights to improve surgical quality and demonstrate best practices in TEP procedures.Graphical abstract

195 Small bowel obstruction through peritoneal defect herniation after a totally extraperitoneal hernia repair- A unusual complication case series

Abstract The rates of major complications associated with totally extraperitoneal (TEP) inguinal hernia repair are reportedly low, and intra-abdominal complications are rare. However, here we present a case series with small bowel obstruction through herniation of the small bowel into the peritoneal defect after a TEP, which is a rare complication. The first case, a 71year old male two weeks post-TEP left inguinal hernia repair, presented with abdomen pain, vomiting, distension, and bowels not opened for three days with elevated inflammatory markers. Computed Tomography of the abdomen and pelvis (CTAP) demonstrated small bowel obstruction secondary to a loop of inflamed small bowel adherent to the anterior abdominal wall in the left inguinal region. During emergency diagnostic laparoscopy found to have a small bowel loop passing through a peritoneal defect just lateral to the medial umbilical ligament, converted to laparotomy, and small bowel resection was performed. In the second case, a 61-year-old male presented with similar complaints and elevated inflammatory markers two days post bilateral TEP. The CTAP showed dilated small bowel with a transition point in the left iliac fossa. Emergency diagnostic laparoscopy found a peritoneal defect on the left groin with small bowel herniation. The bowel-reduced back and the defect was closed with sutures. Small bowel obstruction due to a peritoneal defect after TEP is a rare but potentially fatal complication. Therefore, the clinician should have a low threshold for surgery, as it is unlikely to resolve with conservative treatment like the adhesional bowel obstruction.

Use of the LigaSure for Closing Peritoneal Defects in an Experimental Rat Model

Background: There has not been an absolute consensus over the routine closure of peritoneal defect (PD) during laparoscopic totally extraperitoneal inguinal hernia repair (TEP). Pretied sutures, endoscopic stapling, and suturing are surgical techniques for closing PDs. Moreover, we observed that we could close small PDs during the TEP procedure by sealing with the LigaSure (LS). Objectives: The present study aimed to evaluate the necessity of closure PDs under a polypropylene mesh and the early intraperitoneal inflammatory, fibrotic, and adhesional effects of sealing PDs with the LS in an experimental rat model. Methods: A total of 35 male rats were assigned to five groups. 1- Control group: mesh was not used, and the peritoneum was left open; 2- Mesh group; mesh was placed directly on the PD without repairing, and three peritoneal repairing methods; 3- Stapling group: PD was repaired with metal clips; 4- Suture group: PD was repaired with Vicryl sutures; and 5- LigaSure group: PD was closed with the LS. Rats were sacrificed on the postoperative 14th day. Adhesion scores, fibrosis, and inflammation scores were compared between all groups. Results: All rats completed the 14 days of follow-up without complication. The Mesh group had significantly higher adhesion scores than the other groups (P&lt;0.001). Nonetheless, no significant difference was observed between peritoneal repairing methods (P=0.696). Fibrosis and inflammatory scores were similar in peritoneal repairing methods (P=0.394 and P=0.112, respectively). Conclusion: The direct contact of foreign bodies with the intra-abdominal organs increases the risk of adhesion; therefore, the remaining PDs under the polypropylene mesh should be repaired. Sealing PDFs with LS is a simple method that does not increase the inflammatory response, fibrosis, and the risk of adhesion formation.

Comparison of extraperitoneal and intraperitoneal laparoscopic procedures for intracranial pressure increase: a prospective clinical study.

According to the literature, higher levels of both intracranial pressure (ICP) and intraabdominal pressure (IAP) are related in a way that suggests a causal relationship. An increase in ICP can cause major neurological problems both during and after laparoscopic surgery. In this study, we aimed to examine the increase in ICP between totally extraperitoneal (TEP) inguinal hernia repair and laparoscopic cholecystectomy. We investigated 52 individuals who underwent laparoscopic surgery for the treatment of inguinal hernia (n = 26) or had a laparoscopic cholecystectomy (n = 26). The optic nerve sheath diameter (ONSD) was assessed before the procedure (T0), 10 minutes after carbon dioxide insufflation (T1), and immediately before extubation (T2). There were significant differences in the ONSD values between the two groups as a function of time (p = 0.001). In terms of ONSD, the laparoscopic cholecystectomy value (LV) group showed a greater shift from T0 to T1 and T2 than the inguinal hernia value (HV) group. At T1, the ONSD values of both groups were considerably higher than those of T0 and T2. The impact of the extraperitoneal and transperitoneal laparoscopic methods on ICP was investigated. The ONSD value reached its maximum at T1 in both groups. At all measurement periods, the ONSD values of the LV group were noticeably higher than those of the HV group. The diagnostic accuracy of ONSD ultrasonography is an important approach for determining the ICP level. During the decision-making process of TEP inguinal hernia repair, this study can guide medical professionals in the evaluation of elevated ICP.

Laparoscopic Groin Hernia Repair Using the Totally Extraperitoneal Approach: A Retrospective Study and Our Experience.

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 repairperformed 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.

Retracted: Efficacy of Laparoscopic Totally Extraperitoneal Repair for Inguinal Hernia.

[This retracts the article DOI: 10.1155/2022/2970257.].

Logistic analysis of the recurrence of laparoscopic percutaneous extraperitoneal repair of pediatric inguinal hernia: A report of 486 cases

BackgroundAlthough the laparoscopic treatment of pediatric inguinal hernia (PIH) has more benefits than traditional surgery, it is difficult to completely avoid the problem of recurrence. The aim of this study was to use a logistic regression model to investigate the causes of recurrence after laparoscopic percutaneous extraperitoneal repair (LPER) of PIH. Patients and methodsFrom June 2017 to December 2021, 486 cases of PIH were performed using LPER in our department. We utilized a two-port approach to implement LPER for PIH. All cases were followed up and the recurrent cases were recorded in detail. We used a logistic regression model to analyze the clinical data in order to find the reasons for recurrence. ResultsWe completed 486 cases with an internal inguinal ostium high ligation using laparoscopic surgery without conversion. Patients were followed for 10–29 months with an average of 18.2 months and 8 cases had recurrent ipsilateral hernia, including 4 recurrent cases in 89 cases (4.49%) using absorbable suture, 1 in 7 cases (14.29%) with internal inguinal ostium larger than 25 mm, 2 in 26 cases (7.69%) with BMI greater than 21, 2 in 41 cases (4.88%) with postoperative chronic constipation. The total recurrence rate was 1.65%. A foreign body reaction occurred in 2 cases, there were no complications such as scrotal hematoma, trocar umbilical hernia and testicular atrophy, and no deaths in this study. Univariate logistic regression analysis showed that patient BMI, ligation suture, diameter of the internal inguinal ostium and postoperative chronic constipation were significant variables (P values 0.093, 0.027, 0.060 and 0.081). The multivariate logistic regression analysis showed that the ligation suture and the diameter of the internal inguinal ostium were the main risk factors for postoperative recurrence, the odds ratio (OR) value were 5.374 and 2.801, the P values 0.018 and 0.046, and the 95% CI were 2.513–11.642 and 1.134–9.125. The area under ROC curve (AUC) for the logistic regression model was 0.735 (the 95% CI 0.677–0.801, P < 0.01). ConclusionAn LPER for PIH is a safe and effective operation, but there still remains a small probability of recurrence. In order to reduce the recurrence rate of LPER, we should improve surgical skills, choose an appropriate ligature and avoid using LPER for a huge internal inguinal ostium (especially over 25 mm). It is appropriate to be converted to open surgery for the patients with a very wide internal inguinal ostium.

P-005 SINGLE-PORT VS. MULTI-PORT TOTALLY EXTRAPERITONEAL (TEP) INGUINAL HERNIA REPAIR: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Abstract Objective The value of single-port totally extraperitoneal inguinal hernia repair (STEP) when compared to the conventional multi-port approach (TEP) is still a matter of controversy. We conducted a meta-analysis of randomized controlled trials comparing the feasibility and safety of the above-mentioned techniques. Materials and Methods A systematic literature search for randomized controlled trials (RCTs) comparing the outcome STEP and TEP in patients with inguinal hernia was conducted. Data regarding postoperative outcomes were extracted and compared by meta-analysis. The Odds Ratio and Standardized Mean Differences with 95% Confidence Intervals (CI) were calculated. Results Six RCTs were identified, involving a total of 636 cases (STEP: n=328, TEP: n=308). There was a statistically significant difference noted between the two groups regarding return to everyday activities favoring the STEP group (SMD=-0.23; 95% CI [-0.41, -0.06]; p=0.009; 4 studies; I2=9). For the remaining primary and secondary endpoints, intra- and postoperative morbidity, conversion rate, peritoneal tears, major intraoperative bleeding, postoperative haematoseroma, operative time, postoperative pain, chronic pain, cosmetic satisfaction, hernia recurrence and in-hospital length of stay no statistically significant difference was noted between the two study groups. Conclusions Current evidence suggests that patients who underwent STEP had similar outcomes to the traditional TEP technique with the exception of time to return to everyday activities, which was reported to be shorter in the STEP group.

Small bowel obstruction as a complication of laparoscopic extraperitoneal inguinal hernia repair.

Laparoscopic hernia repeair is associated with its own set of complications, such as intra-abdominal organ and vascular injury, gas embolism, penumoperitoneum, small bowel obstruction secondary to trocar site fascial defects, intra-abdominal adhesion, and reaction to synthetic mesh. With the extraperitoneal approach, the abdominal cavity is not violated, thereby eliminating the risks for these complications. However, small bowel obstruction, albeit rarely, do occur with this approach because of inadvertent violation of the peritoneal cavity, or failure to close the peritoneal opening of the hernia sac, as shown in this case presentation.

Laparoscopic total extraperitoneal (TEP) inguinal hernia repair with preperitoneal closed-suction drainage reduced postoperative complications

BackgroundAlthough laparoscopic total extraperitoneal (TEP) inguinal hernia repair has the advantages of less bleeding, less trauma, less pain, and fast recovery, there are several issues that need to be addressed. This study aims to evaluate the effectiveness of preperitoneal closed‑suction drainage on reducing postoperative complications in TEP inguinal hernia repair.MethodsA retrospective analysis of 122 patients who underwent TEP inguinal hernia repair between June 2018 and June 2021 was performed. The patients were divided into the drainage group and the non-drainage group according to whether the drainage tube was placed or not. Clinical data, surgical procedures and outcome of these patients were collected and analyzed to assess the effectiveness of drainage.ResultsA total of 122 patients undergoing TEP surgery were screened, of which 22 were excluded. Most of the patients were male with right indirect inguinal hernia. There was no difference in the mean length of hospital stay between the two groups. Postoperative pain was alleviated by preperitoneal closed‑suction drainage 24 h after operation (p = 0.03). The rate of complications such as scrotal edema, seroma and urinary retention in the drainage group was significantly lower than that in the non-drainage group (p < 0.05). Multivariate regression analysis showed that drainage was beneficial to reduce postoperative complications (OR, 0.015; 95% CI, 0.002–0.140; p < 0.01). In addition, it was worth noting that in subgroup analysis, patients with hernia sac volume > 10 cm3 might receive more clinical benefits by placing drainage tube.ConclusionIn TEP inguinal hernia repair, placing drainage tube is a simple and feasible traditional surgical treatment, which can promote postoperative recovery without increasing the risk of infection, especially in patients with large hernia sac volume.

Total extra-peritoneal inguinal hernia repair: experience in a tertiary care hospital of Bangladesh

Background: Open hernioplasty, a traditional procedure, is practiced for decades all over the world, for inguinal hernia repair and the newer procedure of total extraperitoneal (TEP) inguinal hernia repair is the current trend. Aim of this study was to share the experience of TEP inguinal hernia repair.&#x0D; Methods: This retrospective observational study was done from April, 2012 to March, 2021 at BIRDEM General Hospital, Dhaka, Bangladesh. Patients with inguinal hernia reporting to BIRDEM outpatient department (OPD) were counseled for TEP repair. Those who consented were treated electively with a TEP repair for a unilateral or bilateral hernia defect, either direct or indirect. All procedures were completed with patients under general anaesthesia. Polypropylene mesh was placed in preperitoneal space. Followed up records were noted at one week, one month, one and two years after surgery. Patients’ age, hernia types and locations, complications, length of stay in hospital, return to work and recurrence were noted.&#x0D; Results: Total patients were 118 including one female. Patients were between 22 and 72 years. All of them had primary hernias and 72% of them underwent unilateral repairs. One of the cases required conversion to transabdominal preperitoneal procedure. In five patients (4.2%) intraoperative complication occurred and postoperative courses were complicated in 8 patients (6.7%). Patients were able to resume their daily activities after a mean period of 7 days (3 to 10 days). There was no mortality.&#x0D; Conclusion: In patients with uncomplicated inguinal hernias, TEP is associated with a very low overall risk of serious complications and recurrence with a very good functional outcome. It is equally applicable with bilateral inguinal hernias without added risk.&#x0D; BIRDEM Med J 2023; 13(1): 44-48

Evaluation of light weight large pore mesh versus heavy weight small pore mesh in total extraperitoneal repair of inguinal hernia: A prospective randomized study

Evaluation of light weight large pore mesh versus heavy weight small pore mesh in total extraperitoneal repair of inguinal hernia: A prospective randomized study

SJLA_2024_A17: Use of Perioperative Tamsulosin to Prevent Postoperative Urinary Retention Following Day Case Laparoscopic Inguinal Hernia Repair

Postoperative urinary retention is one of the more common complications following laparoscopic inguinal hernia repair (LIHR). We hypothesized that the oral one adrenergic blocker Tamsulosin, (Flomax, Boehringer Ingelheim) could be used to decrease the incidence of urinary retention after LIHR. Data from all patients undergoing laparoscopic total extraperitoneal (TEP) inguinal hernia repair by a single surgeon from June 2012 through June 2017 were collected prospectively. Patients received Tamsulosin (Flomax) 0.4 mg/day orally for a total of 5 days beginning 2 days before surgery. All TEP procedures were done under general anesthesia without a urinary catheter in place. Patients were discharged home after voiding in the recovery area. Data are expressed as mean ± standard deviation; flomax was administered to 30 of 32 consecutive patients undergoing outpatient TEP inguinal hernia repair. The mean patient age was 51.3 ± 10.5 years (28–72 years). Ten (32.2%) patients were operated on for recurrent inguinal hernias, 14 (45.1%) had bilateral hernias repaired, and 4 (12.9%) had concomitant umbilical hernia repair. The average operative time was 60 ± 24 min. The mean amount of intraoperative fluids given was 998 ± 297 ml. Two patients were excluded from the study because they required a urinary catheter in the operating room for other reasons (one requiring concomitant cystoscopy and one with anticipated complicated repair in patients who had three prior open inguinal hernia repairs and did not take Flomax). None of the patients given Flomax perioperatively developed urinary retention and all were discharged home the same day of surgery. In contrast, the two patients undergoing TEP repairs who did not receive Flomax perioperatively both developed urinary retention that required catheter placement.

Single-port versus multi-port totally extraperitoneal (TEP) inguinal hernia repair: A meta-analysis of randomized controlled trials.

The value of single-port totally extraperitoneal inguinal hernia repair (STEP) when compared to the conventional multi-port approach (TEP) is still a matter of controversy. We conducted a meta-analysis of randomized controlled trials comparing the feasibility and safety of the above-mentioned techniques. A systematic literature search for randomized controlled trials (RCTs) comparing the outcome STEP and TEP in patients with inguinal hernia was conducted. Data regarding postoperative outcomes were extracted and compared by meta-analysis. The Odds Ratio and Standardized Mean Differences with 95% Confidence Intervals (CI) were calculated. Six RCTs were identified, involving a total of 636 cases (STEP: n = 328, TEP: n = 308). There was a statistically significant difference noted between the 2 groups regarding return to everyday activities favoring the STEP group (SMD = -0.23; 95% CI [-0.41, -0.06]; P = .01; 4 studies; I2 = 9). For the remaining primary and secondary endpoints, intra- and postoperative morbidity, conversion rate, peritoneal tears, major intraoperative bleeding, postoperative haematoseroma, operative time, postoperative pain, chronic pain, cosmetic satisfaction, hernia recurrence and in-hospital length of stay no statistically significant difference was noted between the 2 study groups. Current evidence suggests that patients who underwent STEP had similar outcomes to the traditional TEP technique with the exception of time to return to everyday activities, which was reported to be shorter in the STEP group.

Nonfixation of mesh in laparoscopic totally extraperitoneal inguinal hernia repair: A propensity score matched analysis

BackgroundRegarding the need for mesh fixation in total extraperitoneal inguinal hernia repair (TEP), several studies have found no significant differences in the recurrence rate between patients with and without fixation. Furthermore, there is no report on the outcome of this treatment from Japan. We aimed to analyze the outcomes of nonfixation TEP with those of fixation at our institute. MethodsIn May 2016, the nonfixation TEP technique was launched. The fixation group (165 patients) was compared to the nonfixation group (195 patients). Because of the significant bias between the two groups, a propensity score matched analysis was performed (with 109 patients in each group). Moreover, only ordinary cases (with 58 patients in each group) were compared, excluding bilateral, large, and impaction cases. ResultsOne patient in the nonfixation group experienced recurrence. It was a hernia case with a large orifice. In the fixation group, seroma was more prevalent; however, no differences were observed between the two groups in propensity score matching. In unilateral cases, the nonfixation group had a shorter operation time and stayed in the hospital for a shorter time postoperatively. The ordinary cases, excluding cases of bilateral hernias, large hernias on visual examination, impactions, and large hernial orifices, showed no recurrence or significance in surgical complications. ConclusionsThe nonfixation TEP was considered acceptable at least for ordinary hernial cases.