Laparoscopic Inguinal Hernioplasty Research Articles

Comparison of Outcome of Laparoscopic and Open Inguinal Hernioplasty

Objective: To determine the outcome of Open and laparoscopic Inguinal Hernioplasty. Study Design: Comparative prospective study. Place and Duration of Study: Department of Surgery Combined Military Hospital, Multan Pakistan, from Sep 2021 to Oct 2022. Methodology: One hundred patients were enrolled and divided into Group-A and Group-B based on a technique used. Patents with a working diagnosis of inguinal hernia aged 13 to 90 years were included in the study. The data was collectedbfrom the participants at one week and six months post-operatively. Results: The mean age of patients was 43.87±13.63 years. The mean operative time was 70.5±10.48 minutes. The mean hospital stay was 1.88±0.79 days. The median post-op pain at 0 hours was 2(2 – 1); at 6 hours was 4(6 – 3); at 12 hours was 5(5 – 4) and at 24 hours was 5(6-3). Conclusion: The laparoscopic surgical technique is a wonderful addition to the surgical tool kit of a surgeon. When performed by experienced persons, there is speedy recovery and reduced hospital stay with minimal morbidity and mortality. It is highly recommended for inguinal hernioplasty.

A Comparative Study of Laparoscopic Inguinal Hernioplasty with Open Inguinal Hernioplasty

Introduction: Inguinal hernia repair is most common surgical procedures done world-wide. It is repaired by both laparoscopic and open technique. The aim of this study is to compare the outcome of laparoscopic inguinal hernioplasty with open inguinal hernioplasty. Methods: A retrospective comparative study was done from May 2019 to July 2020. Sixty patients enrolled in the study, 30 underwent Laparoscopic hernia repair (LH) and another 30 underwent Lichtenstein’s hernioplasty (OH).These two groups were compared for operative time, postoperative pain, length of hospital stay, surgical site infections and postoperative scar. Results: Out of 60 patients, right sided inguinal hernia was found in 34(56.66%), left sided inguinal hernia in 24 (40%) and bilateral inguinal hernia in 2 (3.33%).Mean operative time in LH group was 122±13.77 minutes where as in OH group it was 55.59±8.53 [p<0.01]. Mean postoperative pain at 8 hours in LH was 4.44±1.87 and in OH was 6.43±0.93 [p<0.01). At first postoperative day pain in LH was 3.46±1.38 and in OH was 5.76±1.0 [p<0.01). At second postoperative day pain in LH was 3.09±1.12 and in OH was 4.43±0.81[p<0.01].Mean duration of hospital stay in LH group was 2.13±0.34 whereas in OH group 2.70±0.46[p<0.01].No surgical site infections noted in LH group whereas 2 developed superficial surgical site infections in OH group(P=0.155). In 2 weeks and subsequent follow up period of 3 months, scarlook cosmetically better in LH group. Conclusion: Laparoscopic hernia repair was associated with less postoperative pain, shorter hospital stay, less surgical site infections, with better cosmesis but prolonged operative time.

Laparoscopic Prostatectomy in Surgical Treatment of Benign Prostatic Hyperplasia

In a contrast to the trauma of open prostatectomy, an alternative treatment for benign prostatic hyperplasia (BPH) is laparoscopic prostatectomy. It was implemented in the practical work of urologists as a minimally invasive alternative procedure to open prostatectomies (transvesical and pubic) in patients with large BPH. The objective: to consider technique and analysis of the results of laparoscopic extraperitoneal pubic (transcapsular) prostatectomy in patients with large BPH (more than 80 ml). Materials and methods. The early (inpatient) and long-term (after discharge from the hospital and up to two years of followup) results of laparoscopic extraperitoneal pubic (transcapsular) prostatectomy in 50 patients with BPH who were operated in Center for Plastic Reconstructive and Minimally Invasive Oncourology of the Cherkasy Regional Oncology Dispensary and the Urology Department of the Vinnytsia Regional Clinical Hospital named after M. I. Pirogov during 2021–2023 are presented. The average age of the patients was 68.2±2.4 years old, the average body mass index was 28.5±1.5, and the average volume of the prostate gland (PG) was 111.5±17.4 ml. Laparoscopic extraperitoneal pubic prostatectomy was performed by creating a pre-abdominal pubic space using a Space Marker balloon trocar. The incision of the PG capsule is transverse, hyperplastic parts of the bladder were removed with step-by-step hemostasis with an attempt to preserve the wall of the prostatic urethra, the anastomosis between the bladder neck and the bladder capsule was placed using a continuous V-Loc suture (2-0). Hyperplastic nodes of the PG were removed by morcellation. The urethral catheter was removed on the 5th day after surgery. The quality of urination before and after surgery was assessed using the International Symptom Questionnaire for PG diseases before and after surgery. Results. The average operation time was 120.3±11.7 min, the average intraoperative blood loss was 118.7±33.6 ml. In 10 (20%) patients the prostatic part of the ureter was saved. One patient had a stone removed from the urinary bladder by cystotomy, another patient had simultaneous pre-abdominal laparoscopic inguinal hernioplasty with a mesh polypropylene implant for an oblique hernia. No intraoperative or postoperative bleeding was observed, no hemotransfusion was performed. The average postoperative bed-day was 6.1±1.1 days. In the postoperative period (up to two years), complications (ureteral and bladder neck strictures, bladder stones, urinary incontinence, infectious complications, etc.) were not registered. Conclusions. The obtained results of laparoscopic extraperitoneal pubic prostatectomy in patients with large BPH confirmed its reliable intra- and postoperative hemostasis, short postoperative bed-day, satisfactory recovery of the act of urination with a minimum number of complications. Further studies should be conducted to establish the benefits of performing laparoscopic extraperitoneal pubic prostatectomy in patients with BPH.

OC-107 IMPLEMENTATION OF LAPAROSCOPIC INGUINAL HERNIA REPAIR IN A LOCAL HOSPITAL. 2 YEARS’ EXPERIENCE AND CHALLENGES

Abstract Background More than 30 years have passed since the first laparoscopic inguinal hernioplasty but nowadays less than 5% of patients are currently operated by this technique as recent Spanish national data suggest. Objective To present our experience 2 years after implementation of laparoscopic inguinal hernioplasty in our local hospital and highlight the challenges we faced. Methods Our hospital deals with a high volume of abdominal wall surgery and has more than 20 years experience in ambulatory surgery. A multidisciplinary clinical pathway was implemented. Strict selection criteria were established and pelvitrainer sessions were done. Results From January 2021 until December 2022, 196 laparoscopic repairs were performed: 167 transabdominal preperitoneal (TAPP), 29 totally extraperitoneal (TEP). The main challenge was the learning curve. 5 surgeons with experience in laparoscopic surgery were trained. Until now 2 completed their learning curve for TAPP and began training in TEP approach while the others still need senior assistance. The duration of laparoscopic hernioplasty, the need for deep relaxation and the increased carbon dioxide absorption were the biggest concerns for the Anesthesia team. The cost of new materials could be afforded, even though different sutures and types of mesh fixation devices were used until getting the non-invasive one. Surgical outcomes were good, with few minor complications. Moreover the outpatient rate could be maintained but the average time in waiting list for laparoscopic approach was increased. Conclusion The implementation of a laparoscopic hernioplasty program is feasible and safe but faces many challenges, especially due to long learning curve.

A comparative study on short term surgical outcome between laparoscopic inguinal hernia mesh repair vs. open inguinal hernia mesh repair for primary unilateral inguinal hernias

Background: Current study was performed to compare the short-term surgical outcome of laparoscopic (TAPP) and open inguinal hernia mesh hernioplasty (Lichtenstein) in primary unilateral inguinal hernias such as time taken by patients to return to routine daily activities and return to work. Methods: This is a prospective, comparative study done in Apollo Main Hospital, Chennai comparing surgical outcomes between laparoscopic and open primary unilateral inguinal hernia mesh repair in a total of 60 patients with 30 patients in each arm. Results: Return to Job is 8 median days in laparoscopic group and 9 median days in open group which is significant with a p value of 0.000. Pain score at 12th hour is significantly lesser in laparoscopic group with a VAS score of 3 compared to open group with a VAS score of 4 with p value of 0.015. VAS score at POD 1 in laparoscopic group is 2 and in open group is 3 which is significantly lesser in laparoscopic group with a p value of 0.026. Pain score at POD 3 and 4 is significantly lesser in laparoscopic group with a p value of 0.001 and 0.008 respectively. laparoscopic group takes analgesia for a lesser number of days than the open group with a p value of 0.019. Conclusions: This study concludes laparoscopic repair for primary unilateral inguinal hernias is superior to Lichtenstein tension free mesh hernioplasty in terms of postoperative pain, early return to job and less consumption of postoperative analgesia.

Influence of the learning curve on the immediate postoperative pain intensity after laparoscopic inguinal hernioplasty.

Inguinal hernia repairs represent one of the most commonly performed surgical operations worldwide. As more experience has been gained over the past decades with laparoscopic techniques, they are now widely used also for the repair of primary and unilateral inguinal hernias, representing a safe and effective alternative. One of the major concerns of patients undergoing inguinal hernia repair is postoperative pain and socio-professional reintegration. This study started from the hypothesis that the learning curve could influence postoperative pain intensity after laparoscopic inguinal hernioplasty. A retrospective - comparative study was performed, including a general surgeon's first consecutive cases (n=87) of TAPP (transabdominal preperitoneal procedure) hernioplasty procedures with implantation of self-gripping surgical prosthesis were investigated. The evaluation of clinical and surgical aspects resulted in similar values in case of the studied groups. A reduction in surgical time was observed in case of patients operated after completing the learning curve (p = 0.0005) On the first postoperative day patients complained mostly about persistent and severe type of pain. Average Pain Index calculated with help of Simple Numeric Pain Scale resulted in similar values. Length of analgesic treatment showed no significant differences. Although higher intensity pain was mostly caracteristic in case of patients operated during the learning process, no significant relationship between learning curve and postoperative pain intensity were highlited. TAPP can be a safe technique for young surgeons as well, with the right study program the procedure can be mastered safely.

Trans abdominal pre peritoneal inguinal hernioplasty: initial experience in resident training service

Introduction: Abdominal wall hernia surgery is one of the most common procedures performed by general surgery departments. The most common techniques currently used are: plastic surgery without mesh (Shouldice), plastic surgery with mesh (Lichtenstein) and laparoscopic plastic surgery (TAPP or TEP). More and more surgical groups are performing laparoscopic inguinal hernioplasty. Numerous studies have shown that treatment of inguinal hernias by laparoscopy has recurrence rates comparable to those established by conventional surgery. However, it has been objected that learning laparoscopic surgery is more difficult and longer than that required for the conventional technique. Objectives: To analyze the results obtained in the short and medium term during the initial experience in the development of the transabdominal pre peritoneal technique (TAPP) in a service that trains residents. Materials and methods: We conducted a prospective, observational study of the first 30 patients operated for inguinal hernias according to the TAPP technique in the General Surgery Service of the Hospital Escuela Eva Perón of Granadero Baigorria, during the period from June 2017 to June 2018. Results: 30 patients underwent elective surgery. 28 men and 2 women (93.3% and 6.7%), with a mean age of 51.17 years (range: 21 and 78 years); the mean BMI was 26.86. All were operated by TAPP (transabdominal pre peritoneal) technique. 100% of the surgeries were performed by a resident always accompanied by a staff surgeon. Comorbidities: 9 patients (30%) had arterial hypertension. 3 patients (10%) had asthma and another 3 (10%) had diabetes. 27 were indirect inguinal hernias, 6 were direct and 2 were mixed. 5 patients (16.6%) had a contralateral hernial defect as an intraoperative finding and bilateral hernioplasty was performed. The average anesthetic time was 130 minutes (range 90-180 minutes). Sixty percent of the cases were managed as outpatient surgeries, the remaining 40% were hospitalized for 24 hours because they were admitted to the operating room in the afternoon. Complications: 2 patients (6.66%) presented cord or testicular hematomas. One patient (3.33%) presented infection of the umbilical trocar wound. One patient (3.33%) had recurrence in the immediate postoperative period. Two patients (6.66%) presented chronic groin pain (more than 30 days) of mild intensity, evaluated by VAS (visual analogue scale) and required additional analgesia. There were no conversions from laparoscopic to conventional repair. Seven patients (23.3%) were not working at the time of surgery. Of the remaining 23, 82% returned to their usual work activity one week after surgery. 20 patients (66.6%) went for follow-up one year after the operation and underwent a survey, which showed that 100% of the patients surveyed were satisfied with the operation and would recommend it. Conclusion: Laparoscopic inguinal hernioplasties have a low rate of recurrence and complications, comparable to those obtained with the conventional technique. Likewise, the learning curve is longer, but it is possible to perform it during the training stage as a resident doctor.

Development of a laparoscopic technique for inguinal hernioplasty in standing horses.

Most previously described techniques for laparoscopic inguinal hernioplasty (IH) in horses require advanced laparoscopic skills. Our objective was to describe a new laparoscopic IH technique using a surgical anchoring system. Standing laparoscopic IH was performed unilaterally in eight experimental stallions, using the contralateral inguinal canal (IC) as a control. A polyether ether ketone harpoon was anchored in the craniolateral aspect of the vaginal ring, and an extracorporeal knot was used to fix the device. Clinical evaluation, including testicular palpation and lameness examination, was conducted before and for 4 weeks after surgery. Repeat laparoscopy was performed 28 days later. Standing laparoscopic IH was performed in all horses with a surgical time of 38 ± 12.85minutes. In two animals, a small peritoneal tear occurred that did not require repair. No other complications were recorded. On repeat laparoscopy, all devices were in place, and the IC remained partially closed in all horses. The procedure was performed on normal experimental horses and has not been employed on horses that have had an inguinal hernia. This new standing laparoscopic hernioplasty technique provides another potential method for simple partial closure of the IC in stallions at risk of or with history of inguinal herniation.

BILATERAL TRANSVERSUS ABDOMINIS PLANE BLOCK REDUCES POSTOPERATIVE NSAIDS USE AFTER LAPAROSCOPIC HERNIA REPAIR

INTRODUCTION: Bilateral peripheral block (TAP - block) is usually performed under ultrasonography (US) guidance in the plane between the inner oblique abdominal muscle and the transversal abdominal muscle, and it aims to block the thoracoabdominal nerves from Th6 to L1 by infiltrating local anesthetic. TAP block is effective tool of managing pain control, especially in the first twenty-four hours after surgery. It improves recovery pathway following minimally invasive surgery and reduces narcotic and non-steroidal anti-inflammatory drugs (NSAIDs) use for postoperative pain management in various different abdominal surgery. AIM: The purpose of this research was to assess the analgesic efficacy of TAP block in regard to used NSAIDs concentrations during the first 24 hours following laparoscopic inguinal hernioplasty. METHODS: The study was conducted with 60 patients, who were randomized into two groups. Control group – were patients who received general anesthesia (GA), and experimental group, were patients who have received GA and a bilateral TAP block. All patients received NSAIDs in the postoperative period. RESULTS: From the acquired data, during the first postoperative hour (POH) only 20% of the experimental group required Paracetamol in a dosage of 1000 mg. Control patients used three times more NSAIDs (60%). Compared to the control group, 63.3% of TAP-block patients did not require analgesia from the 6th to the 12th POH. In the control group average amount of paracetamol was 5167 mg, while in experimental group it was twice lower. Similar finding was established in regard to Ketonal consumption. The control group (without TAP-block) consumes around twice as many NSAIDs as the experimental group at all post-operative time intervals. CONCLUSION: The findings of our research demonstrate that patients undergoing bilateral laparoscopic inguinal repair, administering ropivacaine as part of an US-guided bilateral TAP-block decreases the requirement of NSAIDs in the first twenty-four hours after surgery. TAP-block is a component of multimodal anesthesia and an adjuvant for intraoperative and postoperative analgesia.

Does closure of the direct hernia defect in laparoscopic inguinal herniotomy reduce the risk of recurrence and seroma formation?: a systematic review and meta-analysis.

Recurrence is a known complication to inguinal herniotomy with an incidence of 10 to 15 percent (Hernia Surge Group in Hernia 22:165, 2018). Previous studies have shown that direct hernia or large defects are risk factors for postoperative seroma formation (Morito et al. in Surg Endosc https://doi.org/10.1007/s00464-021-08814-2 , 2021). These types of defects are often closed during open herniotomy (Rosenberg et al. in Dan Med Bull 58: C4243, 2011). This is not routine during laparoscopic surgery. A recent study has indicated that closure of the medial defect during laparoscopy may reduce recurrence and seroma formation. As a result, we performed the present systematic review to evaluate the efficacy of this add on to the standard procedure. An extensive search was carried out in PubMed and Embase. All studies involving adults undergoing laparoscopic direct hernioplasty were enrolled and screened with predefined inclusion criteria, to be part of a systematic review with data synthesis and meta-analysis. The search identified 108 publications of which four met the inclusion criteria. Two studies (Ng et al. in Hernia 24:1093-1098, 2020; Usmani et al. in Hernia 24:167-171, 2020) showed reduced risk of recurrence. The remaining studies (Zhu et al. in Surg Laparosc Endosc Percutan Tech 29:18-21, 2019; Li and Zhang in Surg Endosc 32:1082-1086, 2018) reported no recurrence in any of the patients included. Two articles (Usmani et al. in Hernia 24:167-171, 2020; Zhu et al. in Surg Laparosc Endosc Percutan Tech 29:18-21, 2019) showed a decrease in risk of postoperative seroma, one showed a significant increase (Ng et al. in Hernia 24:1093-1098, 2020). None of the included studies showed an increase in the risk of postoperative pain or postoperative complications. This review suggests that closure versus non-closure of the medial hernia defect in laparoscopic inguinal hernioplasty reduces the risk of recurrence and seroma formation without an increase in postoperative pain or complications. Further randomized controlled trials are needed for further evaluation.

Transurethral resection of the prostate (TURP) and laparoscopic inguinal hernioplasty as combined versus separate procedures in the Era of COVID 19

Background: This study aimed to evaluate concurrent transurethral resection of the prostate (TURP) and laparoscopic totally extraperitoneal (TEP) inguinal hernia repair with determination of outcomes as combined versus separate procedures in the era of COVID 19. Materials and Methods: This prospective randomized control study was conducted at Theodor Bilharz Research Institute hospital from 2021 to 2022. It included 52 patients with co-existing uncomplicated unilateral or bilateral primary inguinal hernia and significant benign prostatic hypertrophy were operated in the same sitting in group A while in separate sessions in group B. The following outcomes were compared: duration of the surgery, conversion to open surgery (TURP or TEP), intraoperative and post-operative complications, duration of hospital stay, recurrence, patient satisfaction and pain scores, time taken to resume normal activity and cost of the treatment. Results: This study included 52 patients with a mean age of 53 years (range of 45–80 years). The average time taken for the surgery was 126 min in group A while in group B was 140 min with no conversion to open prostatectomy or open hernia repair. The mean post-operative stay was 1.2 days in group A while in group B was 4.8 days.

Implementation and Validation of a Novel and Inexpensive Training Model for Laparoscopic Inguinal Hernia Repair.

Purpose: The aim of this study was to develop and validate a reproducible low-cost model useful for the development and acquisition of skills and competencies required for endoscopic hernia repairs. Methods: Ten general surgery residents (PGY3) were instructed to construct the model and perform the maneuvers necessary for the simulation of laparoscopic inguinal hernioplasty by the trans-abdominal pre-peritoneal (TAPP) technique. They practiced for 4weeks in the model, and the time required to perform simulated hernioplasty by the laparoscopic TAPP technique in the initial session was compared to the time required after 4weeks of training. Results: The time required to perform the exercise was significantly lower than in the initial session (p < 0.01). The time required by residents to complete the exercise in the initial session was significantly longer than that used by expert surgeons in the same task (p < 0.01), and although a significant difference persisted, this difference was substantially reduced to 3.60min after the residents completed 4-week training in the model (p < 0.01). An independent expert, blinded to the level of training of the person who performed the exercise, could recognize all residents as novices and all experienced surgeons as experts in the initial session of the exercise with the model, but after 4 weeks of training, they did not recognize 4 of the 10 residents as novices (p < 0.05). Conclusion: The routine implementation of training in this model could be very useful in the laparoscopic inguinal hernioplasty teaching-learning process.

ARE THERE DIFFERENCES IN CHRONIC PAIN AFTER LAPAROSCOPIC INGUINAL HERNIA REPAIR USING THE TRANSABDOMINAL TECHNIQUE COMPARING WITH FIXATION OF THE MESH WITH STAPLES, WITH GLUE OR WITHOUT FIXATION? A CLINICAL RANDOMIZED, DOUBLE-BLIND TRIAL.

ABSTRACTBACKGROUND:Regarding postoperative pain, it remains unclear whether non-fixation of the polypropylene prosthesis in transabdominal preperitoneal inguinal hernia repair produces the same outcomes as mesh fixation with glue or tackers. In addition, hernia recurrence is another aspect to be assessed in the comparison between non-fixation and mesh-fixation techniques (tackers and glue).AIMS:This study aimed to evaluate the incidence, quality of pain, and recurrence in patients undergoing laparoscopic inguinal hernioplasty (transabdominal preperitoneal) technique, comparing the fixation of the mesh with tackers versus with glue versus without fixation.METHODS:This is a prospective, double-blind study in which 63 patients presenting with primary unilateral inguinal hernia underwent laparoscopic transabdominal preperitoneal inguinal hernia repair and were randomized into three groups: no mesh fixation (n=21), mesh tacked (n=21), and mesh fixed with fibrin glue (n=21). Patients also responded to questionnaires in order to assess pain and pain quality and were followed up for 2 years.RESULTS:Neither mesh-fixation nor non-fixation techniques were found to affect postoperative chronic pain (p=0.535), but patients undergoing tacker fixation reported more pain descriptors (p=0.0021) and a higher pain index (p=0.002) on the McGill scale in the first 15 postoperative days (T0 and T1). No hernia recurrences were observed.CONCLUSIONS:Both mesh-fixation techniques (tackers and glue) used with the transabdominal preperitoneal approach did not influence the onset of inguinodynia, but tacker fixation was more likely to increase patient sensitivity to pain. Mesh placement without fixation produced the same pain and recurrence outcomes as mesh-fixation techniques. Also, no recurrence was observed in patients without mesh fixation in this study. Consequently, it has become an alternative therapy deserving consideration for hernia repair.

Inguinal Hernias Repair by Laparascopy (TEP)

Introduction: The hernia affection is one of the processes that has been studied into much detail and whose treatment pursues excellence, although many controversies are still yet to be resolved. Laparoscopy repair of inguinal hernia is a treatment method that improves the quality of management given to our patients. Objective: To identify perioperative events, surgical complications and to evaluate the pain referred for the patients who have had inguinal hernia repair by the laparoscopic method. (TEP). Methods: A prospective and descriptive study was done on 80 patients who have had endoscopic (TEP)repair of inguinal hernias between January 2013 and December 2020. Results: We performed 100 hernioplastias by laparocoscopy in 80 patients. The male sex predominated in a 5:1 ratio and the surgical time average was, 53.5 minutes for unilateral hernias and 71.3 minutes for the bilateral ones. The most frequent complication in the transoperatory stage was ¨minor bleeding¨. At 15 days after surgery, 86.3% of the operated did not complain of pain, but social and laboral reintegration was at a 34% of the total. Conclusions: Laparoscopic inguinal hernioplasty is a good therapeutic option, mainly in patients with bilateral and reproduced inguinal hernias.

Inguinal Hernias Repair by Laparascopy. (pet).

Introduction: The hernia affection is one of the processes that has been studied into much detail and whose treatment pursues excellence, although many controversies are still yet to be resolved. Laparoscopy repair of inguinal hernia is a treatment method that improves the quality of management given to our patients. Objective: To identify perioperative events, surgical complications and to evaluate the pain referred for the patients who have had inguinal hernia repair by the laparoscopic method. (TEP). Methods: A prospective and descriptive study was done on 80 patients who have had endoscopic (TEP)repair of inguinal hernias between January 2013 and December 2020. Results: We performed 100 hernioplastias by laparocoscopy in 80 patients. The male sex predominated in a 5:1 ratio and the surgical time average was, 53.5 minutes for unilateral hernias and 71.3 minutes for the bilateral ones. The most frequent complication in the transoperatory stage was ¨minor bleeding¨. At 15 days after surgery, 86.3% of the operated did not complain of pain, but social and laboral reintegration was at a 34% of the total. Conclusions: Laparoscopic inguinal hernioplasty is a good therapeutic option, mainly in patients with bilateral and reproduced inguinal hernias.

Mesh Migration into Sigmoid Colon after Inguinal Hernioplasty Presenting as Lower Abdominal Mass: A Case Report

Mesh related visceral complications are, in general, considered to be infrequent and rarely reported in literature, but in the last decade, incidence of such complications have increased. Our study highlights the case of an elderly patient, who developed rare complication of Mesh migration after laparoscopic inguinal hernioplasty.

Simulated training model in a low cost for laparoscopic inguinal hernioplasty.

ABSTRACTPurposeDevelop a 3D model for the simulation of laparoscopic inguinal hernioplasty transabdominal preperitoneal (TAPP).MethodsThis is an experimental study, 18 participants were selected, divided into three groups, experimental (GE) surgeons in training, control (GC) experienced surgeons and Shaw (GS) nonexperienced surgeons. The simulation in the 3D model was carried out in 6 sessions fulfilling the 5 stages. Opening the peritoneum with the creation of the preperitoneal space; identification of important structures; hernia identification and reduction; placement and fixation of the mesh in Cooper’s ligament and closure of the peritoneum.ResultsIn the 1st stage, the GE obtained an average of 1.25 ± 0.42 in the 1st session and 3.25 ± 0.62 in the 6th session (p = 0.05) and in the 5th stage 0.91 ± 0.29 in the first session. 1st session and 1.91 ± 0.29 in the 6th session (p = 0.001), with no significant difference between groups. The learning and skill curve in the SG represented 1.08 ± 0.29 1st and 3.50 ± 0.90 6th session (p = 0.001).ConclusionsThe creation of a systematization of training in simulation applied to the three-dimensional model enabled gain in laparoscopic skills and underpinned its theoretical and practical foundations.

The Socio-Economic aspects of Laparoscopic Approach in the Treatment of Inguinal Hernia by Mesh in Cameroon

Background: In Sub-Saharan Africa (SSA), economic conditions often do not always permit the use of modern surgical techniques, especially for hernia treatment. Aim of the study: To demonstrate that a modern technique such as Laparoscopic Total Extraperitoneal inguinal hernioplasty (TEP) can be performed at a significantly lower cost thanks to the use of a less expensive mesh material. Settings: The study was performed in Douala at the Gynaecology-Obstetric and Paediatric University Hospital and at governmental Regional Hospitals of Ayos and Edea in Cameroon. Material and methods: Prospective, randomised, double-blind, controlled trial (RCT) including consecutive adult patients presenting with primary inguinal hernia treated by TEP, with implantation of either sterilised mosquito net mesh (MNM) or conventional polypropylene mesh (CPM). Results: 62 patients were enrolled; randomization allocated 32 to MNM and 30 to CPM. Both groups were comparable for age and professional activities. Significant perioperative differences pertained to conversion rate (2/32 MNM), due to external (electrical power) factors and mesh removal for early obstruction (1/30 CPM). Hospital stay was less than 2 days in both groups. All patients resumed their activities after 3 weeks. Costs were significantly lower in the MNM group. No recurrences were noted with a follow-up of median 21(12-30) months. Conclusion: This RCT shows that TEP with MNM is feasible, cost-effective with good outcomes in SSA hospital setting.

Comparative Study Of Clinical Outcome Of Laparoscopic Total Extraperitoneal Repair Vs Lichtenstein Repair In 50 Cases Of Inguinal Hernia

INTRODUCTIONAbdominal hernia includes groin hernia (70%), umbilical hernia (15%), epigastric hernia (7%) and incisional hernia (9%). After Bassini’s published paper on the techniques of tissue repair, numerous modifications like use of prosthetic material by Usher and open preperitoneal mesh repair introduced by Stoppa but these were associated with significant postoperative pain and morbidity. The concept of Tension free open mesh repair was first introduced by Lichtenstein. Totally extra peritoneal hernia repair (TEP) is a relatively new technique of repairing inguinal hernias laparoscopically where the dissection and repair are carried out without violating the peritoneal cavity laparoscopically. This study compares the results of laparoscopic hernioplasty by Total Extra-Peritoneal (TEP) technique and Lichtenstein tension free repair hernioplasty technique by open method and determine if the relative advantages achieved could be put in practice in large scale and also identify criteria which may help to choose the patient to a particular type of repair to obtain encouraging results for that particular patient.METHODS AND MATERIALS:The present study was carried out with 50 patients admitted in the department of general surgery at our hospital from period May 2018 to December 2019.Inclusion criteria: Patient aged 18 years and above giving written valid consent. Patients diagnosed as having unilateral incomplete inguinal hernia. Patients medically fit to undergo the procedure. Exclusion criteria:Single or multiple previous lower abdominal surgeries;Complicated inguinal hernia, i.e., irreducible, obstructed, or strangulated;Uncorrected coagulopathies;Patients unfit for general anaesthesiaRESULTIn our prospective Comparative study of laparoscopic and open inguinal hernioplasty, we studied 50 patients with unilateral direct inguinal hernia. Average operative time in open repair was 48 minutes and 70 minutes in laparoscopic repair. In TEP, complications such as difficulty in dissection was seen in 3 patients (12%), accidental opening of peritoneum in 2 patients (8%), and inadequate/inability to insufflate was seen in 1 patient (4%). On postoperative day 7, 8 patients (32%) have mild pain and 3 patients (12%) have moderate pain after open hernia repair. And rest 14(56%) patients experienced no pain. After laparoscopic hernia repair 16 patients (64%) have no pain and 7 patients (28%) have mild pain and 2 patients (8%) had moderate pain. Duration of hospital stay in open (3.5 days) is more compared to laparoscopic repair (2.5 days). Return to normal routine activities in open repair (15.3 days) is delayed than laparoscopic repair (12.92 days). CONCLUSION Here, we have done prospective comparative study of clinical outcome of laparoscopic TEP Vs Lichtenstein open inguinal repair in 50 cases of inguinal hernia. We have reached to following conclusion in our study. Incidence of wound infection and scrotal edema are more in open repair then TEP. TEP is less painful in the early postoperative period leading to earlier ambulation than open repair. TEP results in significantly earlier return to work and better cosmetic results. TEP results in decreased hospital stay and faster recovery than open repair. Average operative repair in TEP is more (70 mins) compared to open repair (48mins) Issue of steep learning curve for laparoscopic surgery should be addressed with better supervision and standardization of training in laparoscopy

Immediate and long-term results of laparoscopic hernioplasty in inguinal hernias with and without mesh endoprosthesis fixation

The objective of this study was to conduct comparative analysis of the immediate and long-term results of laparoscopic inguinal hernioplasty performed with and without fixation of the mesh endoprosthesis.Methods and materials. The base group included 77 patients who underwent laparoscopic inguinal hernioplasty without fixation of the mesh by herniostepler. The control group included 76 patients who underwent laparoscopic inguinal hernioplasty with mesh fixation by herniostepler. To assess the postoperative period, the following criteria were studied: the severity of postoperative pain on a Visual Analog Scale; postoperative complications on the Clavien-Dindo scale; an early recurrence of inguinal hernias determined by ultrasound.Results. In both groups, the severity of postoperative complications did not exceed grade I. Among the entire list of complications, there were observed: pain in the area of surgery, an increase in body temperature above 38.5 °C, acute urinary retention, swelling and hematoma of the scrotum, seroma. There were no cases of conversion, intraoperative damage to internal organs and vascular structures. Complications in both groups do not differ significantly and do not depend on the method of laparoscopic inguinal hernioplasty: with fixation of the endoprosthesis by herniostepler or without fixation. The level of pain in the early postoperative period in patients operated by laparoscopic inguinal hernioplasty with mesh fixation was significantly higher. During control examinations of patients on the day after surgery, at the time of discharge and 6 months after surgery, no cases of dislocation of mesh endoprosthesis and relapse of inguinal hernia were detected.Conclusion. The obtained data indicate the effectiveness of laparoscopic hernioplasty in inguinal hernias with polypropylene mesh without fixing with herniostepler.