Laparoscopic Preperitoneal Repair Research Articles

OV11 GIANT SPIEGEL HERNIA: 3D PLANNING AND MINIMALLY INVASIVE TREATMENT

Abstract Aim Demonstrate the advantages of 3D technology planning in complex cases of hernia surgery and technical tricks for giant Spiegel hernia repair. Material and Methods 71 year old patient, BMI 38, asthma, hypertensive; long history of symptomatic left flank mass. Giant Spiegel hernia was diagnosed, with significant omentum and colon migration to hernial cavity. It was decided to perform minimally invasive surgery. 3D model of the abdominal scan was performed, assessing hernia size, volume and its relationship with the abdominal cavity. We were able to rule out the possibility of compartment syndrome, and foresee that we could probably close the defect. Results preperitoneal transabdominal repair (TAPP) is performed, beginning with herniated content reduction, a delicate step where injuries should be avoided, with careful traction of the colon and omentum. Hernial defect is assessed, coinciding with the 3D model, the peritoneum sac is reduced, taking as much as possible to facilitate its posterior closure. The entire peritoneum of the Spiegel and inguinal region are dissected en bloc. Defect tension-free closure is performed with 2 continuous V-LOOK 2.0, subsequent placement of 15x15cm polypropylene mesh and posterior peritoneum closure. The patient is discharged the same day without incidents. Conclusions The 3D model allows us to assess the actual abdominal and hernia volume to simulate surgery findings. Its benefits are yet to be developed. Laparoscopic preperitoneal repair is an excellent approach for Spiegel's hernia. Complex cases are also candidates for outpatient surgery.

Laparoscopic repair of primary unilateral inguinal hernia is it to pamper the ego of the surgeon

Background: The study compared the procedure of open Lichtenstein tensionless repair of primary unilateral incomplete uncomplicated inguinal hernia with laparoscopic preperitoneal repair by TEP in a rural secondary level hospital for plantation workers. The aim of the study was to compare both the procedures and if laparoscopic repair had any specific advantage over the conventional open repair with specific relation to time of return to work, recurrence and cost effectiveness of the procedures.Methods: This was a prospective study involving 200 cases which were detected and operated between 2006 and 2014 at our hospital and subsequently followed up till 2016 which is 2 years. The patients selected were plantation workers.Results: In all 200 cases got enrolled in the study 100 underwent open tensionless Lichtenstein repair and 100 of them underwent Laparoscopic repair-TEP.Conclusions: Primary unilateral uncomplicated incomplete inguinal hernia repaired by laparoscopic method has no distinct advantage with reference to return to work recurrence of hernia and the cost involved is more as compared to open Lichtenstein repair.

Open extraperitoneal approach for recurrent inguinal hernia

Hernia recurrence has always been a challenge to general surgeons. With the use of synthetic polypropylene mesh, the situation has become more difficult. Currently the standard of care for recurrent inguinal hernias, at least in the developed world, is laparoscopic preperitoneal repair. However laparoscopic repair has several drawbacks. This new technique provides the freedom of dissection in a virgin plane and our small series of cases show some promising results. The Sri Lanka Journal of Surgery 2015; 33(3): 6-8

Repeated Groin Hernia Recurrences

To describe the characteristics of patients undergoing multiple groin hernia repairs and to identify strategies that prevent further recurrence. Although relatively infrequent, recurrent groin hernias where several repairs have previously been undertaken constitutes a major problem in hernia surgery. Low numbers and heterogeneity have made it difficult to perform large prospective studies on this group. The study was designed as an observational population-based register study. All repairs for recurrent hernia recorded in the Swedish Hernia Register (SHR) 1992-2006 were identified. Risk for reoperation by number of previous repairs, with adjustment for gender and age, and risk for reoperation by unit responsible for previous repair were determined using Cox proportional hazard analysis. There were 12,104 cases of hernia repaired once, 2 repairs in 4199 cases, 3 repairs in 310 cases, 4 repairs in 32 cases, and 5 repairs in 3 cases. The risk for further reoperation increased with the number of previous repairs (P < 0.001). The hazard ratios for reoperation following open preperitoneal mesh repair and laparoscopic repair decreased; whereas, the hazard ratio for sutured repair increased with the number of previous repairs. The difference between Lichtenstein repair and laparoscopic repair was significant for the first 2 repairs (P < 0.05). Laparoscopic preperitoneal repair provides the best surgical outcome in repeated groin hernia recurrence.

Lap Aroscopic Inguinal Herniorrhaphy: Techniques and Controversies

Because of the remarkable success of laparoscopic cholecystectomy, numerous investigators have attempted to duplicate this success with laparoscopic herniorrhaphy. This article presents a different view of the preperitoneal anatomy, reviews the rationale behind the various laparoscopic approaches, and presents, in detail, the laparoscopic preperitoneal repair with mesh, including complications and early recurrences. An attempt is made to put the new laparoscopic procedures into perspective with regard to economic issues and safety.