Laparoscopic Inguinal Hernia Surgery Research Articles

Prospective Study Comparing Lower Urinary Tract Symptoms (LUTS) Before and After Laparoscopic Inguinal Hernia Surgery in Adult Patients With and Without Benign Prostatic Hyperplasia with Repaired Hernia

Objective: Benign prostatic hyperplasia (BPH) is the most prevalent cause of bladder outlet obstruction in elderly males. The occurrence of both inguinal hernia and BPH with lower urinary tract symptoms increases with age. This study is aimed at comparing lower urinary tract syndrome using the International Prostate Symptom Score (IPSS) before and after laparoscopic inguinal hernia surgery.Material and Methods: This prospective study was conducted at Somdech Phra Pinklao Hospital. Thirty-five patients who presented with lower urinary tract symptoms (LUTS) and underwent inguinal hernia repair were selected according to inclusion criteria and evaluated using an IPSS scoring chart for urinary symptoms before and after an operation.Results: Thirty-five patients who presented with LUTS symptoms and underwent inguinal hernia repair between 1 December 2020 and 30 November 2021 were included in the study. Statistical analysis by Wilcoxon Signed-Rank test for the 35 patients resulted in an average IPSS that was compared at 2 weeks with a preoperative score of 6.54 and postoperative score of 4.69 (p-value<0.001), preoperative obstructive score of 2.6 and postoperative score of 1.51 (p-value<0.001), preoperative irritative score of 3.94 and postoperative score of 3.17 (p-value<0.001). At 4 weeks, there was an average preoperative IPSS score of 6.54 and postoperative score of 3.86 (p-value<0.001), preoperative of obstructive score of 2.6 and postoperative score of 1.03 (p-value<0.001), and preoperative irritative score of 3.94 and postoperative score of 2.83 (p-value<0.001). At 8 weeks, there was an average preoperative IPSS score of 6.54 and postoperative score of 3.49 (p-value<0.001), preoperative obstructive score of 2.6 and postoperative score of 0.80 (p-value<0.001), and preoperative irritative score of 3.94 and postoperative score of 2.69 (p-value<0.001).Conclusion: Comparison of LUTS before and after laparoscopic inguinal hernia surgery showed a significant decrease in the IPSS score after laparoscopic surgery inguinal hernia at 2, 4 and 8 weeks for both obstructive and irritative scores.

Perioperative complications of laparoscopic inguinal hernia repair in India: a prospective observational study.

These days laparoscopic inguinal hernia surgery, both totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP), is a commonly performed procedure due to advancements in laparoscopic instruments and the availability of skilled laparoscopic surgeons. The purpose of this study was to compare the perioperative complications of these two procedures. This was a prospective observational study between July 2019 and December 2020. Perioperative complications were compared with a 6-month follow-up. It included 144 patients, of whom 71 underwent TAPP repair and 73 underwent TEP repair. The selection was based on the surgeon's choice. Early postoperative complications were scrotal edema (12 cases in TEP and 16 in TAPP), urinary retention (one case in TEP), ecchymosis (six cases in TEP and two in TAPP), and scrotal subcutaneous emphysema (two cases in TEP). On follow-up, seroma was found in a total of 22 cases, of which 12 were TEP and 10 were TAPP. While only one case of TAPP developed surgical site infection. There was no statistically significant difference in hospital stay between the two groups (p = 0.58). The pain scores significantly decreased throughout recovery and were comparable between the groups. Neither group experienced a recurrence during the 6-month follow-up. Fifty-eight patients developed Clavien-Dindo grade I complications, one had grade II, and three had grade IIIa complications. With the increasing experience of the surgical fraternity in laparoscopic surgery, TEP and TAPP were proven to be comparable in terms of duration of surgery, postoperative complications, hospital stay, pain scores, and recurrence during the 6-month follow-up.

Comparison of the analgesic efficacy of two different fascial blocks in patients undergoing laparoscopic inguinal hernia surgery: A randomized control trial.

Moderate-to-severe intensity pain is reported on the first day following lower abdominal surgery. No study has compared transversus abdominis plane (TAP) block with retrolaminar block (RLB) in laparoscopic inguinal hernia surgery for postoperative pain relief. In this prospective, randomized trial, 42 male patients of American Society of Anesthesiologists (ASA) physical status I and II, aged 18-65 years, and having a BMI <40 kg/m2 received TAP or RLB following laparoscopic inguinal hernia surgery. A standard general anesthetic technique was performed. Patients were randomized into two groups: single-shot TAP block (group I) (n = 21) or the RLB (group II) (n = 21) with bilateral 20 ml of 0.375% ropivacaine. Postoperatively, IV paracetamol 1 g was administered as rescue analgesia. Postoperative cumulative Visual Analogue Scale (VAS) score 24 hours after surgery was considered as the primary outcome. Postoperative cumulative VAS score at rest at 24 h, represented as mean ± S.D (95% CI), in the TAP block group was 3.54 ± 3.04 (2.16-4.93) and in the RLB group was 6.09 ± 4.83 (3.89-8.29). P value was 0.112 and VAS on movement was 7.95 ± 3.41 (6.39-9.50 [2.5-15.0]) in TAP block group, whereas P value was 0.110 and VAS on movement was 10.83 ± 5.51 (8.32-13.34) in the RLB group. Similar postoperative cumulative pain score on movement at 24 h was present in patients receiving TAP block or RLB. However, VAS score at rest and on movement was reduced in patients receiving TAP block at 18 and 24 h postoperatively.

Intraoperative cardiac arrest caused by unexpected vasospastic angina requiring prolonged resuscitation using extracorporeal membrane oxygenation: a case report

BackgroundVasospastic angina (VSA) occurring during surgery is rare but can lead to sudden intraoperative cardiac arrest.Case presentationA 77-year-old man with hypertension, and no history of coronary artery disease, displayed an abrupt ST-segment elevation on the electrocardiogram (ECG) during laparoscopic inguinal hernia surgery under general anesthesia. Subsequently, ventricular fibrillation (VF) occurred, with a finding suggesting ischemic myocardial contracture by transesophageal echocardiography. VF was refractory to cardiopulmonary resuscitation (CPR), and veno-arterial extracorporeal membrane oxygenation (VA ECMO) was introduced. Spontaneous circulation resumed 77 min post-cardiac arrest. VSA was confirmed through the patient’s clinical course and coronary angiography. Subsequently, VA ECMO was terminated, and the patient was discharged uneventfully.ConclusionsExtracorporeal CPR may be a valuable alternative to extended resuscitation for refractory ventricular arrhythmias by VSA.

Comparison of Rise in Inflammatory Markers between Laparoscopic and Open Inguinal Hernia Surgery

Comparison of Rise in Inflammatory Markers between Laparoscopic and Open Inguinal Hernia Surgery

Assessment of Surgical and Quality-of-Life Outcomes Between Laparoscopic Versus Open Inguinal Hernia Repair in Geriatric Patients.

Introduction: Inguinal hernia repair is a common surgery, especially in the elderly population. However, the decision to perform surgery in elderly patients can be challenging due to higher complication rates. Laparoscopic inguinal hernia surgery is less commonly used in the elderly population despite its advantages. In this study, we aimed to investigate the safety and advantages of laparoscopic inguinal hernia surgery in elderly patients. Methods: We retrospectively compared the preoperative and postoperative (PO) data and Short Form-36 (SF-36) forms of elderly patients who underwent laparoscopic transabdominal preperitoneal and open inguinal hernia surgery. The primary outcomes were PO pain scores and complication rates. Results: A total of 79 patients with an age range between 65 and 86 years, who presented with inguinal hernias to Cekirge State Hospital's General Surgery Department between January 2017 and November 2019, were included. Seventy-nine patients underwent laparoscopic transabdominal preperitoneal technique and Lichtenstein hernia repair. The laparoscopic group had a lower rate of PO complications and less analgesic medication consumption and usage time compared with the open group. Furthermore, compared with the open group, the laparoscopic group had lower PO pain scores and higher SF-36 scores for physical function, physical role, pain, and general health at the 30th and 90th days after surgery. Conclusion: Our study suggests that laparoscopic inguinal hernia surgery can be safely performed in elderly patients with lower complication rates and faster recovery times compared with open surgery. The advantages of laparoscopic surgery, such as lower PO pain scores and faster recovery times, were also observed in elderly patients.

Pain and quality of life after laparoscopic unilateral inguinal hernia repair

Introduction Surgical repair of inguinal hernias is one of the most frequently performed operations. Transabdominal preperitoneal (TAPP) and Total extraperitoneal (TEP) methods are the two commonly employed laparoscopic methods for herniorrhaphy. Objective To evaluate the pain and quality of life (QoL) following laparoscopic inguinal hernia surgery utilizing the TAPP and TEP methods. Patients and methods One hundred individuals with unilateral inguinal hernias who had received a clinical diagnosis participated in this prospective trial. The research population was randomly split into two groups by computer-generated software: group A, which consisted of 50 inguinal hernia patients who experienced laparoscopic TAPP surgery, and group B, which consisted of 50 inguinal hernia patients who were treated with laparoscopic TEP surgery. Results After one week and one month postoperatively, the TAPP group had a higher median pain VAS score than the TEP group, which was significant statistically (p values 0.001 and 0.001, respectively). The two groups’ VAS scores did not differ significantly after three- and six-months follow-up. In terms of preoperative and six-month postoperative QoL related domains, the TAPP versus TEP patients showed insignificant difference. Cases involving TAPP and TEP showed an increase of statistical significance in QoL domains from preoperative to six months following surgery. Conclusion According to our investigation, TEP is superior to TAPP. When performed by skilled hands, it appears to be the best method for repairing inguinal hernias.

Initial Experience of Robot-Assisted Transabdominal Preperitoneal (TAPP) Inguinal Hernia Repair by a Single Surgeon in South Korea.

Background and Objectives: Inguinal hernia is a common surgical disease. Traditional open herniorrhaphy has been replaced by laparoscopic herniorrhaphy. Nowadays, many attempts at robotic herniorrhaphy have been reported in western countries, but there have been no reports in South Korea. The purpose of this study is to report our initial experience with robotic inguinal hernia surgery, compared to laparoscopic inguinal hernia surgery. Materials and Methods: We analyzed the clinical data from 100 patients who received inguinal hernia surgery in our hospital from November 2020 to June 2022. Fifty patients underwent laparoscopic surgery, and 50 patients underwent robotic surgery using the da Vinci Xi system. All hernia surgeries were performed by a single surgeon using the transabdominal preperitoneal (TAPP) method. Results: The mean operation time and hospital stay were not statistically different. On the first postoperative day, the visual analog scale (VAS) pain score was significantly lower in the robotic surgery group (2.9 ± 0.5 versus 2.5 ± 0.7, p = 0.015). Cumulative sum analysis revealed an approximately 12-case learning curve for robotic-assisted TAPP hernia surgery. Conclusions: Robotic-assisted TAPP inguinal hernia surgery is technically acceptable to surgeons who have performed laparoscopic inguinal hernia surgery, and the learning curve is relatively short. It is thought to be a good step toward learning other robot-assisted operations.

Comparison of open and laparoscopic inguinal hernia surgery based on chronic pain, paraesthesia and recurrence

Aim: To assess the preoperative and operative findings and postoperative early and late complications in patients who were operated on electively and to compare the factors affecting these results through open and laparoscopic hernia techniques. Materials and Methods: In this retrospective study, the patients were initially divided into two groups as open inguinal hernia repair (OIHR) and laparoscopic inguinal hernia repair (LIHR); then the LIHR group was divided into two subgroups as transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP) groin hernia repair with respect to the operation techniques. Preoperative, operative, and early and sixth-month late-period complications of the patients were statistically analyzed. Results: In a total of 241 patients included in the study, 170 patients were included in the OIHR group, and 71 patients were included in the LIHR group (TAPP=20, TEP=51). No statistically significant difference was noted between the OIHR and LIHR groups and between the TAPP and TEP subgroups in terms of chronic pain, paraesthesia, and recurrence. Conclusions: We believe that there is no difference in long-term results between open and laparoscopic elective inguinal hernia surgery.

Laparoscopic versus Open Inguinal Hernia Repair Is Feasible in Infants with Caudal Anesthesia and Spontaneous Respiration.

Minimally invasive surgery (i.e., laparoscopy) and minimally invasive anesthesia (i.e., caudal anesthesia with spontaneous respiration) have separately shown benefits for inguinal hernia repair in infants, yet to what degree these techniques can be combined remains unknown. This study investigated whether laparoscopy impacts the feasibility of performing caudal anesthesia with spontaneous respiration in infants. Prospectively collected data of all infants less than 12 months old and over 3 kg weight who underwent laparoscopic indirect hernia repair (LAP) at our department from 2019 to 2021 were compared with a historical control-matched group of infants who underwent open repair (OPEN) from 2017 to 2021. We assessed the patients' characteristics, anesthesia, and surgical data as well as intra- and postoperative complications. A total of 87 infants were included (LAP n = 29, OPEN n = 58). Caudal anesthesia with spontaneous respiration was feasible in 62.1% of cases (LAP n = 55.2%, OPEN n = 65.5%; nonsignificant). Neither group registered anesthetic intra- or postoperative complications. Sedatives were utilized in 97% of LAP patients versus 56.9% of OPEN patients (p < 0.00001). The airway was secured with a laryngeal mask in 89.7% of patients during LAP versus 41.4% during OPEN (p < 0.00001). No significant differences were found regarding the use frequency of opioids (48.3% LAP vs. 34.5% OPEN; nonsignificant) or neuromuscular blockers (6.9% LAP vs. 5.2% OPEN; nonsignificant). This is the first comparative study on caudal anesthesia and spontaneous respiration in infants undergoing laparoscopic versus open inguinal hernia surgery. Laparoscopy increased the need for ventilatory support and sedatives but did not significantly impair the feasibility of caudal anesthesia and spontaneous respiration.

Quality of life following laparoscopic inguinal hernia surgery with self-adhesive mesh in 552 patients: a two surgeon experience.

Given negative publicity surrounding surgical mesh in the media, the aim of this study was to assess post-operative morbidity and quality of life (QoL) following laparoscopic inguinal hernia surgery with self-adhesive ProgripTM mesh. This study is a retrospective analysis of ProgripTM mesh for laparoscopic inguinal hernia repairs by two experienced surgeons in the public and private sectors. Data were collected by screening electronic clinical records. A sample of participants were contacted directly for QoL assessment using the Carolinas Comfort Scale (CCS). Descriptive statistical analysis was performed in Microsoft Excel. Five hundred and fifty-two patients had 648 hernia repairs using ProgripTM mesh from 2013 to 2019. The rate of hernia recurrence was 0.2% (n=1). The rate of reoperation was 0.5% (n=3). There were no mesh explant procedures, no adhesion-related readmissions and no perioperative deaths. Haematoma was the most common post-operative complication, occurring in 3.1% of participants (n=17). The CCS assessment had a response rate of 55.8%. A total of 93% of CCS questions were answered with no sensation of mesh, 92% with no pain and 98% with no movement limitation. No participants reported severe or disabling symptoms. In this cohort, laparoscopic inguinal hernia repair with ProgripTM has shown a low recurrence rate and excellent post-operative QoL. The QoL data shows that the public perception of mesh based on media reports of complications may not be relevant for this operation. The knowledge gained from this study reinforces the potential value of a national mesh registry such as those seen overseas.

Comparison of Analgesic Efficacy of Local Anesthetic Infiltration and Ultrasound-guided Abdominal Wall Nerve Block in Children Undergoing Ambulatory Inguinal Hernia Repair

PurposePlacement of local anesthetics either as infiltration (LAI) or as abdominal wall nerve block (AWNB) has been shown to reduce postoperative pain following laparoscopic surgery. We aimed to compare intraoperative remifentanil consumption and postoperative pain of AWNB and LAI in children undergoing ambulatory two-port laparoscopic inguinal hernia surgery with propofol-remifentanil based general anesthesia. DesignRandomized controlled trial. MethodsChildren aged between 1 and 6 years undergoing two-port laparoscopic inguinal hernia repair were enrolled for analysis. These children received one of the three anesthesia regimens (1) standard general anesthesia (SGA); (2) SGA with preemptive LAI; (3) SGA with preemptive AWNB; and were categorized accordingly. Primary outcome variable were intraoperative average infusion rate of remifentanil and postoperative FLACC (Face, Legs, Activity, Cry, and Consolability) pain score. Secondary outcome data included demographics, intraoperative variables (hemodynamics and bispectral index score recorded at three different time points), and duration of surgery. FindingsA total of 90 children (30 in each group) were included in the analysis. General information, intraoperative hemodynamic variables, bispectral index score, and duration of surgery were not significantly different among groups. The intragroup variation of hemodynamic variables were less stable in the SGA group compared with the other two groups, while BIS score was similar among groups. The intraoperative infusion rate of remifentanil was significantly lower in the AWNB group than in the SGA or the LAI group (median [25th to 75th centiles]: 0.11[0.11 to 0.11] µg/kg/min, 0.33[0.33 to 0.33] µg/kg/min; 0.17[0.17 to 0.20] µg/kg/min, respectively, P < .001 for both), and lower in the LAI group than in the SGA group (P < .001). The postoperative FLACC pain score was significantly lower in the AWNB group than in the SGA or the LAI group (P < .001 for both). ConclusionsAWNB is associated with a lower intraoperative remifentanil requirement and a lower postoperative FLACC pain score compared with LAI in children undergoing laparoscopic inguinal hernia repair with propofol-remifentanil based general anesthesia.

The Status of Laparoscopic Inguinal Hernia Surgery in Children: A Nationwide Assessment.

Inguinal hernia repair (IHR) is a common procedure in childhood. Laparoscopic IHR has been evolving for the last three decades. Although clear advantages have been shown, adaptation in Germany has been slow. We aim to study the current status of pediatric laparoscopic IHR. A survey was sent to all 89 pediatric surgical departments in Germany on current practices and preferences of open versus laparoscopic IHR. Two nationwide databases of administrative claims data from 2019 were analyzed and correlated with responses from the survey. A total of 56% of the pediatric surgical departments supplied data through the quality reports. The recall of our survey was 58% of all pediatric surgery departments. According to the pooled data, laparoscopic IHR was performed in 8.2% of all inpatients treated. Laparoscopic IHR was considered a training procedure in 48% of the departments. Five different laparoscopic techniques were described (most commonly percutaneous closure of the hernia under laparoscopic vision). The choice between open and laparoscopic IHR was mainly determined by the child’s age. Currently, only a minority of German children undergo inguinal hernia repair by laparoscopy. More training opportunities in the form of hands-on and video workshops may lead to more widespread employment of the laparoscopic technique.

Лапароскопічне лікування пахових гриж у дітей

Вступ. Операції з приводу пахових гриж є найбільш частими хірургічними втручаннями в дитячій хірургії, частота яких більше ніж 30 % від усіх планових операцій у дітей. Незважаючи на поширеність захворювання в дитячій популяції, кількість порівняльних досліджень відкритого та лапароскопічного підходів до лікування пахової грижі в дітей обмежена. Метою нашої роботи було оцінити результати лапароскопічних хірургічних втручань при пахових грижах у дітей.Матеріали та методи. Під нашим спостереженням перебували 458 дітей із паховими грижами в період 2011–2015 рр. Усі діти були прооперовані в плановому порядку. У 120 з усіх дітей використовували модифіковану методику, що полягала в проведенні гидравлічної препаровки парієтальної очеревини в ділянці внутрішнього кільця пахового каналу за допомогою попереднього введення в очеревину 0,25% розчину новокаїну. З метою об’єктивної оцінки кровотоку яєчка в післяопераційному періоді в дітей із паховою грижею проводили ультразвукову діагностику з допплерівським картуванням.Результати та обговорення. При аналізі отриманих даних виявлено, що однопортових операцій було виконано 369 (80 %). У 89 дітей проведено мультипортові операції. Дослідження кровотоку в яєчках у дітей першої групи вірогідно показали, що у 26,6 % із них було зниження кровотоку в яєчку з боку прооперованої грижі. У пацієнтів другої групи в післяопераційному періоді не виявлено значущих відхилень від норми. При спостереженні протягом 1 року після операції кількість пізніх післяопераційних ускладнень у пацієнтів була невеликою. Тільки у 12 (2,6 %) дітей першої групи відзначений рецидив грижі, в 11 (2,4 %) — водянка яєчка.Висновки. 1. Переважна більшість оперованих дітей була віком до 2 років. 2. Метод лапароскопічної герніорафії з гідропрепаровкою супроводжується більш низькою частотою рецидивів. 3. Така технологія є прийнятною для відтворення в умовах будь-якого дитячого хірургічного або урологічного відділення і може вважатися методом вибору при лікуванні дітей із паховою грижею.

Femoral nerve injury following transabdominal preperitoneal inguinal hernia repair: A case report

Chronic postoperative pain is a complication of open and laparoscopic inguinal hernia surgery. The most important factor to the development of postoperative pain is nerve injury. Of all nerve injuries, the damage to the femoral nerve is very rare. Electromyogram and nerve conduction velocity may provide the clue to proper treatment. The authors present a rare case of femoral hernia injury following transabdominal preperitoneal inguinal repair for a primary right inguinal hernia and emphasize the importance of non- or atraumatic mesh fixation during laparoendoscopic inguinal hernia repair.

Laparoscopic repair of inguinal hernias: Risk factors for urinary retention and chronic pain after totally extraperitoneal repair and transabdominal preperitoneal repair.

PurposeThere are various opinions about the postoperative complications of the two methods for laparoscopic inguinal hernia surgery; totally extraperitoneal repair (TEP) and transabdominal preperitoneal repair (TAPP). The aim of this study was to compare the postoperative course after TAPP and TEP, focusing on immediate postoperative pain, incidence of postoperative urinary retention (POUR), and chronic pain.MethodsThis study retrospectively analyzed a consecutive series of 344 inguinal hernia patients who were treated with laparoscopic surgery between November 2016 and December 2019 at a single tertiary referral center.ResultsPatient demographics did not differ significantly between the groups. The operation time was significantly shorter in the TEP group than in the TAPP group (43.1 ± 14.9 minutes vs. 63.5 ± 16.5 minutes, p < 0.001). The postoperative pain scores were significantly lower in the TEP group than in the TAPP group immediately (3.6 ± 1.3 vs. 4.4 ± 1.1, p < 0.001) and 6 hours (1.5 ± 1.4 vs. 2.3 ± 1.8, p < 0.001) after the operation. The other complications did not differ significantly between the groups. Age was a significant risk factor for POUR (odds ratio [OR], 1.083; 95% confidence interval [CI], 1.018–1.151; p = 0.011), and history of benign prostate hyperplasia (BPH) was a significant risk factor for chronic pain (OR, 5.363; 95% CI, 1.028–27.962; p = 0.046).ConclusionTEP and TAPP seem to be safe and effective for laparoscopic inguinal hernia repair and have similar postoperative outcomes. Age was a significant risk factor for POUR, and BPH history was a significant risk factor for chronic pain.

Study of Laparoscopic Inguinal Hernia Repair Using an Anatomically Contoured 3D Mesh

Background: Laparoscopic inguinal hernia surgery frequently is performed with mechanical fixation of polypropylene mesh. This mechanical fixation, though is necessary to prevent mesh migration, may be associated with pain syndromes and buckling. Recently an anatomically contoured 3D mesh (developed by Dr. Philippe Pajotin) has been introduced which is made up of monofilament polypropylene and resembles normal inguinal area curvature.&#x0D; Aims and Objective: This study was conducted to know whether elimination of tacking the 3D mesh during Total extraperitoneal approach (TEP) inguinal hernia repair results in decreased postoperative pain without increasing the incidence of hernia recurrence.&#x0D; Materials and Methods: This was a prospective interventional study in which 63 patients with clinical diagnosis of inguinal hernia were included on the basis of a predefined inclusion and exclusion criteria. All selected patients underwent laparoscopic TEP inguinal hernia repair using anatomically contoured 3D mesh. Patients were assessed for postoperative pain (using visual analogue scale) during their stay in the hospital as well as in the followup period.&#x0D; Results: In this study of Lap aroscopic inguinal hernia surgery using anatomically contoured 3D mesh of 63 male patients the most common affected age group was found to be 41-50 years (25.3%) with a mean age of 47.12 years +/- 13.01. Most common inguinal hernia was of indirect type (50.7%) and was seen on right side (52.3%). Mean operative time was 113.57+/- 29.04 minutes in unilateral and 170.6 ± 5.85 minutes in bilateralinguinal hernias. Postoperative mean VAS score (12 hrs) was found to be 3.46 ± 1.51. During follow up at 1 week, 1 month and 3 months mean VAS scores were found to be 0.46 ± 0.50, 0.14 ± 0.35 and 0.01 ± 0.12 respectively. Common complications included seroma (12.6%), pneumoscrotum (7.9%) and peritoneal breech (6.3%). None of the patients developed recurrence during follow up period.&#x0D; Conclusion: An anatomically contoured mesh for laparoscopic preperitoneal hernia repair usually requires no fixation and has minimal complications. It is associated with excellent recovery and marked reduction in pain.

Iatrogenic Pseudoaneurysm after Laparoscopic Bilateral Inguinal Hernia Surgery: Treatment with Endovascular Coil Embolization

Although laparoscopic interventions have provided significant achievements in hernia surgery, they may cause complications such as pain, hematoma, intestinal injuries, testicular complications, and sometimes arterial pseudoaneurysms. Arterial pseudoaneurysms are a very rare complication of laparoscopic inguinal hernia surgery. Pseudoaneurysms have serious various causes such as inflammation, trauma, and iatrogenic injury. The patient was diagnosed with bilateral inguinal hernia and a laparoscopic total extra-peritoneal repair was completed. Pelvic bleeding developed on the first postoperative day. A pseudoaneurysm that was 80x70x50 cm was detected in an abdominal computer tomography angiography. In this case because of having high rate morbidity and mortality of open surgery, we selected endovascular angioembolization instead of open surgery in the treatment of pseudoaneurysm which occurred after laparoscopic inguinal hernia surgery

A Single Surgeon’s Experience of Total Extra Peritoneal Repair Vs Transabdominal Preperitoneal Repair- A Prospective Cohort Study

Introduction: Hernia surgery has evolved over a period of 2500 years from the Bassini-Shouldice era to conventional Lichenstein’s meshplasty to the laparoscopic era. Since, inception of the laparoscopic approach 25 years ago, there were several advancements in the techniques of inguinal hernia repairs. The two most commonly practiced laparoscopic approaches are the Total Extra Peritoneal (TEP) and Transabdominal Preperitoneal (TAPP) repair. Aim: To compare the outcomes for TEP and TAPP approaches in laparoscopic inguinal hernia surgery in terms of operative time consumed, postoperative pain, duration of hospital stay, complications and recurrence rate when performed by a single surgeon. Materials and Methods: A prospective interventional cohort study was carried out among 70 patients with uncomplicated inguinal hernia. Patients were divided equally into two groups of 35 patients and underwent TAPP and TEP repairs depending on group randomisation. All surgeries were performed by the same surgeon. Factors including operative time, postoperative pain, duration of hospital stay, complications and recurrence were documented and compared for both the groups. The statistical analysis was done using Statistical Package for the Social Sciences (SPSS) software version 21. Unpaired t-test was used to compare the mean between the two groups. The p-value of &lt;0.05 was considered to be statistically significant. Results: The mean operative time measured in minutes for TEP repair was 31.03 minutes and TAPP repair was 42.26 showing a difference of 11.23 minutes which was statistically significant (p-0.001). The mean Standard Deviation (SD) pain score at 24 hours for TEP repair was 2.43 (1.195) and TAPP repair was 3.43 (0.917). The mean (SD) pain score at 48 hours for TEP repair was 1.31 (1.051) and TAPP repair was 2.20 (0.901). The mean (SD) pain score at one week for TEP repair was 0.37 (0.690) and TAPP repair was 0.91 (0.781). The mean (SD) duration of hospital stay in TEP repair was 2.60 days (0.553) when compared to 3.49 days (0.658) in TAPP repair. All the results were statistically significant with a p-value of 0.001. Conclusion: TEP repair had superior outcomes in terms of reduction in operative time, less postoperative pain and shorter hospital stay than TAPP repair.

Surgical Procedures and Results of Modified Intraperitoneal Onlay Mesh Repair for Inguinal Hernia After Radical Prostatectomy.

Background: Although inguinal hernia occurs frequently after radical prostatectomy, transabdominal preperitoneal (TAPP) inguinal hernia repair occasionally poses challenges due to fibrosis of the preperitoneal cavity. In patients with severe intrapelvic fibrosis, we have adopted a modified intraperitoneal onlay mesh (IPOM) technique. The surgical factors were compared between patients who underwent modified IPOM and those who underwent TAPP for inguinal hernia repair. Materials and Methods: In total, 57 patients underwent laparoscopic surgery for inguinal hernias after radical prostatectomy between February 2013 and January 2020. TAPP was successfully completed in 44 patients, whereas 13 patients underwent modified IPOM converted from TAPP. The surgical results were retrospectively compared. Results: The median follow-up duration was 36.0 months (range, 1-84 months). Intraoperative complications, recurrence of hernia, and chronic pain were not observed in both groups. The average duration of surgery in the modified IPOM group was longer than that in the TAPP group (137 versus 107 minutes, P < .05). There was no significant difference in the incidence of the inguinal-related complications such as inguinal pain or inguinal swelling. Conclusions: Postoperative complications including recurrence of hernia after modified IPOM are comparable to those after TAPP hernia repair. Modified IPOM repair is a surgical option for repairing inguinal hernias following radical prostatectomy.