Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair Research Articles

Cessation vs. no cessation of acetylsalicylic acid preoperatively in laparoscopic totally extraperitoneal inguinal hernia repair (CAPTAIN): interim report from a multicentre, single-blind, randomised controlled trial.

Given the increasing prevalence of antiplatelet agent use and the lack of high-quality evidence, the CAPTAIN trial aimed to investigate the safety and provide recommendations on continuing acetylsalicylic acid perioperatively in patients undergoing elective laparoscopic totally extraperitoneal inguinal hernia repair (LIHR). The CAPTAIN trial was a multicentre, surgeon blind, randomized controlled trial conducted from April 2016 to April 2023. Patients undergoing LIHR were eligible for inclusion. Participants were randomized to either the acetylsalicylic acid cessation group or the continued acetylsalicylic acid group. The primary endpoint was the incidence of hematoma formation at discharge. After a total of 69 patients were randomized, four patients dropped out, leaving 35 patients in the acetylsalicylic acid cessation group and 30 in the continued acetylsalicylic acid group. The baseline characteristics of both groups were similar. While the distribution of hernia types was largely comparable, there were significantly more direct inguinal hernias in the continued acetylsalicylic acid group (p < 0.001). The primary outcome, hematoma formation at discharge, was similar between groups (3.3% vs. 2.9%, p = 1.000). Secondary outcomes, including wound bruising, post-discharge hematomas, pain, seroma formation, wound infection rates, and length of hospital stay, did not differ significantly between groups. No thromboembolic complications, readmissions, chronic pain, or recurrences were observed during follow-up in either group. This study found that it is safe to continue acetylsalicylic acid perioperatively in selected patients undergoing LIHR without an increased risk of complications.

Efficacy of transversus abdominis plane block in postoperative pain management of laparoscopic totally extraperitoneal inguinal hernia repair: a propensity score-matched analysis.

Transversus abdominis plane (TAP) block is a promising technique for postoperative pain control. In this study, we aimed to evaluate the efficacy of the TAP block in managing postoperative pain after laparoscopic totally extraperitoneal (TEP) inguinal hernia repair. In this retrospective study, medical records of patients who had received ultrasonography-guided TAP blocks after surgery from January 2019 to August 2023 were reviewed and compared with those of patients who had not received. Propensity score matching was controlled for age as a confounder. Postoperative pain levels were measured using the numeric rating scale (NRS). After matching, 95 patients were included in each group. The TAP block group (2.7 vs. 4.0, P < 0.001) had significantly lower NRS scores immediately and early postoperative pain than the control group (1.9 vs. 2.5, P < 0.001). However, there was no significant difference between the 2 groups in terms of postoperative complications (P > 0.05). TAP block is effective and safe for managing immediate and early postoperative pain in laparoscopic TEP inguinal hernia repair and does not increase the risk of complications.

Telescopic dissection versus balloon dissection during laparoscopic totally extraperitoneal inguinal hernia repair: A prospective randomised control trial.

Totally extraperitoneal (TEP) repair involves creating a preperitoneal space. The preperitoneal space can be created by balloon or telescopic dissection (TD). Nevertheless, these techniques may have some complications. However, there are very few studies that compare these two techniques. This study aims to assess the impact and comprehensively compare the TD and balloon dissection (BD) methods in patients undergoing laparoscopic TEP inguinal hernia repair. This was a single-centre, double-blinded, prospective, randomised, controlled trial comparing BD and TD for the creation of the preperitoneal space. The primary end point was to compare the post-operative pain score, intraoperative complications and surgical site occurrence between the two groups. The secondary end point was to assess the impact of the dissection technique on operative time for the creation of extraperitoneal space during laparoscopic TEP inguinal hernia repair. A total of 46 patients were included in the study (23 in each group). Baseline parameters were comparable between the groups. The total operative time between the groups (120 min vs. 160 min; P < 0.005) was statistically significant. The incidence of the peritoneal breach was statistically less in the BD group (43% vs. 13%; P < 0.005). Other short-term and long-term complications were less in the BD group but not statistically significant. BD in TEP inguinal hernia repair reduces the operative time and peritoneal breach. When compared to TD in terms of operative time, routine use of BD can be proposed. It will be beneficial in the early part of the learning curve.

Quality of life following laparoscopic totally extraperitoneal repair of a unilateral reducible inguinal hernia.

Laparoscopic totally extraperitoneal (TEP) inguinal hernia repair has become increasingly favored over open Lichtenstein tension-free mesh repair owing to its associated benefits, including reduced postoperative pain, early return to normal activities, and a comparable recurrence rate. In recent years, emphasis has been placed on patient-reported outcomes, particularly health-related quality of life (QOL), as a critical metric for evaluating surgical success. This study aimed to evaluate the overall QOL following laparoscopic TEP repair of unilateral inguinal hernia. This prospective study enrolled patients aged 18 years or older who underwent elective laparoscopic TEP hernia repair for unilateral inguinal hernia from April 2020 to March 2022. Data collected include demographic details, hernia characteristics, postoperative complications, and postoperative QOL assessment. The Short Form 36 Health Survey Version 2 (SF-36v2), a validated general QoL questionnaire, was administered preoperatively and at 1 month, 6 months, and 1 year postoperatively. Statistical analysis utilized paired t-tests for comparisons, with significance set at a p-value <.05. A cohort of 49 patients, with a mean (standard deviation) age of 56.7 (14.0) years, predominantly comprising 47 men, was available for evaluation. Complications were observed in three (6.1%) of cases, with seroma/hematoma occurring in two patients and a wound infection necessitating antibiotic treatment in one patient. Notably, there were no instances of recurrence during the study period. Postoperative assessments revealed significant improvements in both physical and mental health at 1 month, with continued improvement noted up to 12 months. Laparoscopic TEP inguinal hernia repair has been shown to improve both physical and mental health in patients with unilateral reducible inguinal hernia, with the majority of the improvement typically occurring within the initial month following surgery. It is crucial to communicate these improvement trends to patients undergoing hernia repair to help manage their expectations effectively.

Evaluating a Single Surgeon's Learning Curve for Laparoscopic Totally Extraperitoneal Repair of Inguinal Hernia with Telescopic Dissection: A Cumulative Sum Control Chart Analysis.

Background: Laparoscopic totally extraperitoneal (TEP) inguinal hernia repair (IHR) reduces risk of injury to intraperitoneal structures. Balloon dissection is more costly and has theoretical risk of injury to the surrounding structures compared with telescopic dissection (TD). This study aims to evaluate the learning curve (LC) for TEP IHR with TD of a single surgeon. Methods: This is a 3-year retrospective cohort study from January 2020 to December 2022 on patients who underwent elective laparoscopic TEP unilateral IHR with TD. Exclusion criteria were recurrent inguinal hernia. Cumulative sum (CUSUM) analysis was performed to evaluate the number of cases required to surmount the LC, that is, NLC for operating time (OT) and open conversion. One way analysis of variance was used to perform groupwise comparison. Results: There were 69 patients who underwent laparoscopic TEP unilateral IHR with TD. The median age was 58.0 years (range 24.0-80.0) and body mass index was 23.0 (range 18.6-30.0). Majority of the hernia was indirect (n = 48, 69.6%). The median OT was 70 minutes (range 35-210). Three cases (4.3%) had open conversion. One-year recurrence was 4.2% (n = 1/24). CUSUM analysis showed improvement in OT after the eighth case. However, this was followed by multiple inflection points with no apparent stabilization in OT. Pairwise comparison showed a decrease in OT between cases 18-36 and cases 37-54. There was no incidence of open conversion until the 56th case. Conclusion: Laparoscopic TEP IHR using TD is safe in the absence of a practor. A minimum of 36 cases is required to surmount the initial LC.

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.

Laparoscopic Inguinal Hernia Repair- Transabdominal Preperitoneal (TAPP) versus Totally Extraperitoneal (TEP) Approach: A Comparative Analysis

ABSTRACT Background and Aim: Totally extraperitoneal (TEP) repair and transabdominal preperitoneal (TAPP) repair are the two standardized laparoscopic techniques for inguinal hernia repair. Although several studies were conducted in the past, there are still no certain answers regarding the best laparoscopic approach for inguinal hernia repair. Therefore, our aim was to compare the outcomes of the TAPP versus TEP for inguinal hernia. Materials and Methods: This prospective study was conducted at Dayanand Medical College and Hospital, Ludhiana, from January 1, 2018 to March 31, 2019 and included 54 patients admitted with unilateral or bilateral uncomplicated inguinal hernia. Patients undergoing laparoscopic TEP or TAPP inguinal hernia repair were compared on various intraoperative and postoperative parameters. Results: Fifty-four patients were included in the study (TEP, 27; TAPP, 27). Both groups were comparable in terms of demographic profile and hernia characteristics. TEP had significantly less mean operative time compared to TAPP. Pain scores and injectable analgesics’ requirement were significantly higher in TAPP compared to TEP. Postoperative stay was significantly higher in TAPP than TEP. Surgical outcome in terms of intraoperative and postoperative complications, hernia recurrence, and chronic pain for the two laparoscopic techniques was comparable. Conclusion: The lesser intraoperative duration of surgery with lesser postoperative pain scores and lesser postoperative hospital stay favor the use of TEP over TAPP for repair of inguinal hernia.

Surgical outcomes of laparoscopic total extraperitoneal (TEP) inguinal hernia repair compared with Lichtenstein tension-free open mesh inguinal hernia repair: A prospective randomized study.

Inguinal hernia repair is one of the most frequently performed surgery. The ideal procedure for inguinal hernia repair remains controversial. Open Lichtenstein tension-free mesh repair (LMR) is one of the most preferred open techniques with satisfactory outcomes. Laparoscopic approach in inguinal hernia surgery remains controversial, especially in comparison with open procedures. In this study, we have reported a comparison of laparoscopic total extraperitoneal (TEP) inguinal hernia repair with LMR. Postoperative pain, operative time, complications like seroma, wound infection, chronic groin pain, and recurrence rate were parameters to evaluate the outcome.One hundred seventy-four patients were included in the study by consecutive randomized prospective sampling. The patients were divided into 2 groups: group A, laparoscopic TEP inguinal hernia repair, and group B, LMR. The procedures were performed by experienced surgeons. The primary outcomes were evaluated based on postoperative pain and recurrence rate. Secondary outcomes considered for evaluation were operative time, complications like seroma, infection, and chronic groin pain.Severe pain was reported in group A (7.9%) compared to group B (15.1%), which was statistically significant (P < .001). Moderate pain was reported more in group B (70.9%) compared to group A (29.5%) (P < .001). The mean operative time in group A was 84.6 ± 32.2, which was significantly higher than that in group B, 59.2 ± 14.8. There was no major complication in both groups. The chronic pain postoperatively was significantly in higher number of patients in group B vs group A (22.09% vs 3.4%). The postoperative hospital stay period was significantly lesser for group A vs for group B (2.68 ± 1.52 vs 3.86 ± 6.16). Time duration taken to resume normal activities was significantly lower in group A (13.6 ± 6.8) vs (19.8 ± 4.6) in group B (P < .001).Although there is definite evidence of longer operative time and learning curve, laparoscopic TEP has added advantages like less postoperative pain, early resumption of normal activities, less chronic groin pain, and comparable recurrence rate compared to open Lichtenstein repair. Laparoscopic TEP can be performed with acceptable outcomes and less postoperative complications if performed by experienced hands.

Short-term comparative study of three-dimensional and two-dimensional laparoscopic surgery for total extraperitoneal primary inguinal hernia repair.

PurposeThe aim of this study was to compare the short-term outcomes of two-dimensional (2D) and three-dimensional (3D) laparoscopic surgery for total extraperitoneal (TEP) primary inguinal hernia repair.MethodsThis was a single-center, retrospective, observational database study of 38 patients who underwent laparoscopic TEP inguinal hernia repair from March 1, 2019 to August 30, 2019 at Kyung Hee University Hospital at Gangdong in Seoul, Korea.ResultsThere was no significant difference in sex ratio, age, or body mass index between the two groups. The 2D group had two patients with direct hernia and 18 patients with indirect hernia. The 3D group had five patients with direct hernia, 11 patients with indirect hernia, and two patients with femoral hernia. The mean operation time was 38.2 minutes in the 2D group compared with 37.2 minutes in the 3D group. There was no severe intraoperative bleeding in either group. During the operation, peritoneal tearing occurred in 12 out of 20 patients in the 2D group compared with five out of 18 patients in the 3D group (p = 0.02). The average length of hospital stay was 1.3 days in both groups. The numeric rating scale score was 3.3 and 3 in the 2D group and the 3D group, respectively. In the 2D group, two patients revisited the outpatient clinic because of the postoperative occurrence of seroma and varicocele.ConclusionA 3D laparoscopic surgery is feasible and safe for inguinal hernia repair and showed less peritoneal tearing compared with 2D laparoscopic surgery for primary inguinal hernia repair.

Total extra peritoneal inguinal hernia repair: a single-surgeon preliminary findings report.

Inguinal hernia repair is one of the most frequent operations in general surgery. Various techniques have been used to repair inguinal hernias since the first reconstructive technique described by Bassini in 1887. In 1989 Lichtenstein reported a new technique: tension free inguinal hernia repair. Laparoscopic inguinal hernia repair was introduced in the early 1990s, and soon also became popular. Literature has shown the benefits of laparoscopy (in comparison with open repair) to be mostly related to the more minimally invasive nature of the surgery, having lower wound infection rates, faster recovery, and less postoperative pain. To evaluate our totally extraperitoneal (TEP) inguinal hernia repair initial results and compare them to literature data. In a prospective review and analysis, we examined 61 cases of hernia repair via laparoscopy (specifically TEP), performed by a single surgeon, between April 2019 and December 2019 at the Kaspela University Hospital in Plovdiv. The centre's Institutional Review Board approved the study with no specific consents required due to the retrospective, minimal risk nature of the study. The routine informed consent required by the National Insurance Fund has been considered sufficient for the study objectives.The surgical outcome measures included operating time (hours/minutes), conversion, peritoneal injury, surgical emphysema; and the clinical outcome measures included postoperative seroma, post-operative infection, and post-operative chronic groin pain. Inguinal pain on discharge was characterized as mild by 56 (96.55%) patients and moderate by 2 (3.44%), there were no patients describing the pain as severe. The most frequently reported postoperative complications were annoyance and discomfort (10.34%), swelling (6.9%), seroma (3.44), hematoma (1.72%), paresthesia 1.72% (1); however, only those with seromas required special treatment. Limitations of the present study include the relatively small number of patients, all cases were operated on by a single surgeon and short postoperative follow-up period, but we are sharing our initial six months results. These results demonstrate that laparoscopic TEP inguinal hernia repair without mesh fixation is a reliable technique, which can reduce postoperative morbidity when applied by experienced surgeons.

Cyanoacrylate Glue Versus Absorbable Tacks in Mesh Fixation for Laparoscopic Extraperitoneal Inguinal Hernia Repair: A Randomized Controlled Trial.

Cyanoacrylate glue (Glubran 2) is a synthetic adhesive mesh fixation material. Its utility is being evaluated in laparoscopic total extraperitoneal (TEP) inguinal hernia repair (IHR). A multicentre randomized controlled trial was performed comparing Glubran 2 to standard of care absorbable tacks, particularly assessing chronic postoperative inguinal pain and its effects. Patients undergoing elective TEP IHR at 2 centers from 2017 to 2019 were randomly assigned to Glubran 2 or absorbable tack mesh fixation, and followed for 6 months. All other aspects of surgery and aftercare remained the same. Surgeons documented operative and fixation time, and the placement of fixation on standardized diagrams. Via a questionnaire, aspects of inguinal pain were evaluated before surgery, and at various time-points postoperatively over 6 months. Postoperative clinical factors were also collected. A total of 106 operative sides were randomized to either glue (51) or tack (55) mesh fixation over a 14-month period. Similar median operative times between tack (83.0 min) and glue fixation (75.0 min) were observed. There were no significant surgical complications or observed hernia recurrences in either group. There was no significant difference in pain scores between the 2 groups at all time-points after analysis through mixed effects modeling. Temporal pain profiles over time were also similar. Totally, 55% of patients in the glue group had returned to work within 2 weeks of surgery. There was no increase in complications or pain scores despite regular lateral fixation of glue in these patients. Adding to known data, we observed no significant difference in postoperative pain, demonstrating that cyanoacrylate glue is a viable and safe alternative fixation method to absorbable tacks in laparoscopic TEP IHR. As secondary outcomes, cyanoacrylate glue permits some patients to return to work early, and we observed regular lateral mesh glue fixation without increased pain or complications.

Laparoscopic Total Extraperitoneal Repair and Open Prolene Hernia System for Inguinal Hernia Repair Have Similar Outcomes: A Retrospective Study.

To compare the results of Laparoscopic total extraperitoneal inguinal hernia repair (LTEPR) and the open prolene hernia system repair (OPHSR), in terms of complications, postoperative pain and quality of life. Background: Inguinal hernia repair is one of the most frequent surgeries made by general surgeons. Although, with the technological development and scientific advances even today it is not possible to define which is the gold standard procedure to hernia repair. Material and Methods: For this observational study, all 577 consecutive patients who underwent hernia repair were included in the study, 293 LTEPR, and 284 OPHSR. The average age for OPHSR was 62.49 years and for LTEPR 55.35 years. The average follow-up of 38.10 months, the mean operative time for OPHSR was 55.58 minutes and for LTEPR was 45.46 minutes, with a hospital stay of 1.1 and 1.08 respectively. Results: Each type of hernia was classified according to Gilbert/Rutcow-Robbins criteria, resulting in the OPHSR, 80.28 % were assigned to class 1 to 3 and only 19.72% in class 4 to 7. In the LTEPR, 52.22% of the patients are classified in degree 1 to 3 and 47.78% were class 4 to 7. In the LTEPR group there was more complications with 9 cases of bleeding controlled at the same time, one tear of the bladder, no other visceral complications; in the OPHSR group, there were fewer complications with significant differences (p= .014). The postoperative complications, principally hematoma, and seroma were the most common complication without statistic differences. The postoperative pain was in the OPHSR group, 77.46% of patients reported suffering from mild or pain-free pain, 21.47% reported moderate pain, and 1.05% reported severe pain, in the LTEPR group 74.4% of patients reported mild pain, 25.25% reported moderate pain and only one patient reported severe pain, without significant differences. In both groups, the patients reported a high index of satisfaction, and in the LTEPR group scare results were better than OPHSR (p .001). The outcomes of LTEPR are similar to OPHSR. However, LTEPR has shorter operative time, more intraoperative complications and better scar satisfaction.

Dulucq's technique for laparoscopic totally extraperitoneal hernioplasty.

Background:Inguinal hernia repair has been a controversial area in surgical practice. Its complexity is reflected by the fact that numerous different procedures including both open and laparoscopic techniques are in use today. Laparoscopic totally extraperitoneal (TEP) repair is preferred over transabdominal pre-peritoneal repair as the peritoneum is not breached and also due to fewer intra-abdominal complications. This is the most elegant technique but rather difficult to perform.Aim:The purpose of this study was to describe Dulucq's technique for inguinal hernia repair and the use of three-dimensional mesh without fixation in laparoscopic TEP inguinal hernioplasty.Methods:Surgical technique of laparoscopic TEP inguinal hernia repair is detailed in the text.Results:A total of 945 hernia repairs were included in the study. The hernias were repaired by Dulucq's technique. Mean operative time was 45 min in unilateral hernia and 65 min in bilateral hernia. There were no serious complications.Conclusion:The laparoscopic TEP hernioplasty by Dulucq's technique is feasible with fewer intra-abdominal complications. The dissection must always be done with the same stages with minimal monopolar diathermy and patient in a slight Trendelenburg position.

Is inguinal hernia mesh safe? A prospective study.

Hernia repair surgery using synthetic mesh is the standard of care in modern surgery. Complications from uro-gynaecological mesh have been reported in the New Zealand media and there is public concern regarding the use of any mesh for any reason. This study reports long-term outcomes in inguinal hernia surgery in a large cohort of elective operations using mesh. A prospective database of patients having inguinal hernia mesh repairs was maintained in a private two surgeon practice from 2002 to 2016. Patient demographics, method of repair, the pre-operative and post-operative pain scores and complications following surgery were recorded. A total of 1711 hernia in 1366 patients were repaired from 2002 to 2016. One thousand and forty-seven repairs were laparoscopic total extraperitoneal (LTEP), 333 were open. Post-operative pain scores were significantly lower than pre-operative scores in inguinal hernia repair by any method. Only 22% of patients described no pain pre-operatively and this rose to 76% post-operatively; conversely 7.9% described severe pain pre-operatively and this reduced to 1% post-operatively. The recurrence rate for open inguinal hernia was zero and for LTEP repair was 0.81%. Inguinal hernia repair using mesh does not appear to produce significant rates of chronic pain long term. Overall, the complications from open or LTEP inguinal hernia repair with mesh are low.

Triangle Trocar Configuration in Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair: A Prospective Randomized Controlled Study

BackgroundIn totally extraperitoneal (TEP) operation, when trocars are arranged with midline configuration, operative instruments can easily interfere with each other because of the small operative angle. The triangle trocar configuration, which creates a large operative angle, may minimize interference. Therefore, we evaluated the use of triangle trocar configuration in TEP inguinal hernia repair. MethodsA prospective randomized controlled study was conducted in 113 patients of laparoscopic TEP inguinal hernia repair in the Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, between July 2016 and June 2017. Patients were randomly assigned to TEP laparoscopic inguinal hernioplasty with triangle trocar configuration (study group, n = 59) or midline trocar configuration (control group, n = 54). Perioperative outcomes (operative time, operative complications, postoperative pain, hospital stay, and costs), early postoperative complications (seroma/hematoma and uroschesis), and mid-term outcomes (late postoperative complications and recurrence) were observed and compared. ResultsAfter a mean follow-up of 10.21 ± 2.32 mo, there was no significant difference in operative time, operative complications, postoperative pain, postoperative hospital stay, costs, postoperative complications, and recurrence rate between the two groups. The indirect hernia sac dissection time was shorter in the study group than in the control group. ConclusionsTriangle trocar configuration in TEP laparoscopic hernia repair is safe and reliable and is an option for hernia surgeons. The technique creates a large operative angle and avoids interference between endo-instruments, which facilitates TEP and decreases the indirect hernia sac dissection time.

Postoperative urinary retention after laparoscopic total extraperitoneal inguinal hernia repair

BackgroundPostoperative urinary retention (POUR) after laparoscopic inguinal hernia repair has an incidence of 2%-30%. POUR can lead to increased length of stay, decreased patient satisfaction, and increased health-care costs. The objective of this study was to determine the patient risk factors at our institution contributing to POUR after laparoscopic total extraperitoneal (TEP) inguinal hernia repair. MethodsA retrospective chart review of patients who underwent a laparoscopic TEP inguinal hernia repair at our institution from 2009 to 2016. POUR is defined as the inability to urinate requiring urinary straight or indwelling catheterization in the postoperative period. Univariate analyses were performed on perioperative variables and their correlation with POUR. ResultsIn total, 578 laparoscopic TEP inguinal hernia repair patients were included in the study: 277 (48%) indirect, 144 (25%) direct, 6 (1%) femoral, and 151 (26%) combination of direct, indirect, and/or femoral hernias. Of these, 292 (51%) were bilateral, and 286 (49%) were unilateral. Overall, 64 (11.1%) of the 578 patients developed POUR. POUR was significantly associated with benign prostatic hyperplasia, age 60 y or older, urinary tract infection within 30 d, and decreased body mass index. ConclusionsPatients aged greater than 60 y, with benign prostatic hyperplasia, and a decreased body mass index (≤25.8 kg/m2) were more likely to develop POUR after laparoscopic TEP inguinal hernia repair. In addition, these patients were more likely to develop a urinary tract infection within 30 d. Future quality initiatives can be explored to minimize the incidence of POUR in high-risk patient populations.

Laparoscopic totally extraperitoneal (TEP) inguinal hernia repair in patients with previous lower abdominal surgery.

We have performed laparoscopic totally extraperitoneal (TEP) repair for inguinal hernia repair for the last 20years. We use two balloon dilators (sphere and kidney type) to dissect the preperitoneal space for the TEP repair. It may be difficult to obtain exposure in patients who previously underwent lower abdominal surgery, because of adhesions to the abdominal wall. We reviewed our experience with inguinal hernia repairs to retrospectively analyze factors that limit the laparoscopic TEP approach. From 2006 to 2016, 313 patients (281 men and 32 women) underwent laparoscopic TEP inguinal hernia repair at Yuki Hospital. The medical records of these patients were reviewed, and data for patients who previously underwent lower abdominal surgery were analyzed. Eighty-four patients previously underwent lower abdominal surgery including appendectomy (N = 23), inguinal hernia repair [N = 45; including contralateral TEP repair (N = 26), ipsilateral anterior approach (N = 11)], and laparotomy with a lower abdominal midline incision (N = 22). TEP repair was successfully completed in 75 patients (75/84; 89%) and the procedure changed in nine patients to an anterior approach (N = 5), or transabdominal preperitoneal (TAPP) repair (N = 4). The reasons for changing the procedure included difficulty to develop the operative field (N = 5), violation of the integrity of the peritoneal envelope (N = 2), and intraoperative bleeding (N = 2). Seven patients had a contralateral inguinal hernia after TEP repair. The majority of patients with an inguinal hernia and previous lower abdominal surgery underwent successful laparoscopic TEP repair. There is no need to avoid the laparoscopic TEP approach, even in patients with a history of previous lower abdominal surgery. However, patients after TEP repair of a contralateral inguinal hernia may be at increased risk for peritoneal injury and the approach may need to be changed.

Perioperative outcomes of laparoscopic total extraperitoneal inguinal hernia repair

Background: Laparoscopic total extraperitoneal (TEP) inguinal hernia repair has become increasingly common over the past decade due to reported reduced postoperative pain, shorter convalescence and lower incidence of long-term surgical related morbidity such as chronic pain and numbness. However, the technique has not yet become standard of care in many institutions. The hesitation to adopt this approach may be related to the relatively long learning curve and limited high quality outcome data available. The purpose of this study was to evaluate perioperative morbidity and short-term outcomes of laparoscopic TEP repair. Methods: We performed a retrospective review of a consecutive series of patients who underwent laparoscopic TEP inguinal hernia repair over a 10-year period. Data collected included patient demographics, operative parameters and postoperative complications. Results: A total of 403 patients underwent laparoscopic TEP repair for the management of unilateral or bilateral inguinal hernia. The median age was 51 and 97% were males. The median BMI was 26 and 96% were ASA grade 1 or 2. Ninety-seven percent of repairs were primary, 15% were bilateral and 65% were indirect. The mean operative duration was 50 minutes over the entire study period, however this decreased significantly with time to a mean of 37 minutes in the final year. Postoperative complications occurred in 10.6%, 86% were Clavien-Dindo grade 1 and there were no significant visceral or vascular injuries. The most common complications were seroma formation (4.2%), urinary retention (3.7%) and rectus sheath haematoma (1.4%). Almost all patients were discharged within 24 hours. Conclusions: Laparoscopic TEP repair is a safe and well tolerated surgical treatment of inguinal hernia, associated with a low incidence of perioperative complications.

Perioperative outcomes of laparoscopic total extraperitoneal inguinal hernia repair

Background: Laparoscopic total extraperitoneal (TEP) inguinal hernia repair has become increasingly common over the past decade due to reported reduced postoperative pain, shorter convalescence and lower incidence of long-term surgical related morbidity such as chronic pain and numbness. However, the technique has not yet become standard of care in many institutions. The hesitation to adopt this approach may be related to the relatively long learning curve and limited high quality outcome data available. The purpose of this study was to evaluate perioperative morbidity and short-term outcomes of laparoscopic TEP repair. Methods: We performed a retrospective review of a consecutive series of patients who underwent laparoscopic TEP inguinal hernia repair over a 10-year period. Data collected included patient demographics, operative parameters and postoperative complications. Results: A total of 403 patients underwent laparoscopic TEP repair for the management of unilateral or bilateral inguinal hernia. The median age was 51 and 97% were males. The median BMI was 26 and 96% were ASA grade 1 or 2. Ninety-seven percent of repairs were primary, 15% were bilateral and 65% were indirect. The mean operative duration was 50 minutes over the entire study period, however this decreased significantly with time to a mean of 37 minutes in the final year. Postoperative complications occurred in 10.6%, 86% were Clavien-Dindo grade 1 and there were no significant visceral or vascular injuries. The most common complications were seroma formation (4.2%), urinary retention (3.7%) and rectus sheath haematoma (1.4%). Almost all patients were discharged within 24 hours. Conclusions: Laparoscopic TEP repair is a safe and well tolerated surgical treatment of inguinal hernia, associated with a low incidence of perioperative complications.

Evaluation of short-term outcomes of totally extraperitoneal laparoscopic inguinal hernia repair using a polyester anatomical mesh

Background Laparoscopic hernia repairs have been gaining worldwide popularity, especially totally extraperitoneal (TEP) repair. The choice of prosthesis became a very important factor as a determinant of the outcome. Polyester anatomical mesh provides enough coverage of hernia defect with many benefits of its polyester-based chemistry. Aim The aim of the study was to assess the short-term outcomes of laparoscopic TEP repair using a polyester anatomical mesh regarding its safety, efficacy, and impact on patient’s quality of life (QOL). Patients and methods A prospective assessment of 20 adult patients with uncomplicated inguinal hernia, who underwent laparoscopic TEP repair using polyester anatomical mesh between June 2015 and May 2016 at Tanta University Hospitals. The patient’s QOL was checked preoperatively, at 3 and 6 months postoperatively (PO) using the visual analog scale. The follow-up period was 6 months. Results The mean age of the patients was 46.18±18.35 years. The mean operative time was 69.7±25.1 min. There were no conversions to other procedures or major complications. The most common operative complication was peritoneal tears in seven (33.3%) hernias. Most common PO complication was small hematoma at the umbilical port in two (10%) patients, which resolved spontaneously. The mean time to return to daily activities was 4.1±0.54 days. There were no recurrences or mesh-related complications. The patient’s QOL significantly improved 6 months PO. Conclusion Laparoscopic TEP inguinal hernia repair using polyester anatomical mesh without fixation is feasible and safe. It is associated with no chronic pain, no recurrence, minor complications, and better QOL.