Laparoscopic Total Extraperitoneal Hernia Repair Research Articles

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.

Large Symptomatic Inguinoscrotal Seroma Occurred Early after Laparoscopic Total Extraperitoneal Hernia Repair (TEP): a Case Report and Literature Review

Large Symptomatic Inguinoscrotal Seroma Occurred Early after Laparoscopic Total Extraperitoneal Hernia Repair (TEP): a Case Report and Literature Review

A Long-Term Study on Recurrence, Chronic Pain, and Quality of Life in Obese Patients with Groin Hernia undergoing Laparoscopic Total Extraperitoneal Hernia Repair: Comparison between Mesh Fixation and Nonfixation Techniques.

"Laparoscopic Total Extraperitoneal (TEP)" repair of hernia is a common surgical procedure for treating groin hernias. This study focused on the long-standing assessment of "quality of life (QoL)," chronic pain, and recurrence to compare the effectiveness of TEP hernia surgery with "mesh fixation (MF)" against "nonfixation (NF)" in patients who are obese with a BMI of 35 kgs/m2 or higher. In this study's randomized controlled experiment, 73 obese individuals with groin hernias underwent total extraperitoneal hernia repair with either MF (n = 35) or NF (n = 38). A check-up was conducted 1, 3, and 5 years after the operation. Recurrence, chronic pain, and QoL were assessed using a physical examination and validated questionnaires. There were no changes between the subjects of either group in baseline characteristics, hernia recurrence rate, chronic pain rate, or QoL. There were neither significant variations in surgical complications nor hospital stay duration. The results suggest that treating TEP hernias among people with a BMI of 35 kgs/m2 or above with mesh NF may be successful. The recurrence rates among the subject groups were not substantially different; however, NF was linked with reduced rates of chronic pain which would be beneficial for patient satisfaction and recovery. To decide the optimal technique for MF in TEP hernia repair, these findings need to be verified by additional studies.

Comparison of balloon dissection and telescopic dissection of the preperitoneal space in laparoscopic totally extraperitoneal hernia repair: a systematic review and meta-analysis.

Safety in creating a preperitoneal space is crucial in laparoscopic totally extraperitoneal (TEP) hernia repairs. In this systematic review and meta-analysis, we compared the outcomes of balloon dissection and telescopic dissection in patients with inguinal or femoral hernias who underwent TEP hernia repair. We searched PubMed, Embase, Web of Science, and Cochrane databases for randomized controlled trials (RCTs) and prospective and retrospective studies published from inception to July 2022. Meta-analysis was performed using a random-effects model. The treatment outcome was measured using operation time, incidence of intraoperative hemorrhage, peritoneal laceration, conversion to other approaches, surgical site infection (SSI), hematoma, seroma formation, hernia recurrence, and postoperative pain. Five RCTs, one prospective study, and two retrospective studies (in total, 936 patients) were included. No significant between-group differences were noted in operation time, SSI, hematoma, seroma, recurrence rate, and postoperative pain on days 1 and 7. The conversion rate was significantly lower in the balloon group than in the telescopic group (odds ratio, 0.34; 95% confidence interval, 0.15-0.81). Both balloon dissection and telescopic dissection are viable techniques for creating preperitoneal space in laparoscopic TEP hernia repair and have similar operation time, complication rate, and postoperative pain. Nevertheless, the conversion rate was lower in patients undergoing balloon dissection than in those undergoing telescopic dissection.

Prospective comparative study of mesh fixation in laparoscopic TEP hernia repair using tacker versus cyanoacrylate versus fibrin glue tep mesh fixation with cyanoacrylate

Background: Laparoscopic inguinal hernia repairs done by totally extra peritoneal (TEP) or trans abdominal preperitoneal techniques require mesh fixation which is commonly done by either tackers or fibrin glue. In this study, we discuss about using cyanoacrylate glue for mesh fixation as a more cost effective but equally suitable alternate. Aims and Objectives: The aim of the study was to evaluation of suitability of using highly economical cyanoacrylate ($ 0.13) with tackers ($ 318.52) and fibrin glue ($ 11.94) for mesh fixation during TEP hernia repair. Materials and Methods: A comparative study was done in the Department of Surgery over a period of 3 years (2018–2021). This study included 210 patients who underwent laparoscopic TEP hernia repair. Cases were randomized into three groups of 70 subjects each: Group A - mesh was fixed with tacker, Group B - mesh was fixed using cyanoacrylate, and Group C - mesh was fixed with fibrin glue. Subjects were followed up for 3 months. Type of presentation, diagnosis, and type of mesh fixation were compared to post-operative complications that included pain, seroma, hematoma, and urinary retention findings were recorded and data were statistically analyzed using “SPSS” software. Results: Decreased incidence of post-operative pain (P=0.01) and hematoma was observed in Group B as compared to Groups A and C. Average hospital stay was significantly less in fibrin glue group (P=0.02) and cyanoacrylate group (P=0.02) as compared to tacker group. There was same incidence of postoperative urinary retention (P=0.520) and seroma (P=0.354) formation between all groups. Patients of Group B started daily activities earlier at 15 days follow-up (P=0.032) as compared to Groups A and C. Conclusion: Cyanoacrylate and fibrin glue fixation of mesh in laparoscopic TEP have better outcomes when compared to tackers. Furthermore, as cyanoacrylate is 300 times cheaper than tacker and 10 times cheaper than fibrin glue, this imparts a huge cost advantage to this technique in developing countries. Therefore, use of cyanoacrylate for mesh fixation in laparoscopic TEP can be safely advocated over tackers and fibrin glue.

Early Results of Comparison of Hydrophilic Anatomical Mesh and Polypropylene Mesh for Laparoscopic Total Extraperitoneal (TEP) Inguinal Hernia Repair.

To compare the results, feasibility, and effectiveness of laparoscopic total extraperitoneal (TEP) hernia repair made using anatomical hydrophilic mesh and polypropylene mesh. Descriptive study. Department of General Surgery, Recepc Tayyip Erdoğan University Training and Research Hospital, Rize, Turkey and Department of General Surgery, Ondokuz Mayıs University Medical Faculty, Samsun, Turkey from January 2017 to October 2020. Comparative analysis on patient who had TEP for inguinal hernia. Group 1 included repairs using hydrophilic anatomical mesh, Group 2 included repairs using polypropylene mesh. Both were compared for operation times, complications, and return to work. There were 34 patients in Group 1 and 31 patients in Group 2. The average operation time was shorter in Group 1 (p = 0.001). Postoperative complications, were significantly less common in Group 1 (p = 0.045). Patients were able to return to their work-life earlier in Group 1 after surgery (p = 0.001). Both anatomic mesh and polypropylene mesh can be used in TEP hernia repair. These two materials stand out with their different properties. Whereas anatomical mesh shortens the operation time, decreases the rate of postoperative complications, and enables the early return to work, polypropylene mesh is cost-effective and easily accessible. Inguinal hernia, Postoperative complication, Laparoscopic total extraperitoneal (TEP).

Comparison of the impact of open and laparoscopic inguinal hernia operations on male sexual function and pain during sexual activity

In the current study, we aimed to compare sexual function and pain during the sexual activity of men who underwent surgery with the open or laparoscopic total extraperitoneal hernia repair techniques. Patients were randomised into two groups according to the technique used during the operation: the Lichtenstein hernia repair open technique (n=63) and the laparoscopic total extraperitoneal repair technique (n=57). In both groups, postoperative sexual function score was significantly improved compared with the preoperative period (p<.001 for both), but the change was higher in the laparoscopy group (6.8±3.7) compared with the open group (4.3±4.4) (p<.001). In both groups, postoperative pain during sexual activity score was significantly decreased compared with the preoperative period (p=.001 for the open group and p<.001 for the laparoscopy group), with the amount of decrease being higher in the laparoscopy group (1.8±0.9) compared with the other (1.1±1.4) (p=.002). This study showed that both hernia repair techniques had a positive impact on sexual function and pain during sexual activity. The improvement in sexual parameters and pain during sexual intercourse was better in the laparoscopy group.

Learning curve of single-incision laparoscopic totally extraperitoneal repair (SILTEP) for inguinal hernia.

Laparoscopic totally extraperitoneal hernia repair (TEP) is a widely used treatment for inguinal hernia. Single-incision laparoscopic TEP (SILTEP) has attracted the attention of several surgeons, given its superior cosmetic results and patient satisfaction, as well as comparable outcomes to multiport surgery. Nonetheless, no relevant studies have evaluated the learning curve (LC) of SILTEP in terms of both operation time (OT) and surgical failure. Therefore, we aimed to investigate the LC of SILTEP for inguinal hernia. Medical records of 180 patients who underwent SILTEP performed by a single surgeon from a single institution between October 2012 and November 2017 were retrospectively reviewed. The LC was analyzed using the moving average method and cumulative sum control chart (CUSUM) for OT and surgical failure. Surgical failure was defined as the need for additional ports, open conversion, severe postoperative complications (Clavien-Dindo ≥ IIIa), and recurrence. Eight patients who underwent combined surgery or bilateral hernia repair were excluded from the OT analysis. From CUSUM graphs, the study period was divided into three phases: OT-phases 1 (1st-32nd), 2 (33rd-83rd), and 3 (84th-172nd) for OT and failure-phases 1 (1st-29th), 2 (30th-58th), and 3 (59th-180th) for surgical failure. Mean OTs were statistically different in the three OT phases (64.6 vs. 50.8 vs. 35.2min; p < 0.001). Open conversion (31.0% vs. 0% vs. 2.5%) and additional port insertion (6.9% vs. 24.1% vs. 2.5%) stabilized consecutively at failure-phases 2 and 3 (p < 0.001). Surgical failure rates decreased to 5.7% by failure-phase 3 (37.9% vs. 24.1% vs. 5.7%; p < 0.001). For an experienced laparoscopic surgeon, we estimated that approximately 60 cases are needed to overcome the LC for SILTEP in terms of both reducing OT and achieving a surgical failure rate < 10%. Further proficiency could be achieved after approximately 85 SILTEP procedures with a stable OT of approximately 35min.

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

Conversion of Total Extraperitoneal (TEP) to Transabdominal Preperitoneal (TAPP) for repair of inguinal hernia; Frequency and causes.

Objectives: Our study aims to determine the incidence of and reasons for the conversion of hernia operations from laparoscopic guided total extraperitoneal (TEP) to transabdominal preperitoneal inguinal hernia repair (TEPP). Study Design: Cross-sectional study. Setting: A large tertiary care hospital in Karachi Pakistan. Period: From August 2016 to November 2018. Material &amp; Methods: The sampling technique utilized was consecutive non-probability sampling. The study population consisted of patients between the ages of 22 and 50 years, males, having unilateral inguinal hernia, both direct and indirect presentation. A complete history and physical examination was performed and recorded in a pre-designed proforma for all the patients. Laboratory investigations were performed per routine. The patients underwent laparoscopic total extraperitoneal hernia repair and were noted for complications and conversion to transabdominal preperitoneal inguinal hernia repair. Data was analyzed using IBM SPSS statistics version 20. Chi-square test was used to analyze categorical variables, while mean and percentages were used for numerical data. A p value of less than 0.05 is considered to be statistically significant. Results: The study population was n= 150, mean age of the patients was 36.25 +/- 7.08 with a minimum of 22 and a maximum of 50 years. The direct hernia was present in 47.33% (71 patients) while an indirect hernia was present in 52.67% (79 patients). Out of the total patient population, 21 (14%) of the patients (having a p-value of 0.013) were converted to the TAPP procedure of which 10 (14.08%) has a direct hernia and 11 (13.92%) had an indirect hernia respectively (having a p-value of 0.953). The most common reason for conversion was peritoneal tear, hemorrhage and instrument failure. Conclusion: According to the results of our study, 14% of cases of direct and indirect hernia had to convert from TEP to TAPP procedure, and the main reasons for this conversion were found to be hemorrhage, peritoneal tear and instrument failure.

A cheap and effective hand-made balloon trocar for laparoscopic total extraperitoneal hernia repair (TEP)

A cheap and effective hand-made balloon trocar for laparoscopic total extraperitoneal hernia repair (TEP)

Retrospective comparison of open- versus single-incision laparoscopic extraperitoneal repair of inguinal hernia procedures: A single-institution experience

Purpose: In recent years, single-incision laparoscopic surgery (SILS) became more popular worldwide for its safety and feasibility. This study aims to compare the clinical outcomes of open- and single-incision laparoscopic total extraperitoneal (TEP) hernia repair procedures. Materials and Methods: This retrospective study included 498 consecutive patients undergoing open- and single-incision laparoscopic surgeries for inguinal hernia between January 2012 and December 2016 at Kaohsiung Municipal Ta-Tung Hospital. Results: Open inguinal hernia repairs were performed in 436 patients and SILS-TEP repairs in 62 patients. There were no significant differences between the two groups in patients' characteristics except hernia laterality. Mean operative time was significantly longer in the SILS-TEP compared with the open group (108.9 vs. 87.6 min, P = 0.001), but less mean operative duration was observed when surgeons performed bilateral SILS-TEP repairs. Minor amount of analgesic agent usage was noted in the SILS-TEP group. There were no significant differences between the two groups in bleeding volume and postoperative hospital stay and complications. There were 6/453 (1.3%) recurrences in the open group and no recurrences in the SILS-TEP group at a 1-year follow-up. Conclusion: SILS-TEP is both possibly safe and technically feasible and provides less postoperative pain, acceptable operative implications, and better cosmetic outcomes for patients. It also has less possibility of conversion to laparotomy and recurrence rate.

Eight-fold path to attain laparoscopic totally extraperitoneal (TEP) hernia repair Nirvana - a standardized technique to reduce the learning curve of surgical residents.

Laparoscopic totally extraperitoneal (TEP) hernia repair remains technically challenging due to the steep learning curve and unfamiliar territory. This paper describes an eight-step standardized technique of laparoscopic TEP hernia repair that is easily reproducible, thus reducing the learning curve. The eight steps are as follows: (a) creation of the pneumo pre-peritoneal space; (b) identify the pubis symphysis; (c) identify the inferior epigastric vessels; (d) lateral to medial dissection of the hernia sac; (e) identification of cord structures and triangle of doom/pain; (f) herniotomy; (g) parietalization of the hernia sac; (h) placement and fixation of the mesh. The learning curve of laparoscopic TEP can be decreased by proctoring, standardization of the procedure and having a formal set of operative steps that residents can follow and easily repeat.

Simultaneous laparoscopic total extraperitoneal inguinal hernia repair and laparoscopic appendectomy for Amyand\u2019s hernia: a case report

BackgroundAn Amyand’s hernia is defined by the presence of a vermiform appendix within an inguinal hernia sac. Most of these cases are not diagnosed preoperatively and the surgical approach is dependent on the type present and associated intraoperative findings. We present a case of a preoperatively diagnosed Amyand’s hernia in a man who underwent treatment by simultaneous laparoscopic totally extraperitoneal repair and laparoscopic appendectomy.Case presentationWe encountered the case of a 76-year-old Japanese man with a right inguinal pain. Ultrasound and computed tomography confirmed his vermiform appendix herniated into the right inguinal canal. We managed a simultaneous laparoscopic total extraperitoneal inguinal hernia repair with mesh and laparoscopic appendectomy. He was discharged without any postoperative morbidity.ConclusionsWe recommend laparoscopic appendectomy and totally extraperitoneal hernia repair with mesh after laparoscopic reduction for Amyand’s hernia.

Evaluation of Laparoscopic Total Extraperitoneal Repair of Inguinal Hernia Under Regional Anesthesia: A Prospective Case Series

This study evaluated the feasibility and safety of laparoscopic total extraperitoneal (TEP) inguinal hernioplasty under regional (spinal/epidural) anesthesia, on the basis of duration of surgery, conversion to general anesthesia (GA), intra-operative and post-operative complications, post-operative hospital stay, time taken to resume normal activity and recurrence. A prospective observational study was conducted from 1st November 2014 to 31st December 2015 on a series of 33 patients with direct or indirect inguinal hernia treated in the Department of General Surgery. All the patients underwent laparoscopic TEP hernia repair under regional anesthesia and the outcome was evaluated. The study included 33 patients, 32 male and 1 female. All the patients were operated on under regional anesthesia and the operative procedure performed was laparoscopic TEP. There was no conversion of the operative procedure from TEP to the transabdominal preperitoneal (TAPP) procedure or to open hernioplasty, but conversion of regional anesthesia to GA was needed in 5 cases, because of hypotension, shoulder tip pain, pneumoperitoneum, intraoperative straining and/or inadequate preperitoneal space. A sensory level achieved after regional anesthesia below T6 was found to be a significant reason for conversion to GA. The mean post-operative hospital stay was 3.9 ± 0.9 days (range 2–6 days). The mean time taken to resume normal activity was 13.3 ± 1.8 days (range 10–15 days). TEP hernioplasty is a feasible and safe procedure which can be performed under regional anesthesia and on patients who are at high risk or unfit for GA as well as in patients with no other problems.

Analysis of clinical effect on 19 cases of inguinal hernia treated by laparoscopic totally extraperitoneal repair

Objective To investigate the effect of laparoscopic total extraperitoneal tension-free hernia repair (TEP) in the treatment of inguinal hernia with absorbable biological mesh. Methods A retrospective analysis of the clinical data of 19 patients with inguinal hernia with biological mesh was performed from September 2015 to September 2016 in Shengjing Hospital of China Medical University. The average operative time, average incision pain time, average postoperative venting time, average hospital stay, average operative cost, and long-term chronic pain, postoperative complications, and recurrence rate were observed. Results All the 19 patients were successfully operated. The average operation time was (35.0±4.0) min, the average incision pain time was (1.5±0.6) d, and the average postoperative venting time was (1.5±1.2) d. The average hospital stay was (4.5±0.9) d, the average surgery cost was (23 534.6±1 259.9) yuan. Two patients developed swelling of the scrotum after surgery, and one patient developed postoperative fat liquefaction. All patients were followed up for 1 year by telephone, with no recurrence, no serious complications, and chronic pain discomfort. Conclusions The application of absorbable biopsy TEP is a good and reliable way to treat inguinal hernia. Postoperative patients have mild pain and low complication rate. There is no recurrence in recent follow-up, and the short-term effect is satisfactory. It is a reliable method for the treatment of inguinal hernia. The cost is high, and can be selected according to age and individual needs. Key words: Hernia, inguinal; Laparoscopes; Laparoscopic totally extraperitoneal repair; Biological mesh; Tension-free repair

Comparison of short- to mid-term efficacy of nonfixation and permanent tack fixation in laparoscopic total extraperitoneal hernia repair: A systematic review and meta-analysis.

Objective:We systematically reviewed the literature and pooled data for a meta-analysis to compare the efficacy and safety of mesh fixation and nonfixation in laparoscopic total extraperitoneal (TEP) hernia repair.Materials and Methods:We performed a systematic search of PubMed® and a Cochrane review for all randomized controlled trials that compared the efficacy and complications of mesh fixation versus nonfixation in TEP hernia repair. The evaluated outcomes included perioperative (operative time and conversion rate) and postoperative parameters (pain scores, duration of hospital stay, surgical complications including seroma, delayed return of bladder function, chronic pain, and recurrence). Cochrane Collaboration Review Manager Software (RevMan®, version 5.2.6) was used for statistical analysis.Results:Ten trials met the inclusion criteria and were included in a pooled analysis. In total, 1099 patients (1467 hernias) had received TEP hernia repair (748 and 719 hernia defects in the nonfixation and fixation groups, respectively). The nonfixation group required shorter operative time (weighted mean difference [WMD] = −2.36 min, P = 0.0006) and had less pain on postoperative day 1 (WMD = −0.44, P = 0.04) than the fixation group. No significant differences were observed between groups with regard to conversion rate, hospital stay, recurrence rate, or complication rate. However, the incidence of postoperative urine retention was higher in the fixation group (odds ratio = 0.26, P = 0.03).Conclusion:For patients with a nonrecurrent uncomplicated hernia defect with the size <3 cm, nonfixation yielded comparable efficacy with mesh fixation, but less short-term postoperative pain, and a lower risk of urine retention. In addition, the nonfixation method involved a shorter operative time and lower costs. However, no difference in the incidence of chronic pain was observed.

Laparoscopic total extraperitoneal hernia repair under regional anesthesia: a systematic review of the literature.

General anesthesia has been used as a standard for laparoscopic inguinal hernia repair including both techniques (Trans-Abdominal Pre-Peritoneal repair and the Total Extra-Peritoneal repair), while regional anesthesia has been occasionally applied in high risk patients where general anesthesia is contraindicated. In case of the total extraperitoneal repair (TEP), several authors have attempted to perform TEP repair under regional anesthesia and reported on the safety and feasibility of this procedure. The present review was conducted according to the PRISMA guidelines. Outcome parameters where patients and hernia characteristics, characteristics of anesthesia and surgery procedure, perioperative complications, length of hospital stay, follow up duration. Eight studies on 1287 male and 24 female patients underwent laparoscopic TEP under spinal anesthesia were systematically analyzed. The most common anesthetic agent used, was bupivacaine 0,5%. The conversion rate to general anesthesia, due to anesthesia failure was 0.76% and the rate of conversion to open procedure was 0.2%. The most common intraoperative incidence was hypotension which was successfully managed with the appropriate medical intervention. Seroma was the most common postoperative complication regarding the procedure. The estimation of overall mean length of stay was 1.56 days. Spinal anesthesia for total extraperitoneal inguinal hernia repair seems safe and feasible. However, more well-designed randomized clinical studies are required to determine the safety as well as the advantages and disadvantages of regional anesthesia in TEP hernia repair in different population groups before this method can be adopted into routine daily clinical practice.

Pre-peritoneal local anaesthetic does not reduce post-operative pain in laparoscopic total extra-peritoneal inguinal hernia repair: double-blinded randomized controlled trial.

Laparoscopic total extra-peritoneal hernia repair (TEP) is associated with less post-operative pain and earlier return to normal activity compared to open hernia repair (OHP). Despite this, post-operative pain remains a major issue. The aim of this double-blinded randomized controlled trial was to identify whether the instillation of local anaesthetic in the pre-peritoneal space improves pain scores following TEP. One hundred patients undergoing laparoscopic total pre-peritoneal hernia repair (TEP) between the years of 2009-2014 were included. Patients were randomly assigned to receive either 20mL of normal saline or 0.25% bupivacaine with adrenaline. Visual analogue scores (VAS 0-10) were recorded post-operatively at the 4h, 1day, 2weeks, and 6week mark. Secondary endpoints included complications, time to discharge, and return to normal activity. 51 patients were allocated to the local group. 49 patients were allocated to the placebo group. The baseline characteristics and demographics of patients in both groups were comparable. Patients in the local group had similar VAS scores compared to the placebo group at both 4h (1.1 vs. 1.4, respectively; p=0.19) and 24h (2.1 vs. 2.3; p=0.63). No statistically significant difference noted in other primary and secondary outcomes. Although the concept of pre-peritoneal local anaesthetic instillation following laparoscopic TEP is attractive, this appropriately powered study has failed to show any advantage in pain scores at 4 and 24h. The pain scores recorded, however, were remarkably low in both groups.

Prevention and treatment of peritoneal laceration in the laparoscopic totally extraperitoneal hernia repair during learning curve

Objective To explore the causes and managements of peritoneal laceration in the laparoscopic totally extraperitoneal (TEP) hernia repair during learning curve. Methods The retrospective cross-sectional study was conducted. The clinical data of 120 patients with inguinal hernia who underwent laparoscopic TEP hernia repair in the Third Affiliated Hospital of Anhui Medical University (98 patients) and Anhui Provincial Hospital (22 patients) during surgeons′ learning curve between February 2012 and January 2017 were collected. Patients underwent laparoscopic TEP hernia repair, meshes were intraoperatively placed and then fixed by medical glue. Observation indicators: (1) intraoperative situations: surgical procedure, operation time, using of mesh, intra-operative peritoneal laceration; (2) postoperative situations: time to anal exsufflation, time for fluid diet intake, occurrence of complications, duration of hospital stay; (3) follow-up: number of patients receiving follow-up, follow-up time, recurrence of hernia during follow-up, pain in inguinal region, intestinal adhesion and obstruction induced abdominal pain, incisional infection. Follow-up using outpatient examination and telephone interview within 10 days postoperatively and using telephone interview at 10 days postoperatively was performed to detect the recurrence of inguinal hernia, pain in inguinal region, intestinal adhesion and obstruction induced abdominal pain and incisional infection up to May 2017. Measurement data with normal distribution were represented as ±s. Results (1) Intraoperative situations: of 120 patients, 112 underwent laparoscopic TEP hernia repair, 5 converted to laparoscopic transabdominal preperitoneal hernia repair and 3 converted to open surgery due to adhesion between hernial sac and surrounding tissues induced bleeding of separation. Total operation time of 120 patients was (71±13)minutes, including (63±7)minutes in 106 patients with unilateral hernia and (79±11)minutes in 14 patients with bilateral hernia. All the patients used intraoperatively meshes of 10.0 cm×15.0 cm and 16.0 cm×10.8 cm. Forty-eight patients had intraoperative peritoneal laceration, peritoneal laceration occurred for reconstruction of preperitoneal space in 10 patients, separation of anterolateral preperitoneal space in 11 patients and improperly operating equipment or hernial sac in 27 patients. Of 48 patients with peritoneal laceration, 40 continued to finish operation through acupuncturing into the abdominal cavity for exsufflation and then received peritoneal suture and repair, including 5 with recurrence of indirect inguinal hernia (receiving tissue repair) undergoing peritoneal repair through opening hernial sac, and 8 intraoperatively converted to other or open surgery. (2) Postoperative situations: time to anal exsufflation and time for fluid diet intake in 120 patients were (18±4)hours and (15±6)hours. Of 120 patients, 14 had postoperative complications, scrotal emphysema of 6 patients disappeared in 24 hours and inguinal and scrotal seroma of 8 patients disappeared after puncture treatment. All the patients were discharged from hospital in 2 days postoperatively. (3) Follow-up: 112 of 120 patients were followed up for 3-65 months, with a median time of 31 months. During follow-up, there was no occurrence of recurrence of hernia, pain in inguinal region, intestinal adhesion and obstruction induced abdominal pain and incisional infection. Conclusion During surgeons′ learning curve, identifying anatomy of the groin clearly, a right way to treat the hernia sac and broken peritoneum in the operation can ensure the smooth completion of the laparoscopic TEP hernia repair. Key words: Hernia, inguinal; Peritoneal laceration; Laparoscopy