Laparoscopic Total Extraperitoneal 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.

Laparoscopic totally extraperitoneal hernia repair in patients with a history of previous abdominopelvic surgery.

A retrospective cohort study of patients undergoing laparoscopic inguinal hernia repair compared short- and long-term outcomes between individuals with or without history of previous abdominopelvic surgery, aiming to determine the feasibility of totally extraperitoneal (TEP) repair within this population. All patients who underwent elective TEP inguinal hernia repair by one consultant surgeon across three London hospitals from January 2017 to May 2023 were retrospectively analysed to assess perioperative outcomes. Two hundred sixty-two patients were identified, of whom two hundred forty-three (93%) underwent laparoscopic TEP repair. The most frequent complications were haematoma (6.2%) and seroma (4.1%). Recurrence occurred in four cases (1.6% of operations, 1.1% of hernias). One hundred eighty-four patients (76%) underwent day-case surgery. There were no mesh infections or explanations, vascular or visceral injuries, port-site hernias, damage to testicle, or persisting numbness. There were no requirements for blood transfusion, returns to theatre, or readmissions within 30days. There was one conversion to open and one death within 60days of surgery. Eighty-three (34%) had a history of previous AP surgery. There was no significant difference in perioperative outcomes between the AP and non-AP arms. This finding carried true for subgroup analysis of 44 patients whose AP surgical history did not include previous inguinal hernia repair and for those undergoing repair of recurrent hernia. In expert hands, laparoscopic TEP repair is associated with excellent outcomes and low rates of long-term complications, and thus should be considered as standard for patients regardless of a history of AP surgery.

Comparing Laparoscopic Total Extraperitoneal and Lichtenstein Mesh Repair for Inguinal Hernias: A Focus on Patient Outcomes.

This study aimed to evaluate post-operative outcomes by comparing factors such as post-operative pain, duration of hospitalization, time needed to resume normal and full activities, and complications between laparoscopic total extraperitoneal (TEP) and Lichtenstein tension-free mesh hernioplasty or repair (LMR) for inguinal hernias. A prospective study was conducted involving male patients undergoing either LMRor laparoscopic TEP mesh repair, with 30 patients in each group. The study assessed post-operative pain, duration of hospital stay, return to normal activities, and complications. Pain scores were monitored at regular intervals using a visual scale. Before discharge, patients' ability to perform self-care activities was evaluated using the Katz index of independence in activities of daily living. Outpatient follow-up was conducted on day 14, one month, three months, and six months post-surgery. Post-operative pain scores were significantly higher among LMR patients compared to TEP patients until the 14th day post-surgery (p < 0.001). However, pain levels became comparable after that. There were no notable differences in pain scores between unilateral and bilateral hernias. TEP patients experienced significantly shorter hospital stays (p < 0.001) and quicker resumptions of self-care (p < 0.001), light work (p < 0.02), and full work (p < 0.03) compared to LMR patients. Laparoscopic TEP repair offers advantages over Lichtenstein mesh repair in terms of reduced postoperative pain, shorter hospital stays, and faster recovery to normal activities. These findings can guide clinicians and patients in making informed decisions regarding hernia repair techniques.

Comparison of Perioperative Complication Rates of Total Extraperitoneal and Transabdominal Preperitoneal Repairs in Primary Inguinal Hernia.

Hernia may be defined as a protrusion of viscus through layers anatomically designed to contain that viscus. Most abdominal hernias occur at well-described sites of potential weakness. Repair of inguinal hernia is one of the most common operations in general surgery. Objectives: To compare the perioperative complication rates of total extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) repairs of primary inguinal hernias. It is a randomised comparative study, conducted at the department of general surgery. A total of 50 patients were included and divided into two groups with 25 in each. Group A represents the laparoscopic TEP repair and group B represents the laparoscopic TAPP repair. Patients above 18 years with primary unilateral inguinal hernia were included. Patients having complicated inguinal hernia and history of previous abdominal surgery were excluded. We observed that hernia occurrence is more common in the 31-50 years of age group and right-sided hernia is more common. Scrotal oedema and conversion to open surgery chances are similar in both TEP and TAPP groups. The duration of surgery in TEP is significantly higher as compared to TAPP. Patients who underwent TEP experienced less pain as compared to TAPP as per visual analogue scale. Postoperative hospital stay and time taken to resume the routine activity were significantly less in case of TEP. TEP is preferred over TAPP for laparoscopic hernia repair because it preserves the peritoneal integrity and has lesser postoperative pain. The early recovery and return to the routine work were seen with the patient treated with the TEP and also showed better visual analogue score than the TAPP repair group.

The Effect of Mesh Fixation Methods on Pain Sensation After Laparoscopic Inguinal Hernia Repair

Aim: Groin hernia repair is one of the most common surgical procedure in general surgery. The use of prosthetic meshs has reduced the recurrence rate after inguinal hernia repair to less than 5%. Chronic pain is thought to be multi-factorial. Among these, surgical-related factors are the types of mesh used and fixation methods. It was aimed to evaluate the effect of the use of absorbable and non-absorbable screws for mesh fixation on post-operative pain during TEP repair.&#x0D; Material and Methods: The data of patients who were operated on by a single surgeon and who underwent TEP repair for unilateral or bilateral inguinal hernia were reviewed retrospectively. Post-operative first-week pain sensations were compared between patient groups in which absorbable and non-absorbable screws were used for patch fixation.&#x0D; Results: A total of 35 patients who were operated by a single surgeon and who underwent laparoscopic total extraperitoneal (TEP) repair for unilateral or bilateral inguinal hernia were included in the study. It was found that patients in the absorbable screw group felt statistically significantly less pain [VAS: 3 (2-7) vs. 4 (2-8); p=0.03].&#x0D; Conclusion: Chronic pain after patchy hernia repair is also seen as a late complication that can last up to 6 months. This study, which proves that the use of absorbable stabilizers leads to less pain in the early period, reveals that this method may also be a suitable method for preventing the development of possible chronic pain.

P-052 RISK FACTORS FOR PERITONEAL TEARS DURING LAPAROSCOPIC EXTRAPERITONEAL HERNIA REPAIR

Abstract Background Peritoneal tears (PTs) are not uncommon during the course of laparoscopic total extraperitoneal (TEP) repair of groin hernias. There are several mechanisms involved in the occurence of PTs during the course of the operation. There are many studies about the causes of peritoneal tears. Detection of independent risk factors in peritoneal tear formation may identify patients who will benefit from elective inguinal hernia repair in laparoscopic extraperitoneal hernia surgery. Methods Between April 2018 and december 2022, 518 consecutive patients undergoing 575 TEP repair surgery were recruited by the retrospective study. They were divided into two groups as with and without peritoneal tear. Patient characteristics, operative data, and postoperative outcomes were compared between patients with and without peritoneal tear. Risk factors for peritoneal tear were evaluated by univariate and multivariate analyses. Results The overall incidence of peritoenal tear was 19.7% (n=97). The median age was 45 years (18 to 83) and body mass index was 25.7 kg/m2 (15.67 to 35.20). Significant clinical factors associated with peritoneal tear included such as hernia type, previous hernia surgery, large hernial defects, presence of scrotal hernia, and the defect size of inguinal hernia. Multivariate analysis identified independent risk factors for peritoneal tear as indirect hernia type and previous hernia surgery. Conclusion Peritoneal tears is a major complication seen during TEP repair surgery and its incidence varies depending on many factors. Previous hernia surgery and indirect inguinal hernia the risk for peritoneal tears from during TEP repair.

SURGICAL MANAGEMENT OF BILATERAL INGUINAL HERNIAS: A PROSPECTIVE STUDY OF LICHTENSTEIN, STOPPAS AND TEP REPAIR.

BACKGROUND: The choice of surgery for bilateral inguinal hernia repair still remains a debatable question for surgeons. This study was aimed at analysing the effectives as well as comparing Lichtenstein, Stoppas and laparoscopic TEP(total extraperitoneal repair) approaches for Bilateral inguinal hernia. Prospective study invol MATERIALS AND METHODS: ving 60 patients of Bilateral inguinal hernia, were divided into 3 groups, 20 patients each in Lichtenstein, Stoppas and TEP. As per relevant rating scales, parameters analysed were duration of surgery, post operative pain, post operative analgesia requirement, duration of hospital stay, return to normal activity, cost effectiveness, surgical complications, recurrence over 6months. Minor complications such as seroma, scrotal RESULTS: oedema, wound infection were common in Lichtenstein compared to Stoppas and TEP. Shorter duration of surgery, early discharge and early return to normal activities was seen in Stoppas and TEP compared to Lichtenstein. One recurrence was seen in TEP and Lichtenstein. Post operative pain was least with TEP than the other two groups. Open surgery proved to be more cost effective than TEP. TEP in CONCLUSION: comparison with Stoppas and Lichtenstein is safer with lesser complications and earlier recovery, but less cost effective than open surgery. In developing countries, where cost effectiveness plays a crucial role in deciding the surgery, Stoppas is safe with minimal complications and rapid recovery. This study also demonstrates the effect of surgeon's experience on clinical outcome, with learning curve being shorter in open vs TEP repair

Laparoscopic Totally Extraperitoneal Repair Using Self-gripping Polyester Mesh (ProGrip™) in Inguinal Hernia: A Retrospective Study in a Tertiary Care Hospital

Abstract Introduction: Surgical management of inguinal hernia (IH) is advanced with laparoscopy surgery, and total laparoscopic totally extraperitoneal (TEP) repair is gaining popularity. The use of self-gripping mesh (ProGrip™) further provided substantial advancements with improved postoperative outcomes and early recovery. Objectives: The objective of our study was to determine the short-term outcomes, complications, postoperative hernia recurrence, and chronic inguinal pain in laparoscopic IH. Furthermore, we assessed the factors associated with longer operative time. Subjects and Methods: We retrospectively analyzed the data of adult IH patients who had undergone TEP repair with ProGrip™ mesh. Data on demographics, hernia characteristics, operating time, surgical details, and postoperative outcomes such as infection, hernia recurrences, chronic pain, and other complications were collected and analyzed. P &lt;0.05 was considered statistically significant. Results: During January 2020 to January 2022, we collected the data of 208 patients and analyzed them. The mean age of the patients was 59.7 ± 13.1 years and 96.2% were males. Hernia was bilateral in 26% of cases and 78.8% were indirect hernias. The mean duration of surgery was 60.4 ± 8.6 min. Hernia size ≥2.5 cm was associated with significantly longer operative time. After a median follow-up of approximately 1 year, there were no postoperative complications, recurrence of hernia, or chronic inguinal pain. Conclusion: In experienced hands, laparoscopic TEP repair of IH using ProGrip™ mesh is effective and safe without significant complications or recurrences.

Two-point Fixation for Biological Mesh in Laparoscopic Inguinal Hernia Repair.

To evaluate the clinical outcomes and safety of two-point fixation for biological mesh in laparoscopic totally extraperitoneal (TEP) inguinal hernia repair. Case series. The first Affiliated Hospital of Fujian Medical University Hospital, Fuzhou, China, from January to December 2019. A total of 38 patients with a primary inguinal hernia who underwent laparoscopic TEP repair with a small intestine submucosal matrix biological mesh were included. A novel two-point fixation method was performed at the level of 2 cm above the upper margin of the hernia ring. The mesh was fixed at 3 cm medial and lateral to the inferior epigastric artery. The recurrence rate, surgical site infection rate, postoperative chronic pain, hematoma/seroma, and chronic pain were evaluated. There was no conversion to open procedure. The surgical time was 60.0 (range 35-72) min, and the time of mesh fixation was 4.00 (range 2.5-6.0) minutes. All patients were discharged on the first postoperative day and had similar pain scores (VAS score = 1). Hematoma/seroma was detected in only three (7.9%) patients. No infection or recurrence was observed. The two-point fixation for biological mesh is reliable and easy to perform. Further study with a larger sample size may be needed to validate it. Inguinal hernia, Laparoscopy, Biological mesh, Surgical mesh, Herniorrhaphy, Two-point fixation.

P-147 LAPAROSCOPIC SURGERY IS SUITABLE FOR MOST PATIENTS FOR INGUINAL HERNIA REPAIR AND IS AN EXCELLENT OPTION IN EXPERT HANDS

Abstract Introduction This study reviews the practice of a high-volume surgeon, comparing laparoscopic and open surgery for inguinal hernia. In suitable patients the default was laparoscopic Totally Extra Peritoneal (TEP) approach. Materials &amp; Methods Data from patients referred over 5 years with inguinal hernias was collated prospectively and analysed retrospectively. Short and long-term outcomes of laparoscopic and open repairs were compared. Results 205 patients underwent repair of 288 hernias (90.7% laparoscopic, 9.3% open). 83 patients underwent bilateral repair (95.2% laparoscopic). 22 patients underwent repair of 27 recurrent hernias (68% laparoscopic). 1 case (0.5%), started laparoscopically was converted to open. Complication rates were 13.4% vs 36.8% in the laparoscopic and open arms respectively (p&amp;lt;0.01): superficial infection (1.6% vs 0%, p=0.58); haematoma (6.3% vs 15.8%, p=0.14); seroma (4.8% vs 5.3%, p=0.94); persisting numbness (0% vs 5.3%, p&amp;lt;0.01) and chronic pain (1.1% vs 0%, p=0.65). No patients suffered mesh infections or explantation. Mean stay was significantly longer in open group (p=0.03), median stay was 0 nights in both groups. At median follow up 1.8 years (Interquartile-range 0.9–3.6 years) recurrence rate was 1.1% (0 female, 2 male) and 15.8% (1 female, 2 male) in the laparoscopic and open arms respectively (p&amp;lt;0.01). Open surgery was associated with significantly higher risk of recurrence (HR: 16.3, 95% CI: 2.7–97.8, p&amp;lt;0.01). Conclusions This series demonstrates the vast majority of inguinal hernias, both primary and recurrent can be treated with laparoscopic TEP repair. Higher recurrence and complication rates were associated with open repair, with a caveat of strong selection bias.

OC-006 LAPAROSCOPIC TOTALLY EXTRA-PERITONEAL REPAIR OF BILATERAL INGUINAL HERNIAS WITH A LARGE SINGLE MESH: A SINGLE CENTER STUDY WITH MINIMUM 5 YEARS FOLLOW UP

Abstract Background Laparoscopic totally extraperitoneal (TEP) surgery with a single large mesh is currently the technique of choice for repair of bilateral inguinal hernias in our institution. Most surgeons use two meshes for the TEP repair. We present our experience with a single mesh repair. Material &amp; Methods Records of all patients who had bilateral inguinal hernia and underwent bilateral laparoscopic TEP repair at our institution, 2010–2016, were retrospectively reviewed. We excluded patients who had a conversion to transabdominal intraperitoneal or open approach. Results A total of 470 patients were identified. The median age of patients was 56 (IQR 1–3; 41–66) years and median BMI was 25.9 (IQR 1–3; 23.1–28.1). 18.7% of the cohort (88 patients) had previous abdominal surgery and 39 patients (8.41%) had a recurrent inguinal hernia. Median length of operation was 63 (IQR1–3; 48–89) minutes. Operative complication were bleeding (0.4%) and bladder injury (0.2%). Post operative complications occurred in 32 patients; among the complications were seroma (2.6%), hematoma (2.1%), surgical site infection (0.4%) urinary retention (1.5%) and intestinal obstruction (0.2%). Median length of hospitalization was 1 day (IQR1–3; 1–2). After a median follow up of 102 months, 36 patients had a recurrence. 20 patients (4.3%) had a re-operation for recurrent inguinal hernia. Post-operative groin pain was present in 48 patients. Conclusion The use of a large single mesh is an effective and safe technique for TEP repair of bilateral inguinal hernias. The recurrence rate and prevalence of post-operative pain is consistent with the results reported by others.

Mesh size may not affect recurrence in laparoscopic totally extraperitoneal repair of inguinal hernias

A mesh is usually employed to cover defects when performing laparoscopic totally extraperitoneal repair (TEP) of inguinal hernias. However, there is insufficient evidence for an appropriate mesh size. Therefore, we aimed to compare the recurrence rate between large- and medium-mesh laparoscopic TEP. Patients who underwent laparoscopic TEP for primary inguinal hernias from January 2012 to March 2020 were included. We retrospectively reviewed electric medical records. The primary outcome was the difference in recurrence rate between the large and medium meshes. The large mesh was 10.3 × 15.7 cm, and the medium mesh was 7.9 × 13.4 cm or 9 × 13 cm. In total, 446 patients were included in the study. Of these patients, 177 were in the large-mesh group, and 269 were in the medium-mesh group. The average ages of the large- and medium-mesh groups were 58.4 and 56.9 years, respectively (P = .361). In both groups (large vs medium), males were dominant (93.2% vs 93.6%, P = .850), and indirect hernias (87.0% vs 88.1%, P = .740) were dominant. There was no difference in body mass index (P = .883) or hernia side (P = .770). Peritoneal tearing as an intraoperative complication occurred frequently in the large-mesh group (13.6% vs 3.3%, P < .001). During the mean follow-up period of 28 months, recurrence occurred in 3 (1.7%) and 13 (4.8%) patients in the large- and medium-mesh groups, respectively. However, there was no statistical significance (P = .262). Mesh size may not affect recurrence after laparoscopic TEP of primary inguinal hernias.

Comparison of total extraperitoneal and Lichtenstein repair for Inguinal Hernia.

Objective: To compare the outcome of surgical repair of inguinal hernia between total extra peritoneal repair (TEP) and Lichtenstein repair. Study Design: Randomized Controlled Trial. Setting: Department of Surgery, Sheikh Zayed Hospital, Rahim Yar Khan. Period: 24-03-2021 to 23-09-2021. Material &amp; Methods: Non probability consecutive sampling. The cases of both genders with age range of 20-60 years with inguinal hernia (both direct and indirect) were included. The cases in group A were managed by laparoscopic TEP while those in group B underwent Lichtenstein repair. Prolonged hospital stay was labeled when the patients were not discharged after 24 hours of surgery and post-operative pain was labelled as yes when the patient had pain of score of 3 or more assessed by visual analogue scale after the 2 weeks of the surgery. Results: In this study 62 cases were included, 31 in each group. The mean age in group A and B was 32.90±9.89 vs 32.67±7.57 years and mean duration of hospital stay was 22.77±6.84 vs 26.00±11.25 hours with P=0.004 in group A and B respectively. Postoperative pain was seen in 08 (25.80%) cases in group A and 19 (61.29%) cases in group B with P=0.01. Prolonged hospital stay was observed in 10 (32.25%) cases in group A and 18 (58.06%) cases in group B withP= 0.07. Conclusion: Postoperative pain is significantly higher in cases managed with Lichtenstein repair as compared to total extra peritoneal repair.

EP.TH.961Meta-analysis of Spinal Anaesthesia Versus General Anaesthesia During Laparoscopic Total Extraperitoneal Repair of Inguinal Hernia

Abstract Objectives To evaluate comparative outcomes of spinal anaesthesia (SA) and general anaesthesia (GA) during laparoscopic total extraperitoneal (TEP) repair of inguinal hernia. Methods We systematically searched MEDLINE; EMBASE; CINAHL; CENTRAL, and bibliographic reference lists. Post-operative pain assessed by visual analogue scale (VAS), individual and overall perioperative morbidity, procedure time and time taken to normal activities, were the outcome parameters. Combined overall effect sizes were calculated using fixed-effect or random-effects models. Results We identified 5 studies enrolling 1,518 patients (2,134 hernia) evaluating outcomes of laparoscopic TEP repair under SA (n = 1,277 patients, 1,877 hernia) or GA (n = 241 patients, 257 hernia). SA was associated with significantly lower post-operative pain assessed by VAS at 12 hours (MD: - 0.32, P &amp;lt; 0.0001) and shorter time to normal activities (MD: -0.30, P = 0.002) compared to GA. However, it significantly increased risk of urinary retention (OR:4.02, P = 0.01), hypotension (OR:3.97, P = 0.004), headache (OR:7.65, P = 0.003), and procedure time (MD: 3.82, P = 0.004) There was no significant difference in VAS at 24 hours (MD:0.06, P = 0.34), seroma (OR:1.54, P = 0.26), wound infection (OR:1.03, P = 0.94), and vomiting (OR:0.84, P = 0.66) between two groups. There was a non-significant decrease in overall morbidity in favour GA (OR:1.84, P = 0.17) which became significant following sensitivity analysis (OR:2.59, P = 0.01). Conclusions Although TEP inguinal hernia repair under SA may reduce pain in early postoperative period, it seems to be associated with increased postoperative morbidity and longer procedure time. It may be an appropriate anaesthetic modality in selected patients who are considered high risk for GA. Higher level of evidence is needed.

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.

Assessment of early outcome in laparoscopic totally extraperitoneal inguinal hernia repair using lightweight mesh

Background: Laparoscopic surgery is dominating in the field of hernia. The search for the ideal prosthetic biomaterial has been a longstanding issue with debate over simple versus composite biomaterial and lightweight versus heavyweight meshes. This study was done to evaluate the early outcome of lightweight mesh in laparoscopic totally extraperitoneal (TEP) repair.Methods: This prospective observational study was done for a period of 16 months. On the basis of selection criteria patient underwent laparoscopic TEP repair using light weight mesh, early outcomes were evaluated in terms of immediate postoperative pain (analysed via visual analog scale) and chronic groin pain (analysed by visual analogue scale and graded according to Cunningham), patients were also evaluated for operation time, intraoperative bleeding, seroma, stiffness or numbness around groin, or any other complications.Results: There was no intraoperative bleeding among any of the patients. Immediate post-operative pain assessed by visual analogue scale 20% scored one in the visual analogue scale in post-operative day 1. None of the patients were having any complications (like stiffness or numbness in groin or thigh and any other complication) during post-surgery follow up. Only one patient reported mild chronic groin pain at the end of 3 months after surgery.Conclusions: The short term results of laparoscopic TEP repair for inguinal hernia using light weight mesh are quite encouraging. We can conclude that light weigh mesh is fulfilling important role in successful hernia repair as it is associated with very less morbidity.

Laparoscopic totally extraperitoneal hernia repair performed by surgical trainees: overcoming the learning curve.

Surgical trainees struggle to obtain experience in laparoscopic inguinal hernia repair (LIHR) due to a perceived steep learning curve. The purpose of this study was to compare outcomes in totally extraperitoneal (TEP) repair performed by surgical consultants and trainees under supervision as part of a standardised training regimen to assess the safety of residency training in this technique. A retrospective review of patients managed by TEP repair by either a consultant or a supervised trainee was performed. Demographic, perioperative and postoperative data were collected and compared. All trainees underwent a standardised approach to teaching TEP repair. Trainees performed 133 procedures and consultants performed 121 procedures. Estimated blood loss was minimal in both cohorts. A significant difference was noted in mean operating time between consultants and trainees (33 vs. 50 min). However, it was also observed that the trainee mean operating time reduced significantly with experience (from 61 to 42 min). No statistically significant difference was demonstrated in postoperative complications, recurrence rate or length of stay. All trainees achieved the ability to complete a laparoscopic TEP repair under unscrubbed consultant supervision during a 1-year placement. With senior supervision and in the presence of a structured training regimen, trainees can safely and effectively perform LIHR, progressing to performing the procedure under unscrubbed consultant supervision. This is valuable information that can serve to inform the structure and direction of surgical training programmes as the ability to offer LIHR is increasingly becoming an expectation of consultant surgeons.

Outcome of Laparoscopic Total Extra Peritoneal Versus Lichtenstein Repair For Treatment of Inguinal Hernia: A Randomized Control Trial

&#x0D; &#x0D; &#x0D; &#x0D; OBJECTIVES: &#x0D; To compare the outcome of laparoscopic total extra peritoneal (TEP) repair versus Lichtenstein repair (LR) of inguinal hernia in terms of post-operative pain, hematoma, seroma, wound infection and early recurrence.&#x0D; METHODOLOGY:&#x0D; This randomized control trial was conducted at Surgical Unit III, General Hospital Lahore, Pakistan during the period June 2017 to May 2018. Male patients aged up to 50 years diagnosed with unilateral, reducible primary inguinal hernia were randomized into two groups, Group A (TEP) and Group B (LR), with 38 patients each. Data was collected prospectively on structured proforma. Patients were regularly followed up for one year for early postoperative complications. Statistical analysis was done using SPSS version 26.&#x0D; RESULTS:&#x0D; Out of 76 patients, mean age for TEP was 36.72±4.50 years and LR was 34.42±6.8 years. No significant difference was found in both the groups in terms of short-term postoperative complications. LR group had comparatively high rate of postoperative complications; hematoma formation (n=3/38; 7.9%), wound infection (n=3/38; 7.9%) and seroma formation (n=1/38; 2.6%). Postoperative pain with Visual Analogue Score in TEP group on the 1st day, 3rd day, 7th day and 1 month follow up was less as compared to LR group.&#x0D; CONCLUSION:&#x0D; The present study concludes that TEP is better than LR in inguinal hernia in terms of less postoperative pain after 1 month. However, no statistical difference was found in seroma and hematoma formation and wound infection.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

Comparison of General, Epidural, and Spinal Anesthesia in Laparoscopic TEP (Total Extraperitoneal Repair) for Inguinal Hernia.

Laparoscopic total extraperitoneal repair (TEP) is one of the most preferred minimally invasive methods for inguinal hernia repair. In our study, we aimed to compare the advantages and disadvantages of general anesthesia (GA), spinal anesthesia (SA), and epidural anesthesia (EA) for TEP operations. This is a retrospective study involving 221 patients who underwent TEP surgery for inguinal hernia between January 2018 and July 2020. Patients were divided into 3 groups as GA (n=77), SA (n=70), and EA (n=74). Demographic data of the patients, duration of anesthesia and surgery, perioperative and postoperative complications, postoperative pain, anatomical delineation, hospital stay and quality of life were evaluated. Anesthesia time was the longest in the EA group (23.1±2.32 min) and significantly prolonged the operation time (P<0.001). When the visual analog scale scores were compared, it was observed that the patients in the GA group felt significantly more pain (P<0.001). While the rates of hypotension and headache were higher in regional anesthesia (P<0.001 and P<0.002), there was no significant difference in urinary retention, postoperative nausea/vomiting, and shoulder pain (P=0.274, 0.262, and 0.314, respectively). SA and EA groups were found to be superior compared with the GA group in terms of patient satisfaction (P<0.001). Regional anesthesia (SA and EA) can be safely performed in TEP surgeries, gives results similar to the anatomical delineation satisfactory and complication rates of GA, and results in less postoperative pain.

O38: TACKING VERSUS NO TACKING IN LAPAROSCOPIC TOTALLY EXTRAPERITONEAL REPAIR OF PRIMARY INGUINAL HERNIA - A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Introduction The necessity of mesh fixation in laparoscopic totally extraperitoneal (TEP) inguinal hernia repair remains controversial. We performed a systematic review and meta-analysis to compare the effectiveness of mesh tacking versus no tacking in laparoscopic TEP repair for primary inguinal hernia. Materials and Methods PubMed, EMBASE and Cochrane databases were searched for relevant articles from inception until November 2019. All studies that compared tacking versus no tacking in TEP repairs for inguinal herniae were included. Recurrent and femoral herniae were excluded from the current analysis. The primary outcome measure was recurrence, while secondary outcomes included postoperative pain scores at discharge and at 1 month, mean operative time, length of stay and seroma rates. Random effects models were used to calculate pooled effect size estimates. Result Eight randomised controlled trials were included capturing 557 patients and 715 inguinal herniae. On random effects analysis, there were no significant differences between tacking and no tacking in terms of recurrence (OR 0.94, 95% CI=0.10 to 9.28, p=0.96), postoperative pain scores on discharge (Mean difference 0.82, 95% CI=-0.35 to 2.00, p=0.17) or at 1 month (Mean difference 0.53, 95% CI=-0.75 to 1.82, p=0.41), mean operative time (Mean difference 1.58 mins, 95% CI=-0.22 to 3.37, p=0.09), seroma (OR=0.70, 95% CI=0.28 to 1.74, p=0.44) or length of stay (Mean difference 0.11 days, 95% CI=-0.04 to 0.25, p=0.14). Conclusion Mesh tacking in laparoscopic TEP repair for primary inguinal herniae does not translate into improved postoperative outcomes and may be omitted. Take-home message Mesh tacking in laparoscopic TEP repair for primary inguinal herniae does not translate into improved postoperative outcomes and may be omitted.