Laparoscopic Totally Extraperitoneal Research Articles

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.

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.

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.

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 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.

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

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

A Prospective Comparative Study of Laparoscopic Totally Extraperitoneal (TEP) and Laparoscopic Transabdominal Preperitoneal (TAPP) Inguinal Hernial Repair.

Introduction Inguinal hernia is a common surgical problem throughout the world. Currently, the management options available are open mesh hernioplasty and laparoscopic mesh repair. Laparoscopic mesh repair can be performed by either transabdominal preperitoneal (TAPP) repair or totally extraperitoneal (TEP) repair. Many studies comparing the two procedures have been unable to establish the superiority of one procedure over the other and have yielded conflicting results. Thus, we performed this study to compare TAPP and TEP. Aim The aim of this study is to compare the clinical outcomesand safety of laparoscopic TEP and laparoscopic TAPP for inguinal hernia repair. Materials and methods Patients were randomly divided into two groups on the basis of surgical procedures. The first group of patients underwent laparoscopic TAPP mesh repair, and the second group of patients underwent laparoscopic TEP mesh repair. Their intraoperative and postoperative findings were noted. Patients were followed up at regular intervals for up to six months. Results The mean age and mean weight distribution between the two groups were not significant. The duration of surgeryneeded (in minutes) for TAPP was found to be significantly less compared to TEP. In the TEP group, conversion to open occurred for three subjects (6.7%) while there was no conversion in the TAPP group. Postoperative pain at 24 hrs was found to be higher in TAPP subjects compared to that in TEP subjects, but the difference was statistically insignificant. Tolerance to a liquid diet started few hours after surgery was found to be the same in both groups. Association of the duration of hospital stays with the type of surgery was not significant. Six subjects (13.2%) showed hematoma in the TEP group while five subjects (11%) in the TAPP group showed hematoma after one week of surgery. Eight subjects (17.6%) showed seroma in the TEP group while three subjects (15.4%) in the TAPP group showed seroma after one week of surgery. Two subjects (4.4%) showed superficial wound infection in both the TEP group and TAPP group after one week of surgery. Four subjects each (8.9%) showed scrotal edema in the TEP group as well as the TAPP group after one week of surgery. No subject showed port site hernia withoutclosureofthesheathat one-week, one-month,and six-monthfollow-upvisits. Two subjects (4.4%) each showed groin pain in the TEP group as well as the TAPP group after one week of surgery. There were no instances of bowel obstruction or mesh infection. Conclusion TEP is a more skill-demanding procedure as compared to TAPP and thus takes more time to perform. However, it is superior on account of not breaching the peritoneum. TAPP is favorable for larger hernias. The choice of procedure should be individualized according to the patient's characteristics and surgeon's preference.

Pain and quality of life after laparoscopic unilateral inguinal hernia repair

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

Open Mesh Hernioplasty versus Laparoscopic Total Extraperitoneal Mesh Repair in the Treatment of Inguinal Hernia

Background: There are multiple techniques used worldwide to repair inguinal hernia. The open mesh hernioplasty is easy to carry out, tension free repair and having good long term results but has few complications as well. Recently the laparoscopic repair of inguinal hernia is the best option because of its merits like lower recurrence rate, lesser postoperative pain, fast recovery and lower risk of complications. The results are controversial so there is a need to evaluate that which technique is better in our population so the aim of current study was to compare the outcome of open mesh hernioplasty versus laparoscopic total extra-peritoneal mesh repair in the treatment of inguinal hernia. Methods: A randomized controlled trial was conducted in the department of surgery, Ziauddin hospital, Karachi during May to December 2021. Patients included in the study were divided into two groups, Group A included those who underwent open mesh hernioplasty while Group B contained patients treated with laparoscopic total extra peritoneal mesh repair. The complication including scrotal hematoma was assessed clinically and confirmed by ultrasound then putted on follow up for two weeks. Data was collected on self-designed proforma. Statistical Package for Social Science (SPSS) version 20 was used for analysis of data. Results: The mean age of the study participants was 36.2±5.6 years. In both group A and B, majority of patients were having right sided inguinal hernia. In Group A, majority of patients were presented with direct inguinal hernia while majority of Group B patients were presented with indirect inguinal hernia but the p-value was non-significant. Postoperative scrotal hematoma was found in 19.5% of the study participants among them 7.8% participant were having direct inguinal hernia and 11.7% presented with indirect inguinal hernia. The frequency of scrotal hernia in patients of Group A, having open mesh hernioplasty was 15.6% while in Group B lesser frequency of postoperative scrotal hematoma was noted and the results were highly significant. Conclusion: It can be concluded that laparoscopic total extra-peritoneal mesh repair is the best technique for repairing inguinal hernia because of its minimal postoperative complications in comparison to open mesh hernioplasty. It is recommended to consider laparoscopic total extra-peritoneal mesh repair as the first line treatment option in the case of inguinal hernia. Keywords: Inguinal Hernia, Laparoscopic total extra-peritoneal mesh repair, Open mesh hernioplasty

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.

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.

The Learning Curve for Laparoscopic Totally Extraperitoneal Herniorrhaphy by Logarithmic Function: Consecutive 291 cases Performed by a Single Surgeon

Purpose: The Totally extraperitoneal (TEP) herniorrhaphy is not an easy technique for beginner surgeons because of the complexity of inguinal anatomy and narrow space of the operation field. The aim of this study is to estimate learning curve of laparoscopic TEP herniorrhaphy using logarithmic function model and the exponential function model. Revealing the number of cases needs to overcoming the early learning curve and minimizing the recurrence rate.

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.

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.

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).

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.