Laparoscopic Transabdominal Preperitoneal Technique Research Articles

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

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

Implementation and Validation of a Novel and Inexpensive Training Model for Laparoscopic Inguinal Hernia Repair.

Purpose: The aim of this study was to develop and validate a reproducible low-cost model useful for the development and acquisition of skills and competencies required for endoscopic hernia repairs. Methods: Ten general surgery residents (PGY3) were instructed to construct the model and perform the maneuvers necessary for the simulation of laparoscopic inguinal hernioplasty by the trans-abdominal pre-peritoneal (TAPP) technique. They practiced for 4weeks in the model, and the time required to perform simulated hernioplasty by the laparoscopic TAPP technique in the initial session was compared to the time required after 4weeks of training. Results: The time required to perform the exercise was significantly lower than in the initial session (p < 0.01). The time required by residents to complete the exercise in the initial session was significantly longer than that used by expert surgeons in the same task (p < 0.01), and although a significant difference persisted, this difference was substantially reduced to 3.60min after the residents completed 4-week training in the model (p < 0.01). An independent expert, blinded to the level of training of the person who performed the exercise, could recognize all residents as novices and all experienced surgeons as experts in the initial session of the exercise with the model, but after 4 weeks of training, they did not recognize 4 of the 10 residents as novices (p < 0.05). Conclusion: The routine implementation of training in this model could be very useful in the laparoscopic inguinal hernioplasty teaching-learning process.

P139 LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL REPAIR FOR SMALL AND MEDIUM PRIMARY UMBILICAL AND MIDLINE HERNIAS

Abstract Aim Complications of open mesh repair for primary umbilical and midline hernias (PUMH) may lead to significant re-admissions and follow-up costs. Although laparoscopic intraperitoneal onlay mesh repair reduces infection rates, especially in overweight patients, it’s controversial in these hernias, mainly due to potential adhesions’ formation. Laparoscopic transabdominal preperitoneal technique (lap-TAPP) may address these issues, as it combines advantages of both open and laparoscopic approaches. The aim of this study is to present the initial results of lap-TAPP for PUMH in regard to its feasibility and complication rates. Material and Methods We evaluated 25 consecutive cases of lap-TAPP repair for PUMH. Patients’s characteristics, intraoperative findings, and postoperative complications after 30-days follow-up were analyzed. Results 21 male and 4 female patients were included in analysis (mean BMI 29.8 kg/m2). Surgery time was 82 minutes (55-120). We found 20 umbilical and 11 epigastric linea alba hernias. Mesh size was 144cm2 (120-225); mean hernia defect width was 25mm (10-40). In 9 patients (36%) the peritoneal rents were created which were easily closed with sutures. All patients were discharged on 1 POD with no complications. After 30-days we found no recurrences or bulging, no pain complaints. We found one subcutaneous small hematoma with no need for intervention. Conclusions Laparoscopic TAPP for small and medium PUMH is a safe and feasible technique with low complication rate. However, this method is technically demanding and time consuming while performed with laparoscopic approach as it requires precise and subtle plane dissection, and non-ergonomic closure hernia defect.

Kết quả sớm điều trị thoát vị bẹn ở người trưởng thành bằng phẫu thuật nội soi xuyên thành bụng đặt tấm lưới Prolen ngoài phúc mạc tại Bệnh viện Trung ương Huế - Cơ sở 2

Tóm tắt Đặt vấn đề: Thoát vị bẹn là bệnh lý phổ biến trong ngoại khoa, đặc biệt lĩnh vực ngoại tiêu hóa. Từ khi phẫu thuật nội soi ra đời và ứng dụng tấm nhân tạo trong điều trị thoát vị bẹn, đã có những thay đổi trên thế giới về điều trị cho người bệnh thoát vị bẹn. Phương pháp phẫu thuật nội soi đặt tấm nhân tạo đường xuyên phúc mạc TAPP (Trans-Abdominal Pre-Peritoneal) có nhiều ưu điểm như đường cong huấn luyện ngắn, phát hiện thoát vị bẹn đối bên và điều trị cả trường hợp có biến chứng, nên được nhiều phẫu thuật viên trẻ lựa chọn. Phương pháp nghiên cứu: Nghiên cứu tiến cứu, lâm sàng mô tả, theo dõi dọc 19 người bệnh với 21 trường hợp thoát vị bẹn được phẫu thuật TAPP tại Bệnh viện Trung ương Huế - Cơ sở 2 từ tháng 12/2018 đến 3/2019. Kết quả: Tuổi trung bình 66,8 ± 14,35. Thoát vị bẹn nghẹt 4,8%. Thoát vị bẹn cầm tù 9,5%. Thời gian phẫu thuật trung bình một bên 65,3 ± 19,6 phút, hai bên 102,5 ± 12,5 phút. Thời gian hậu phẫu trung bình 4,1 ± 1,6 ngày. Phát hiện 2 trường hợp thoát vị bẹn đối bên. Sau 3 tháng không có trường hợp nào tái phát. Kết luận: Phẫu thuật TAPP là một phẫu thuật an toàn, hiệu quả có thể ứng dụng rộng rãi. Abstract Introduction: Inguinal hernia repair is one of the most common operation performed in general surgery, especially in digestive field. Since the introduction of laparoscopic repair and application of synthetic mesh to treatment, the trends have changed in the last decade in treatment for inguinal hernia. The laparascopic trans-abdominal pre-peritoneal (TAPP) has a short learning cure. TAPP has many advantages, such as wide dissection, contralateral side checkup, treatment strangulated hernia and incarcerated hernia, a short learning cure has been the first choice for surgeons. Materials and Methods: Study subjects included 19 patients with 21 inguinal hernia cases treated by laparoscopic trans-abdominal pre-peritoneal (TAPP) technique at the Hue Central Hospital - Base 2 from 12/2018 though 3/2019. Descriptive and prospective follow-up study. Results: The mean age was 66,8 ± 14,35 years old. Strangulated hernia and incarcerated hernia respectively accounted for 4,8% and 9.5% of cases. The mean durations of unilateral inguinal hernia repair and bilateral inguinal repair were 65,3 ± 19,6 mins and 102,5 ± 12,5 mins, respectively. Mean duration of postoperative stay was 4,1 ± 1,6 days. 2 case (3.2%) with contralateral inguinal hernia were detected. At 3-months evaluation, there was no recurrence. Conclusion: TAPP is a safe and effective surgical technique; should be encouraged and widely applied in different levels hospitals. Keyword: inguinal hernia, TAPP, laparoscopic surgery, mesh.

Laparoscopic Transabdominal Preperitoneal Technique for Inguinal Hernia Repair in Adults.

BackgroundInguinal hernia repair is one of the most commonly performed operations in general surgery, especially in the digestive field. Since the introduction of laparoscopic repair as well as using a synthetic mesh, the surgical trends have changed in the last decade in treating inguinal hernias. The laparoscopic transabdominal preperitoneal gives a better view of the inguinal anatomy, and the procedure also has a short learning curve. We aim to evaluate the safety and early outcome of the laparoscopic transabdominal preperitoneal technique for inguinal hernia repair using a Prolene® mesh (Ethicon Somerville, NJ, USA).MethodsA prospective study was carried out among 31 adult patients with 34 inguinal hernia cases. They underwent the laparoscopic transabdominal preperitoneal technique with a Prolene mesh at the Hue Central Hospital from December 2018 through May 2019.ResultsThe mean age was 60.4 ± 11.8, and 96.8% of cases were male. Strangulated hernia and incarcerated hernia accounted for 2.9% and 8.8% of cases, respectively. The mean duration of unilateral inguinal hernia repair and bilateral inguinal repair was 57.1 ± 17.3 minutes and 80.3 ± 10.6 minutes, respectively. The mean duration of the postoperative hospital stay was 3.9 ± 1.4 days. One (3.2%) case with contralateral inguinal hernia was detected intraoperatively. An early and three-month postoperative evaluation showed that 93.5% and 96.8% of cases were categorized as “very good”, respectively. At the three-month evaluation, one case was reported with sensation disorder of the inguinal area, and there was no recurrence.ConclusionsLaparoscopic transabdominal preperitoneal inguinal hernia repair is a safe and feasible technique. It allows surgeons to explore the opposite site and resolve the combined peritoneal diseases.

A Comparative Study between Laparoscopic Inguinal Hernia Repair and Open Lichtenstein Mesh Repair

AbstractBackground: This prospective study was conducted in a university hospital for comparing the results of two different techniques for surgical repair of inguinal hernia: Open mesh repair and laparoscopic mesh repair to detect the effectiveness of each operation and complications if any.Aim of Study: The aim of this work is to compare the results of mesh repair of inguinal hernia by open technique and by laparoscopic transabdominal preperitoneal technique (TAPP).Patients and Methods: The study included 92 cases of an inguinal hernia. They were selected by nonprobability sampling method. These cases were operated at Al Hussein University Hospital between January 2016 to September 2018. Inclusion criteria included patients with uncomplicated hernia. The age/sex, incidence, BMI, mode of presentation, co-morbidities, operative time, postoperative complications, pain and return to work were all evaluated and compared with many of standard published literature.Results: Postoperative wound infection developed in 6 cases of open hernioplasty and 1 case in laparoscopic surgery. Seroma at the operated site were found in 5 cases of open hernioplasty. The return to normal daily activity was 21 days after open technique compared to 13 days in TAPP. The mean duration of procedure was 59.5min in open surgery while it was 99min in laparoscopic group.Conclusion: Laparoscopic hernioplasty has a comparable result with an open procedure which should be considered in the surgical treatment of inguinal hernia.

Correlation between laparoscopic transection of an indirect inguinal hernial sac and postoperative seroma formation: a prospective randomized controlled study.

Seroma is the most common early minor complication of inguinal hernia repair. Seromas generally resolve spontaneously within a few weeks, but can sometimes cause other complications. The optimal ways to repair inguinal hernia and handle the hernial sac are still debatable. Large scale, prospective, randomized, controlled studies focusing on the correlation between transection of the hernial sac and seroma formation are scarce. A total of 159 adult male patients with primary indirect inguinal hernia who underwent laparoscopic transabdominal preperitoneal repair were recruited. The patients were randomized to undergo either complete dissection or transection of the hernial sacs. Patients were followed up at postoperative 7days, 1 and 3months, looking specifically for seroma. Seroma was diagnosed via physical examination, and a prestructured form was used to evaluate patient recovery and define the type of seroma present at each follow-up visit. There were 83 patients in the completely dissected group and 76 in the transected group. The overall incidence of postoperative seroma was 12.6% (n = 20). The χ2 test demonstrated that significantly more patients developed seroma in the transected group than in the completely dissected group (18.4% vs. 7.2%, p = 0.034); there were also significant differences between the two groups in the incidences of seroma at postoperative 7days (18.4% vs. 6.0%, p = 0.016) and 1month (14.5% vs. 4.8%, p = 0.037). Seroma formation was correlated with age, body mass index, use of anticoagulants, hernia type, hernia size, sac size, and operative time. There were no significant differences between the two groups in the degree of postoperative pain and time taken for the resumption of outdoor activities. When using the laparoscopic transabdominal preperitoneal technique for indirect inguinal hernia repair, the risk of postoperative seroma formation is greater after transection compared with complete dissection of the hernial sac.

Laparoscopic management of Spigelian hernias

Spigelian hernias, also known as spontaneous lateral ventral hernias, are rare primary ventral hernias arising in the Spigelian, or semilunar, line located at the lateral border of recti. Because of its varied presentation, clinical examination is often inconclusive. Traditional repair of such hernias use the open approach. Herein we report on three cases of Spigelian hernias. All were diagnosed and treated laparoscopically at our institution between March 2011 and June 2012. Multiple surgeons performed the repairs using the laparoscopic transabdominal preperitoneal technique of mesh reinforcement and reperitonization. There were no perioperative or postoperative complications. All three were discharged 1 day postoperatively. A complete resolution of preoperative symptoms was observed at follow-up at 1 week, 1 month and 6 months. Laparoscopic transabdominal preperitoneal repair of Spigelian hernia is safe, easy, and feasible for experienced laparoscopic surgeons.

Laparoscopic groin hernia repair: results of 200 consecutive herniorraphies.

Laparoscopic hernia surgery was introduced in this unit in May 1992. Up to September 1993, 175 patients with 200 inguinal and femoral hernias were treated using this approach. This prospective study deals with intraoperative and postoperative complications, patient recovery and early operative results. The median (range) age was 58 (21-87) years and the median (range) follow-up was 12 (5-24) months. A laparoscopic transabdominal preperitoneal technique was used. The median (range) operation time was 67 (23-160) min for unilateral hernias and the median (range) hospital stay was 1 (0-27) day. Major complications were two postoperative bowel obstructions and seven recurrences, six of these in the first 31 patients. Overall, 17 minor complications were recorded; 52 per cent of the patients were back at work within 1 week, and 94 per cent within 1 month. The value of laparoscopic hernia repair remains to be determined and randomized controlled trials will be necessary.