Laparoscopic Transabdominal Inguinal Hernia Repair Research Articles

A prospective study on effects of treatment of hernia sac stump in laparoscopic transabdominal preperitoneal inguinal hernia repair on postoperative seroma

Objective To investigate the effects of treatment of hernia sac stump in laparoscopic transabdominal preperitoneal inguinal hernia repair (TAPP) on postoperative seroma. Methods The prospective study was conducted. The clinical data of 128 male patients with primary indirect inguinal hernia who were admitted to Fujian Medical University Union Hospital from October 2017 to March 2019 were selected. Patients were divided into two groups by random number method. Patients in experimental group had hernia sac stump sutured and fixed at the lower margin of rectus abdominis after transection of hernia sac in TAPP, and patients in control group had hernia sac stump free in the abdominal cavity after dissection and transection of hernia sac in TAPP. Observation indicators: (1) surgical situations; (2) follow-up. Follow-up using outpatient examination and telephone interview was conducted to detect the incidence of postoperative seroma, incision infection, chronic pain, and hernia recurrence up to June 2019. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was done using the t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was done using the Mann-Whitney U test. Count data were described as absolute numbers and percentages, and comparison between groups was analyzed using the chi-square test. Results A total of 128 male patients were screened for eligibility, including 60 patients in the experimental group and 68 patients in the control group. The 128 patients were aged from 47 to 74 years, with an average age of 61 years. (1) Surgical situations: operation time and hospital expenses were (102±34)minutes and (12 813±2 390)yuan for the experimental group, and (97±30)minutes and (12 125±2 205)yuan for the control group, respectively, showing no significant difference between the two groups (t=0.907, 1.685, P>0.05). (2) Follow-up: all the 128 patients received follow-up. There were 8 cases of seroma in both the experimental group and the control group, with no significant difference between the two groups (χ2=0.072, P>0.05). The extraction volume of patients with seroma was 20 mL (range, 4-31 mL) in the experimental group, and 43 mL (range, 23-98 mL) in the control group, showing a significant difference between the two groups (Z=-2.013, P<0.05). There was no incision infection, chronic pain or hernia recurrence in 3 months after operation in patients with seroma of either experimental group or control group. Conclusions During TAPP, suture and fixation of the hernia sac stump to the lower edge of rectus abdominis and free hernia sac stump in the abdominal cavity after dissection and transection of hernia sac can effectively repair indirect inguinal hernia. The former method can reduce the extraction volume of seroma after operation. Key words: Hernia; Indirect inguinal hernia; Transabdominal preperitoneal inguinal hernia repair; Seroma; Laparoscopy; Prospective study

Postoperative Pain and Recurrence after Mesh Fixation with Absorbable versus Non-Absorbable Tacks in Patients undergoing Laparoscopic Transabdominal Inguinal Hernia Repair: A Comparative Study

Introduction: Inguinal hernia is a common disease. Many researches were done to evaluate the different methods of treatment yet there is no ideal method for treatment till now. Since the use of laparoscopy in hernia repair evolved, it is probably becoming the treatment of choice for hernia. Objectives: This is a prospective randomized trial that aimed at comparing the outcome of using absorbable versus non-absorbable tacks as mesh fixation devices in patients undergoing laparoscopic transabdominal inguinal hernia repair (TAPP) regarding postoperative groin pain and early recurrence. Patients and Methods: Thirty patients were enrolled in this study. The patients were divided into two groups: Group A included 15 patients who underwent TAPP with mesh fixation by non absorbable tack (NAT) and group B included 15 patients who underwent TAPP with mesh fixation by absorbable tack (AT). Follow up was done at the first day, second week, sixth month and one year postoperatively. Results: The 2 groups had similar features regarding demographics, operation time, postoperative hospital stay and morbidity. The 2 fixation methods were found similar for postoperative pain and recurrence with no significant difference. Disclosure: This article is not sponsored by any company, so the authors have no competing interests as defined by Nature Publishing Group, or other interests that might be perceived to influence the results and/or discussion reported in this article.

Experiences on shortening the learning curve of laparoscopic hernia repair

There is a longer learning curve in laparoscopic transabdominal preperitoneal inguinal hernia repair. Improvements of surgical procedures and skills can effectively shorten the learning curve. The experiences and operative skills that were summarized by the author can shorten the operation time and simplify the operation procedures, therefore will shorten the learning curve of laparoscopic hernia repair. Key words: Hernia; Transabdominal preperitoneal repair; Learning curve

Fibrin glue versus stapler fixation in laparoscopic transabdominal inguinal hernia repair: A single center 5-year experience and analysis of the results in the elderly

Introduction: Inguinal hernia surgery is one of the most common surgical procedures performed worldwide. Some studies demonstrated clear advantages of laparoscopic approach in terms of chronic pain, recurrence rate and daily life activities Aim of this study was to compare short and long-terms outcome of tacks and fibrin glue used during laparoscopic transabdominal hernioplasty (TAPP). Methods: This is a retrospective study conducted by our division of General Surgery. From May 2008 to May 2013 we performed 116 hernioplasty with TAPP technique. We compared two groups of patients: a group of 59 patients treated with fibrin glue and a group of 57 patients treated with conventional tacks and the two subgroups of patients over 65 years old. We evaluated: perioperative outcomes, early and late complications. Results: There were no significative difference about length of postoperative stay, time to return to work, recurrence rate and complications. Discussion: This study demonstrates that fibrin glue are same tolerated than tacks by patients and that the glues lead to the same good results during initial follow-up and in long term data also in the elderly. Meticulous preparation of the groin with preservation of spermatic sheet is in our opinion necessary to provide effective pain reduction and a good result in every TAPP procedure.

Laparoscopic transabdominal inguinal hernia repair in community hospital settings: a general surgeon's last 10 years experience.

Numerous studies have documented the laparoscopic TransAbdominal Pre-Peritoneal (TAPP) approach as an excellent choice for inguinal hernia repair, especially with an experienced surgeon. A cohort population of patients who underwent TAPP laparoscopic surgery for inguinal hernias over the last 10years, with follow-up, were evaluated, focusing on the feasibility, safety and benefits of this procedure in a community hospital setting. A total of 533 patients underwent TAPP for inguinal hernias between January 2003 and March 2013 in two community hospitals in the Northeast of Italy-"Civil Hospital" in Vittorio Veneto (TV) and "Civil Hospital" in Adria (RO). The total number of hernias treated was 1,000. The overall mean operative time was 43.50min (±13.2). All but three of the procedures were done on a day surgery basis. There were no conversions to open repair or deaths in our series. We had two cases of small bowel obstruction and eight relapses (0.8%) in our series. The mean follow-up was 59.4months (±5.6; range 3-120). No patients reported severe pain at 10days, 21 patients (3.9%) reported mild pain at 3-month follow-up. Over 90% of the patients had a return of physical work capacity within 2weeks, the remaining within 30days. All patients were completely satisfied (numerical rating scale 10/10) 3months after the operation. The analysis of the short- and long-term post-operative outcomes of our experience enabled us to conclude that in an appropriate setting, TAPP is feasible, effective, safe and beneficial for patients. It should be incorporated into general surgeons' expertise and selectively used for the management of patients with hernias, as long as adequate training is obtained and appropriate preparation performed.

Re: Spray Application of Fibrin Glue as Risk Factor for Subcutaneous Emphysema in Laparoscopic Transabdominal Inguinal Hernia Repair

Re: Spray Application of Fibrin Glue as Risk Factor for Subcutaneous Emphysema in Laparoscopic Transabdominal Inguinal Hernia Repair

Autologous fibrin sealant (Vivostat®) for mesh fixation in laparoscopic transabdominal preperitoneal hernia repair

The use of fibrin glue derived from humans or animals has been reported as an alternative method of mesh fixation, instead of staples, in inguinal hernia repair. However, fibrin sealants involve the potential risks of virus transmission or immunological reactions to foreign proteins. This risk could be avoided by using autologous fibrin derived from the patient. A feasibility study on the use of autologous fibrin was therefore carried out in patients undergoing laparoscopic transabdominal inguinal hernia repair. In a series of 10 patients undergoing laparoscopic transabdominal inguinal hernia repair, autologous fibrin was produced from 120 ml of the patient's blood during the hernia repair. The process took an average of 20 min. The perioperative and postoperative results were compared with those in a control group of 20 patients in whom conventional fibrin was used. Producing and applying the autologous fibrin was uncomplicated. No differences in the outcome were observed between the two groups. One patient in the conventional fibrin group developed a seroma. None of the patients reported persistent pain. No recurrences were observed after a mean follow-up period of 9 months (range 6 - 12 months) in the conventional fibrin group and 7 months (range 6 - 8 months) in the autologous fibrin group. This feasibility study suggests that autologous fibrin sealant allowed adequate mesh fixation that did not differ from that in a control group in whom conventional fibrin glue was used. Autologous fibrin may be an interesting alternative for a variety of laparoscopic and endoscopic applications.