Laparoscopic Transabdominal Preperitoneal Inguinal Hernia Repair Research Articles

Comparison of modified tumescent and conventional laparoscopic transabdominal preperitoneal inguinal hernia repair: a retrospective clinical study.

Laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair poses certain challenges to less experienced surgeons. This study was performed to compare the clinical outcomes of modified tumescent laparoscopic TAPP (MT-TAPP) inguinal hernia repair versus conventional laparoscopic TAPP (CL-TAPP) inguinal hernia repair. We retrospectively analyzed the perioperative data of patients with inguinal hernias who underwent either MT-TAPP repair (n = 57) or CL-TAPP repair (n = 54) at the General Surgery Department of Nanjing Yimin Hospital from November 2019 to June 2023. The durations of the total operation and the preperitoneal space dissection were shorter in the MT-TAPP than CL-TAPP group. The estimated blood loss volume was lower in the MT-TAPP than CL-TAPP group. The visual analogue scale scores recorded at the 12- and 24-hour postoperative time points showed significantly greater reductions in the MT-TAPP than CL-TAPP group. Using liquid injection and gauze dissection is both safe and practical. This technique results in a shortened total operation time, less time spent on preperitoneal space dissection, decreased estimated blood loss, and less severe postoperative pain.

No evidence for fixation of mesh in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair: a systematic review and meta-analysis of randomized controlled trials

ObjectiveTo investigate the differences in hernia recurrence and chronic postoperative inguinal pain (CPIP) in randomized, controlled trials comparing fixation and non-fixation of the mesh in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair.MethodsA multi-database systematic search was conducted for randomized, controlled trials comparing fixation versus non-fixation of the mesh in TAPP inguinal hernia repair. All eligible papers were assessed for risk of bias using the revised Cochrane risk of bias tool for randomized trials (RoB 2.0). Quality of evidence was evaluated using the GRADE system. Meta-analyses were performed regarding recurrence and CPIP using RevMan.ResultsSeven prospective, randomized controlled trials were included. Laparoscopic TAPP inguinal hernia repair was performed in 1732 patients with 737 procedures performed without fixation and 995 procedures with fixation of the mesh. Despite all trials being RCTs, the trials were limited by substantial bias and the quality of evidence was low regarding hernia recurrence and very low regarding CPIP. Pooled estimates from meta-analyses were an OR of 2.80 (95% CI 0.61–12.77) for hernia recurrence and a mean difference in visual analogue scale (VAS) of 0.17 (95% CI 0.90–1.24) for CPIP, respectively.ConclusionThe current evidence is very uncertain and mesh fixation may have little to no effect regarding hernia recurrence and chronic postoperative inguinal pain in patients operated with TAPP inguinal hernia repair.

Laparoscopic TAPP repair following tumescent injection: The patient outcomes and feasibility for surgeons

Background: Laparoscopic transabdominal preperitoneal inguinal hernia repair (TAPP) is technically demanding procedure with relatively long learning curve. Procedure is associated with operative and postoperative complications and pain, especially when performed by inexperienced surgeon. Most of the problems are associated with different anatomical environment and technical inadequacy. In order to make TAPP relatively simple with better visibility of landmarks, we used pre peritoneal infiltration of 60-100ml saline with lidocaine and epinephrine before proceeding for TAPP repair. Methods: About 60-100 ml of diluted lidocaine with epinephrine solution was injected in pre peritoneal space below arcuate line and extending to and around hernial sac. Care is taken not to inject in triangle of doom. Laparoscopic aspiration needle was used for injection after lifting peritoneum with grasper. Tumescent TAPP was performed in 35 patients (32 men, 3 women; mean age, 44.3 years). Results: With use of tumescent TAPP, it was relatively simple to identify anatomical landmarks owing to bloodless field. One of the main advantages was demonstration of procedure to residents leading to better understanding and more confident dissection while being performed under supervision. The mean operation time was 95 min. ranging from 55 to 110 minutes. Another advantage was reduced pain in early post-operative period. Conclusions: Tumescent injection before TAPP is easier and safe with advantage of clearer anatomy and reduced post-operative pain. Keywords: Tumescent TAPP, Tumescent local anesthesia, Inguinal hernia

O15 LESS PAIN AFTER TACK FIXATION OF MESH THAN WITH SELF-GRIPPING MESH FOLLOWING LAPAROSCOPIC INGUINAL HERNIA REPAIR: A RANDOMIZED CLINICAL TRIAL

Abstract Aim Acute pain following transabdominal preperitoneal inguinal hernia repair (TAPP) may be attributed to mesh fixation. The aim of the present study was to determine short and long-term complications following laparoscopic TAPP repair using either a self-gripping mesh or a tacked mesh. Material and Methods Healthy male subjects referred for unilateral inguinal hernia repair were randomized to a TAPP procedure using either a tacked mesh (Parietix, Medtronic; AbsorbaTack, Medtronic) or a self-gripping mesh (ProGripTM, Medtronic). Acute postoperative pain and short and long-term complications were recorded using an e-mail generated questionnaire preoperatively and at days 1 and 7 and at 1, 3, 6 and 12 months postoperatively. Acute pain was assessed using the visual analogue scale (VAS). Results A total of 333 male subjects underwent elective repair of a medial (n = 107, 32%) or a lateral (n = 226, 68%) inguinal hernia. Patients were randomized to either a tacked (T = 178) or non-tacked procedure (N = 155). Mean follow-up time was 141 days. Mean number of tacks applied was 2.7 per operation. Mean preoperative VAS score was 2.21 (T) vs 1.78 (N) (P = 0.06). Postoperatively, the mean VAS-score (average within the observation period) was 2.80 (T) vs 3.12 (N) (P < 0.01), resulting in a 10% lower VAS-score following the tacked repair compared to the self-gripping mesh (P < 0.01). Patient-reported signs of recurrence at 12 months was 4.7% (T) vs 7.5% (N) (P = 0.35). Conclusions Postoperative acute pain after laparoscopic inguinal hernia repair is lower following a tacked than a non-tacked (self-adhesive mesh) procedure. Patient-reported recurrence did not differ between groups

Laparoscopic-guided distal loco-regional anesthetic infiltration technique in TAPP inguinal hernia repair: a double-blind randomized clinical trial.

Ultrasound-guided transversus abdominis plane block (US-TAP) is an important component of multimodal analgesia in laparoscopic inguinal hernia repair, although it has certain limitations. To overcome them, surgeons have developed several techniques to perform local anesthetic infiltration under laparoscopic guidance, but no trials evaluating these in transabdominal preperitoneal (TAPP) hernia repair were conducted till the date. The aim of this study was to compare the efficacy of a novel laparoscopic-guided local anesthetic infiltration technique (LDAI) with US-TAP in postoperative pain control and analgesic consumption for patients undergoing elective TAPP hernia repair. This was a double-blind randomized controlled trial conducted at a single tertiary academic center between 2019 and 2020 on adult patients undergoing elective laparoscopic TAPP inguinal hernia repair. Postoperative pain and analgesic consumption were compared for LDAI vs. US-TAP up to 30 postoperative days. 62 patients were included (31 LDAI, 31 US-TAP). Female gender was significantly higher in the LDAI group (8, 25.81%; US-TAP 0; p = 0.005). Mean anesthetic time (US-TAP group: 142.2min, SD = 17.7; LDAI group: 127.1min, SD = 15.5; p < 0.001) and mean operative time (US-TAP group: 117.2min, SD = 15.9; LDAI group: 103.8min, SD = 15.2; p < 0.001) were significantly shorter in the LDAI group. Pain scores assessed at the first-hour postoperative, at the moment of discharge, and at 8, 24, and 48 postoperative hours showed no significant differences between both groups. No significant difference was found regarding postoperative analgesic rescue administration in the recovery room and analgesic consumption after discharge between groups. LDAI is a safe and effective local anesthetic technique in elective TAPP hernia repair. Pain control is similar to US-TAP block, with shorter anesthesthetic and surgical time and better health resources allocation.

Efficacy of celecoxib as preemptive analgesia for patients undergoing laparoscopic inguinal hernia repair: a randomized trial.

To investigate the efficacy and safety of preemptive analgesia with a transversus abdominis plane (TAP) block versus celecoxib for patients undergoing laparoscopic transabdominal preperitoneal inguinal hernia repair (LTAPP). Sixty patients scheduled for LTAPP were randomized into three groups: a celecoxib group, given 200mg celecoxib 2h before surgery; a celecoxib/diclofenac group, given 200mg celecoxib 2h before surgery and 50mg rectal diclofenac sodium on recovery from general anesthesia; and a block group, given a TAP block with 60mL 0.25% levobupivacaine after general anesthesia. We assessed the numerical rating scale (NRS) scores for pain at rest and with movement 24h after surgery. Postoperative analgesia use and adverse events were also evaluated. The NRS scores for pain at rest and with movement were lower in the celecoxib group than in the block group, 24h postoperatively. The time to first request for analgesia tended to be longer in the block group than in the celecoxib group. No significant between-group differences were noted in analgesic use or adverse events. Celecoxib was not inferior to the TAP block as preemptive analgesia. Thus, celecoxib could be given as simple preemptive analgesia for LTAPP by considering a multimodal analgesic strategy in the early postoperative period.

Development and evaluation of a novel simulation model for transabdominal preperitoneal (TAPP) inguinal hernia repair.

Transabdominal preperitoneal (TAPP) inguinal hernia repair requires the surgeon to have good manual skills in laparoscopic surgery, as well as an understanding of the laparoscopic features of the groin anatomy. This is why TAPP is considered a more difficult surgical procedure compared to open techniques. Realistic training model for TAPP inguinal hernia repair would enhance surgeons' skills before they enter in the operation room. Our aim was to create a realistic, inexpensive, and easily reproducible model for laparoscopic TAPP inguinal hernia repair and to assess its effectiveness. The applied TAPP inguinal hernia repair training simulator consists of a laparoscopic box and an inguinal region model placed in it. The model of the groin area is made of the porcine stomach and assembling materials. Uniaxial tensile and T-peel tests were performed to compare the mechanical properties of the porcine stomach and the human cadaver peritoneum. Thirty eight surgeons performed TAPP inguinal hernia repair using this model. Their opinions were scored on a five-point Likert scale. Close elastic modules of the porcine and human tissues (13.5 ± 4.2kPa vs. 15.8 ± 6.7kPa, p = 0.531) gave to trainees a realistic tissue feel and instrument usage. All participants strongly agreed that model was highly useful for TAPP inguinal hernia repair training. They also put the following points: the model as a whole 5 (3-5), simulation of anatomy 5 (3-5), simulation of dissection and mobilization 5 (3-5), and simulation of intracorporeal suture 5 (4-5). We successfully created a model for TAPP inguinal hernia repair training. The model is made of inexpensive synthetic and biological materials similar to the human tissue. The model is easy to reproduce and can be used in the training programs of surgical residents.

Peritoneal closure using self-anchoring-barbed absorbable sutures during laparoscopic transabdominal preperitoneal inguinal hernioplasty: How to make it more safe?

CONTEXT: Peritoneal closure with a barbed suture during laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair is a controversial subject due to the risk of postoperative intestinal adhesions and occlusions formed by this type of suture. This risk, however, was only reported in several case reports. The purpose of this study is to determine the incidence of postoperative intestinal obstructions related to the use of barbed suture materials in laparoscopic hernia repair (TAPP). PATIENTS AND METHODS: We included all patients that underwent laparoscopic TAPP inguinal hernia repair between October 2012 and October 2017. All peritoneal closures were accomplished using absorbable barbed sutures. Operative data were collected in a dedicated database and analyzed retrospectively. RESULTS: Only 3 out of the 320 patients included (0.9%) presented with an early postoperative intestinal obstruction and required further surgery. Two of the three patients (0.6%) were found to have intestinal incarceration in the peritoneal defects initially created during the hernia repair. However, the last patient had an intestinal volvulus due to adhesions formed with the barbed suture. None of the patient characteristics collected were significant risk factors for developing postoperative intestinal obstructions. CONCLUSION: In this study, peritoneal closure using barbed suture material did not increase the risk of early postoperative intestinal obstruction, in comparison to other suture materials reported in the literature. The use of barbed absorbable sutures for peritoneal closure during laparoscopic TAPP seems to be safe when sutures are cut short and covered by the peritoneum.

The Safety and Feasibility of the Single-Port Laparoscopic Transabdominal Preperitoneal Inguinal Hernia Repair Through Retropubic Radical Prostatectomy Scar, Prospective, Case Series.

Introduction: To avoid an additional scar, our novel single-port laparoscopic inguinal hernia repair technique that utilizes the previous prostatectomy scar was conducted. Inguinal hernia is one of the most common complications of radical prostatectomy that require surgical repair. At present, such surgical repair inevitably leaves additional scars on the abdominal wall. This case series study was performed to determine the safety and feasibility of this procedure in patients with inguinal hernia after radical prostatectomy. Subjects and Methods: All patients who underwent retropubic radical prostatectomy (RRP) in 2012-2016 and developed an inguinal hernia as a complication of RRP agreed to undergo single-port laparoscopic transabdominal preperitoneal (TAPP) repair of the inguinal hernia through the RRP scar. TAPP repair was performed using a homemade glove single port through a 2 cm wide incision into the upper part of the RRP scar. The duration between RRP and the development of inguinal hernia, TAPP repair operative time, follow-up duration, TAPP repair-related complications, and rate of inguinal hernia recurrence were recorded. Results: Of the 131 patients who underwent RRP in the study period, 12 (mean age, 67.58 ± 5.73 years) developed inguinal hernia during an average follow-up duration of 33.58 ± 16.49 months. None had a previous history of inguinal hernia. The inguinal hernias developed on average 3.83 ± 1.70 months after RRP. The mean operative time was 64.58 ± 6.20 minutes. There were no surgical complications or recurrence of inguinal hernia during follow-up. Conclusions: Single-port laparoscopic TAPP inguinal hernia repair through the previous prostatectomy scar is safe and feasible.

Laparoscopic inguinal hernioplasty after robot-assisted laparoscopic radical prostatectomy.

To evaluate the efficacy and safety of laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair in patients who have undergone robot-assisted laparoscopic radical prostatectomy (RALP). From July 2014 to December 2016, TAPP inguinal hernia repair was conducted in 40 consecutive patients who had previously undergone RALP. Their data were retrospectively analyzed as an uncontrolled case series. The mean operation time in patients who had previously undergone RALP was 99.5±38.0min. The intraoperative blood loss volume was small, and the duration of hospitalization was 2.0±0.5days. No intraoperative complications or major postoperative complications occurred. During the average 11.2-month follow-up period, no patients who had previously undergone prostatectomy developed recurrence. Laparoscopic TAPP inguinal hernia repair after RALP was safe and effective. TAPP inguinal hernia repair may be a valuable alternative to open hernioplasty.

Innovation in Laparoscopic Inguinal Hernia Reparation – Initial Experiences with the Parietex Progrip Laparoscopic™ – Mesh

The Laparoscopic TAPP (transabdominal pre-peritoneal inguinal hernia repair) - technique is becoming more widely and frequently used due to higher patient satisfaction and lower rates of both relapse and complications. The role of the fixation of the mesh is especially important in regard to the endoscopic technique. The fixation of mesh through penetrating techniques using staples, clips, or screws is associated with a significantly increased risk of developing a chronic post-herniotomy inguinal pain syndrome (CPIP). In order to answer the question "fixation or no fixation of the mesh," the use of self-adhesive mesh is an optimal compromise. With the authors own operative technique consisting also of a standard pre- and post-operative management, the self-adhesive mesh was proven to be extremely reliable. As no specific materials to fix the mesh were needed, the method was fast, simple, and economical. We could also reduce the incidences of chronic inguinal pain in our patient population by using the self-adhesive mesh, without the risk of an increased recurrence rate in the observation period.

Effectiveness and safety of n-butyl-2-cyanoacrylate medical adhesive for noninvasive patch fixation in laparoscopic inguinal hernia repair

Our purpose was to compare the recurrence rate and other clinical outcomes of laparoscopic (LS) transabdominal preperitoneal (TAPP) inguinal hernia repair using n-butyl-2-cyanoacrylate (NBCA) for mesh fixation with those of no mesh fixation and mesh fixation with titanium spiral tacks (ST). The medical records of patients who received LS TAPP inguinal hernia repair between 2009 and 2012 at our institution were reviewed. Patients were included if the received LS TAPP with either no mesh fixation, mesh fixation with NBCA only, fixation with ST only, or fixation with NBCA+ST. Outcome measures were operation time, postoperative length of stay, visual analogue scale (VAS) pain score 24h after surgery, postoperative complications, and hernia recurrence. A total of 1,027 TAPP cases were included. In 552 cases, meshes were fixed with NBCA only, in 89 cases only ST were used, in 47 cases ST and NBCA were used, and in 339 cases meshes were not fixed. The groups were comparable with respect to demographic and clinical characteristics. No surgical complications occurred in any group. VAS pain scores were significantly lower in the nonfixation and NBCA only groups (1.4±0.6 and 1.3±0.6, respectively) than in the ST and NBCA+ST groups (2.2±0.9 and 2.2±0.7, respectively; P=0.001). The mean follow-up duration was ~19months. At the final follow-up, no wound infections or hernia recurrences had occurred in any of the groups. No occurrence of chronic pain was noted in the nonfixation and NBCA only groups, whereas two cases (2.2%) were noted in the ST group and one case (2.1%) in the NBCA+ST group (P=0.005). The use of NBCA medical adhesive for noninvasive patch fixation in laparoscopic hernia repair (TAPP) is effective and safe.

Tension-Free Mesh Inguinal Hernia Repair; Laparoscopic or Open?

Background: Laparoscopic tension-free repair of inguinal hernia was presented in 1990s, promising less pain and shorter recovery period. Objectives: We have presented our experience on laparoscopic inguinal hernia tension-free repair and comparing it with the open one. Patients and Methods: This is a retrospective study of cases undergone tension-free mesh inguinal hernia repair between July 2008 and October 2011. Cases were divided into two groups. Group I included cases that were repaired by the laparoscopic transabdominal preperitoneal (TAPP) approach and II by the open. Cases were compared regarding the operation time, the postoperative pain (early and long-term), the postoperative scrotal-related and wound complications and the recurrence as well as the cost. Results: The study included 217 cases; 114 in the group I and 103 in the group II. The operation time was significantly longer in the TAPP group (76.5 18 vs. 67.6 20 minutes). However, the overall hospital stay was less (2.6 0.79 vs. 2.9 0.87 days.) Early postoperative pain scores in the groups I and II were 0.95 1.36 and 1.48 1.47 and long-term pain and numbness were9% and 7.5% respectively, which were not significantly different between the two groups. The postoperative scrotal-related complications occurred more in the laparoscopic group (15% vs. 7.5%). Local wound complications were significantly more in the open technique (1.8% vs.12%, groups I and II, respectively). Twelve (11%) cases in the group I undergone treatment of an incidentally discovered pathology during laparoscopy including; other side inguinal hernia (7), adhesions (4) and abdominal testis (1). The recurrence rates were 4.3% and 2.4% in the group I and II correspondingly. Conclusions: Laparoscopic TAPP inguinal hernia repair has longer operation time and more cost than the open technique. Local wound complications were more prevalent in the open repair. The postoperative pain, the hospital stay, the scrotal-related complications as well as the recurrence rates were the same in the both groups. The laparoscopy can detect and treat other intra-abdominal pathologies which have not been diagnosed preoperatively.

An evidence‐based approach for laparoscopic inguinal hernia repair: Lessons learned from over 1,000 repairs

In this educational article, we aim to provide a literature review on laparoscopic anatomy of the inguinal region. We share the lessons learnt from the 1,194 laparoscopic hernia operations we have performed in 16 years of experience, trying to provide an anatomical and physiological basis for surgeons. The current study reports a personal experience with a transabdominal preperitoneal (TAPP) hernioplasty procedure. A literature review using the keywords "hernia," "laparoscopic approach," and "hernia repair" was performed using the electronic biomedical database PubMed, Medline Extra, Embase, Biosis, Science Citation Index, Ovid and text books. Between January 1994 and December 2010, a total of 1,194 patients, males and females (average age, 56.7 years), underwent laparoscopic TAPP inguinal hernia repair. Following reduction of the hernia sac and creation of the preperitoneal flap, a polypropylene mesh (10 × 16) and four spiral tacks were placed. TAPP is easy to learn and perform. Through this approach, a much better view from the inguinal anatomy is achieved, and the procedure also offers a brief learning curve. Our patients reported minimal postoperative pain and returned to work after 5-10 days, which is in accordance with the general anesthesia series. During the follow-up period, 10% of seromas, 3% of scrotal hematomas, 1% of hemorrhages, and 3% of recurrent hernias were observed. It should be emphasized that we have not observed abscess formation or acute infection related to the presence of mesh.

Transabdominal pre-peritoneal inguinal hernia repair with external fixation

To find a method that has all the advantages of laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair but with considerably reduced costs. Controversy exits regarding whether it is necessary to secure the mesh prosthesis during laparoscopic TAPP inguinal hernia repair. It is unknown whether stapling the mesh affects recurrence rate or the incidence of neuralgia in a port-site hernia. We choose to fix the mesh to the exterior, thus reducing port size, cost and pain. We conducted a prospective trial for laparoscopic TAPP inguinal hernia repair in which we fixed the mesh to the anterior abdominal wall using two prolene threads that passed to the exterior and were tied in place. The study was conducted at Al Hayat Hospital Jeddah, Saudi Arabia, between September 2008 and April 2009. Included in the study were 42 patients with unilateral inguinal hernia. The operative time ranged from 35 to 85 min and follow up was for 9-16 months, during which time there was no recurrence, no post TAPP pain. The procedure reduces the port size required and was also associated with reduced cost. It is not necessary to secure the mesh during laparoscopic TAPP inguinal hernia repair from the interior. External fixation allows a reduction in size of the ports needed, and leads to a considerable reduction in cost.

Laparoscopic Repair of Inguinal Hernias with Higher Risk for Recurrence: Independent Assessment of Results from 121 Repairs

This study attempts to determine by independent review the results of laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair for hernias with increased risk for recurrence. Indicators used for increased recurrence risk were recurrent hernias or simultaneously repaired bilateral inguinal hernias. Office and hospital records of all such patients who had undergone TAPP repair were reviewed from one surgeon's 242-patient laparoscopic inguinal hernia database from 1992 to 1998. All were called for assessment by an independent surgeon at least 4 months postoperatively (median 34 months). Those unable to come in person were interviewed by telephone. There were 121 hernias: 34 recurrent and 100 bilateral (13 overlap). Recurrence rate was 3 per cent, which was similar for repair of bilateral and recurrent hernias. All recurrences occurred within 3 months of surgery. No unknown recurrence was detected by the independent observer. Laparoscopic TAPP inguinal hernia repair, often claimed as the method of choice for bilateral and recurrent hernia repair, is indeed a safe and effective procedure with a low early recurrent rate in these higher-risk situations.