Laparoscopic Transabdominal Preperitoneal Research Articles

Clinical efficacy of laparoscopic transabdominal preperitoneal hernia repair and risk analysis affecting postoperative complications

Objective To explore the clinical efficacy of laparoscopic transabdominal preperitoneal (TAPP)hernia repair and risk factors affecting postoperative complications. Methods The retrospective case-control study was conducted. The clinical data of 595 patients who received laparoscopic TAPP hernia repair in the First Affiliated Hospital of Soochow University from February 2008 to August 2016 was collected. Operations were performed by the same doctors′ team. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up situations; (4) risk factors affecting complications after laparoscopic TAPP hernia repair. Follow-up using outpatient examination and telephone interview was performed to detect the recovery time of non-restricted activity, postoperative complications and hernia recurrence up to February 2017. Measurement data with normal distribution were represented as ±s. The univariate analysis and multivariate analysis were done using the chi-square test and Logistic regression model. Results (1) Surgical situations: 595 patients underwent laparoscopic TAPP hernia repair using the heavy meshes. Overall operation time and overall volume of blood loss were (55±25) minutes and (7±5)mL, including operation time of (50±20)minutes in 502 unilateral hernias and operation time of (81±29)minutes in 93 bilateral hernias. Of 595 patients, 34 had incarcerated hernia, the contents of hernia: greater omentum, small intestine and sigmoid colon were detected in 21, 11 and 2 patients, respectively, with an incarcerated time of 2-21 hours; 4 with incarcerated hernia induced small intestinal necrosis received laparoscopy-assisted small intestinal resection + anastomosis, 1 with sigmoid colon necrosis received necrotic sigmoid canal resection + sigmoidostomy and 29 received repair after the contents restoration of hernia. Operation time and volume of intraoperative blood loss in 34 patients with incarcerated hernia were (84±39)minutes and (12±6)mL. Thirteen of 595 patients (10 with indirect hernia and 3 with direct hernia) had recurrent hernia, and operation time and volume of intraoperative blood loss were (75±26)minutes and (10±5)mL. (2) Postoperative situations: time to initial exsufflation of 595 patients was (19±12)hours. Of 595 patients, 590 took fluid diet at 6 hours postoperatively and 5 undergoing enterectomy took fluid diet at 24 hours postoperatively. The pain score at 1 day postoperatively and duration of hospital stay were respectively 2.5±1.4 and (2.1±1.9)days. (3) Follow-up situations: of 595 patients, 593 recovered non-restricted activity at 2 weeks postoperatively and 2 didn′t recover non-restricted activity at 2 weeks postoperatively. Of 595 patients, 542 were followed up for 6-60 months, with a median time of 31 months. Fifty-seven, 25, 13 and 1 patients were respectively complicated with seroma, surgical pain, urinary retention and enteroparalysis, they were improved by symptomatic treatment, and the same patient can have multiple complications. There were no severe complications which needed surgical intervention, such as vascular injury, damnify of intestinal canal and poke hole hernia. Of 2 patients with recurrence of hernia, 1 with right indirect hernia had recurrence of direct hernia and then received Lichtenstein tension-free hernia repair, and 1 received treatment in other hospital. (4) Risk factors affecting complications after laparoscopic TAPP hernia repair: results of univariate analysis showed that age, diameter of hernia sac, incarcerated hernia, recurrent hernia, operation time and volume of intraoperative blood loss were related factors affecting complications after laparoscopic TAPP hernia repair (χ2=6.657, 55.296, 44.305, 5.253, 117.461, 100.722, P<0.05). Results of multivariate analysis showed that diameter of hernia sac ≥4 cm, incarcerated hernia, operation time ≥100 minutes and volume of intraoperative blood loss ≥10 mL were independent risk factors affecting complications after laparoscopic TAPP hernia repair (OR=3.610, 11.315, 12.401, 7.346, 95% confidence interval: 2.009-6.486, 3.579-35.772, 5.408-28.437, 3.739-14.434, P<0.05). Conclusion Laparoscopic TAPP approach for inguinal hernia is safe and effective, and diameter of hernia sac ≥4 cm, incarcerated hernia, operation time ≥100 minutes and volume of intraoperative blood loss ≥10 mL are independent risk factors affecting complications after laparoscopic TAPP hernia repair. Key words: Hernia, inguinal; Transabdominal preperitoneal hernia repair; Risk factor; Laparoscopy

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.

Technical points of the laparoscopic transabdominal preperitoneal (TAPP) approach in inguinal hernia repair

Laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair is one of the most commonly used approaches in the treatment of hernia. However, the techniques were usually mastered improperly. This manuscript is to improve surgical skills by concluding the techniques and complications of TAPP.

Clinical comparative analysis of Laparoscopic transabdominal preperitoneal repair and path tension-free hernioplasty in the treatment of recurrent inguinal hernia in adults

Objective To compare the clinical efficacy of laparoscopic repair of laparoscopic transabdominal preperitoneal(TAPP) and Lichtenstein tension-free repair herniorrhaphy in the treatment of recurrent inguinal hernia in adults, and to explore the clinical advantages of TAPP in the treatment of recurrent inguinal hernia. Methods A retrospective analysis was conducted in 54 adult patients with recurrent inguinal hernia from December 2010 to January 2015.The patients were randomly divided into TAPP group and Lichtenstein group.The operation time, intraoperative bleeding volume, postoperative hospitalization time, cost of hospitalization, postoperative complications, early postoperative pain and the recurrence of hernia were compared between the two groups. Results All patients were successfully completed surgery.The operation time of TAPP group (47.2±9.4)min was significantly shorter than (73.1±10.4)min of Lichtenstein group (t=-2.503, P=0.034). The median amount of bleeding during operation of TAPP group was 40(15-110)ml, which was significantly less than 73(11-130)ml in Lichtenstein group (t=-6.018, P=0.000). Postoperative hospital stay of TAPP group[(6.5±1.4)d]was shorter than (8.2±1.6)d of the Lichtenstein group (t=-2.613, P=0.028). Early postoperative pain score of TAPP group[(1.8±1.2)points]was better than (2.9±1.4)points in Lichtenstein group (t=-7.006, P=0.000), the difference was statistically significant.However, the hospitalization cost of TAPP group[(8 842.8±415.2)yuan]was higher than (6 676.9±327.6)yuan of the Lichtenstein group, the difference was statistically significant(t=6.782, P<0.05). In TAPP group, 2 cases had complications after operation, which were less than 5 cases of Lichtenstein group.Postoperative follow up ranged from 6 to 48 months, 1 case of recurrence in Lichtenstein group, the recurrence rate was 3.8%.There was no recurrence in the TAPP group. Conclusion TAPP has the advantages of short operation time, less bleeding, rapid postoperative recovery, less postoperative pain and so on.It can be used as a recommended procedure for the treatment of recurrent inguinal hernia in adults. Key words: Hernia, inguinal; Laparoscopy; Transabdominal preperitioneal laparoscopic herniorrhaphy; Path tension-free hernioplasty; Recurrence

A comparative study between totally extraperitoneal and transabdominal preperitoneal laparoscopic inguinal hernia repair techniques

Background: Laparoscopic groin hernia repair can be done by trans-abdominal pre-peritoneal (TAPP) approach and also by total extra peritoneal (TEP) approach. The objective of this study was to compare the clinical effectiveness and relative efficiency of trans-abdominal pre-peritoneal (TAPP) versus totally extra peritoneal (TEP) techniques of laparoscopic inguinal hernia repair.Methods: All the patients aged 18 years and above admitted in HBT Hospital undergoing laparoscopic inguinal hernia repair were included in this study from June 2014 to January 2016. Diagnosis was made based on history and clinical examination and ultrasound scan of the abdomen. Patients undergoing open hernia surgery and those having contra-indications to laparoscopic hernia repair were excluded from the study. The patients underwent laparoscopic TAPP or laparoscopic TEP repair of hernia based on surgeon’s preference.Results: Total 56 patients were included in the study. It was a non-randomized study, where patients were allocated in TAPP and TEP group based on surgeon’s preference. Hence, 29 patients were included in TAPP group while 27 patients were allocated to TEP group. Post-operatively all patients were evaluated for pain at 6 hours, 12 hours, 24 hours, 1week, 6 months and 1 year. They were also evaluated for length of hospital stay and any operative site complication like hematoma/seroma, wound/mesh infection, recurrence, port site hernia, persisting numbness. 2 patients in TAPP group and 3 in TEP group were lost to follow up at the end of 1 month. Further 4 patients in TAPP group and 1 patient in TEP group were also lost to follow up at 6 months. Apart from statistically significant difference in pain at 24 hours, which was more in TAPP group than TEP group, we found no other significant difference between the two methods.Conclusions: In this prospective non-randomized study comparing laparoscopic TEP and TAPP repair, for the standard parameters of duration of surgery, conversion, serious adverse event, post-operative pain, local complications, recurrence both locally and port site and length of hospital stay, we had a follow up of 1 year which is adequate for most parameters except recurrence. Our follow up does not allow us to make any conclusion about recurrence. Though the patient numbers are small, our study resonates with the larger studies regarding most parameters. This study leaves us none the wiser as to the superiority of one technique and hence, it is the individual surgeon’s preference and proficiency which dictates the choice of procedure.

Clinical outcomes of single incision laparoscopic surgery and conventional laparoscopic transabdominal preperitoneal inguinal hernia repair.

BACKGROUND:Laparoscopic surgery has been a frequently performed method for inguinal hernia repair. Studies have demonstrated that the laparoscopic transabdominal preperitoneal (TAPP) approach is an appropriate choice for inguinal hernia repair. Single-incision laparoscopic surgery (SILS) was developed to improve the cosmetic effects of conventional laparoscopy. The aim of this study was to evaluate the safety and feasibility of SILS-TAPP compared with TAPP technique.MATERIALS AND METHODS:A total of 148 patients who underwent TAPP or SILS-TAPP in our surgery clinic between December 2012 and January 2015 were enrolled. Data including patient demographics, hernia characteristics, operative time, intraoperative and postoperative complications, length of hospital stay and recurrence rate were retrospectively collected.RESULTS:In total, 60 SILS-TAPP and 88 TAPP procedures were performed in the study period. The two groups were similar in terms of gender, type of hernia, and American Society of Anesthesiologists (ASA) classification score. The patients in the SILS-TAPP group were younger when compared the TAPP group. Port site hernia (PSH) rate was significantly high in the SILS-TAPP group, and all PSHs were recorded in patients with severe comorbidities. The mean operative time has no significant difference in two groups. All SILS procedures were completed successfully without conversion to conventional laparoscopy or open repair. No intraoperative complication was recorded. There was no recurrence during the mean follow-up period of 15.2 ± 3.8 months.CONCLUSION:SILS TAPP for inguinal hernia repair seems to be a feasible, safe method, and is comparable with TAPP technique. However, randomized trials are required to evaluate long-term clinical outcomes.

Comparative Study of TAPP Repair Vs Open Tension Free Inguinal Hernioplasty

Aims and Objective: Present study was conducted with objective to compare laparoscopic TAPP (Transabdominal preperitoneal) repair with open tension free repair with respect to operative time, complications, postoperative recovery. Materials and Methods: A comparative study was conducted in tertiary health care center from May 2012 to November 2014 and cases fulfilling inclusion criteria were included in study. 38 cases were operated in laparoscopic TAPP repair while 68 cases with open tension free repair and assessed for complications and postoperative recovery. Result: In the study operative time was higher for Laparoscopic TAPP repair (50 min Vs 30 min, p value <0.05), while post op complication were lower for TAPP repair (15.8 % Vs 16.2 %, p value <0.48) but difference was insignificant, chronic pain at 6 month is less for TAPP repair (0.18 Vs 1.48, p value <0.5) and time to return to normal activity was also lower for laparoscopic group (9.3 days Vs 13.8 days, p value< 0.5). Conclusion: Laparoscopic TAPP repair offers a significant advantage over open tension free hernioplasty. It was associated with less post operative pain, faster recovery and higher operative time due to learning curve with insignificant difference in early post operative complication. Thus, Laparoscopic TAPP repair should be considered for primary hernioplasty in view of lesser post operative pain and faster recovery.

Assessment of the incidence of chronic pain and discomfort after primary inguinal hernia repair

BackgroundChronic pain and discomfort is a notable complication after inguinal hernia repair. This study assesses the incidence and degree of chronic pain and discomfort after primary inguinal hernia repair performed in our hospital and aims to clarify its relationship to the type of mesh placement. Materials and methodsA retrospective analysis was conducted of 334 patients (378 lesions) who underwent primary inguinal hernia using the Lichtenstein (onlay mesh), Ultrapro Plug (UPP; onlay plus plug mesh), modified Kugel Patch (onlay and underlay mesh), or laparoscopic transabdominal preperitoneal (TAPP; underlay mesh) procedure. Postoperative pain was assessed using a numerical rating scale at postoperative 2-3 wk, 3 mo, and 6 mo. Postoperative discomfort was assessed 6 mo afterward. ResultsQuestionnaire responses were received for 378 lesions (100%) after 2-3 wk, 229 (60.6%) after 3 mo, and 249 (65.9%) after 6 mo. The majority of chronic pain experienced was mild, and no patient suffered from severe pain. The level of pain tended to be less for the TAPP procedure than for other methods. Discomfort at rest was significantly less for TAPP versus Ultrapro Plug (P < 0.01), and discomfort with movement was significantly less for TAPP versus modified Kugel (P < 0.05). ConclusionsOnlay mesh appears to be a risk factor in chronic pain and discomfort. The lower level of chronic pain and discomfort with underlay mesh placement is considered to result from the reduced risk of nerve damage in this procedure than in the onlay mesh placement procedure.

Comparison of Laparoscopic TAPP (Transabdominal Preperitoneal) and Laparoscopic TEP (Totally Extra peritoneal) Techniques for Inguinal Hernia Repair- An Observational Study of 60 Cases

Introduction: In the last two decades there has been an increased use of laparoscopic inguinal hernia repair compared to open hernia repair. Laparoscopic techniques have been validated as safe and effective in the treatment of groin hernias and have become common where facilities are available. There has been a shift in the last few years from open repair to laparoscopic repair in India. The laparoscopic approach (TEP and TAPP) for inguinal hernia is bound to get more accessible in the near future. Aims and Objectives: The purpose of this study was to compare laparoscopic TAPP (Transabdominal preperitoneal) and laparoscopic TEP (Totally extraperitoneal) repairs for inguinal hernia. Materials and Methodology: This retrospective observational study was conducted in a tertiary care centre from November 2014 to November 2015. It consisted of 60 operated cases of inguinal hernia distributed 30 each in two groups i.e. Group A (TEP) and Group B (TAPP). After taking informed consent, patient details with respect to the study was entered on case record form. Each patient was followed up post-operatively for a period of 3 months. Statistical tests of significance were applied on various intra-operative and post-operative parameters to be compared between the two techniques. Results: The mean duration of surgery by TEP technique was comparatively less than the TAPP technique. The intraoperative bleeding was minimal in cases of those operated by TEP as well as those operated by TAPP. There was no incidence of intraoperative bowel injury in our study in both groups. There was no incidence of intraoperative nerve injury in both groups. There was no difference in intraoperative conversion to open repair rates between TEP and TAPP. Seroma formation in the postoperative period was significant in TEP technique operated patients. There was no evidence of significant cord edema in the early postoperative phase of TEP and TAPP. The postoperative pain was more in TAPP as compared to TEP. There was no incidence of wound infection in TEP and TAPP. There was no difference in duration of hospital stay in TEP and TAPP. There was no difference in cost for surgery between TEP and TAPP. There was no incidence of recurrence of inguinal hernia in TEP as well as TAPP in early post-operative period. There was no difference in patient satisfaction in both the techniques.

Open preperitoneal mesh repair versus laparoscopic transabdominal preperitoneal repair of groin hernia under spinal anesthesia: results of a prospective randomized multicenter trial

Background It is difficult to decide on which is the best surgical procedure for groin hernia repair. Several studies have compared laparoscopic groin herniorrhaphy with open Lichtenstein repair. The Lichtenstein procedure is premuscular but laparoscopic repair is preperitoneal. This prospective study compared open preperitoneal modified Kugel procedure with transabdominal preperitoneal (TAPP) laparoscopic repair under spinal anesthesia. Patients and methods A total of 200 patients scheduled for unilateral inguinal hernia repair were randomly divided into two groups to undergo either laparoscopic TAPP (group A) or open modified Kugel procedure (group B) under spinal anesthesia in our hospitals (three hospitals) between September 2010 and September 2012. Recurrence was the outcome measure in our comparison, and short-term and long-term complications were also assessed. Results There was no significant difference between the two groups in terms of their demographic data. Operative time was significantly shorter in the TAPP group than in the open group (37.8 ΁ 18.4 vs. 64.1 ΁ 20.1 min; P Conclusion Both open and laparoscopic preperitoneal groin hernia repair under spinal anesthesia are effective and safe with low recurrence rates. The laparoscopic approach is better in terms of operative time, return to normal activity, and chronic pain.

Tack fixation versus nonfixation of mesh in laparoscopic transabdominal preperitonaeal hernia repair

Context Laparoscopic transabdominal preperitoneal (TAPP) repair of inguinal hernia is traditionally performed by fixing the mesh to the abdominal wall by spiral tacks. However, mesh fixation might not be necessary as there is little space for the mesh to migrate; besides, tack fixation predisposes to postoperative pain. Aim The present study aimed to compare mesh fixation versus nonfixation regarding postoperative pain and recurrence rates. Settings and design This study was a prospective, controlled, randomized study. Patients and methods In total, 60 patients with inguinal hernias were divided into two equal groups, were compared regarding mesh fixation versus nonfixation by TAPP technique, and followed-up for up to 12 months for postoperative complications, pain, and recurrence. Statistical analysis Continuous variables are expressed as means and SDs. Categorical variables are expressed as frequencies and percentages. Results There was significant reduction in postoperative pain and chronic pain in patients without mesh fixation in comparison with patients with mesh fixation and early return to work. There was no significant difference between the two groups regarding postoperative complications and recurrence rates. Conclusion Mesh nonfixation reduces the incidence of postoperative pain and chronic pain in patients undergoing TAPP repair without increase in postoperative complications or recurrence rates.

術前CTにて診断しTAPP法を施行した膀胱ヘルニアの1例

術前CTにて診断しTAPP法を施行した膀胱ヘルニアの1例

Laparoscopic Transabdominal Preperitoneal Inguinal Hernia Repair Using Memory-Ring Mesh: A Pilot Study.

Purpose. To evaluate the feasibility, safety, and effectiveness of laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair using a memory-ring patch (Polysoft™ mesh). Patients and Methods. Between April 2010 and March 2013, a total of 76 inguinal hernias underwent TAPP repair using Polysoft mesh in 67 adults under general anesthesia. Three different senior resident surgeons performed TAPP repair under the instruction of a specialist surgeon. Nine patients had bilateral hernias. The 76 hernias included 37 indirect inguinal hernias, 29 direct hernias, 1 femoral hernia, 1 pantaloon hernia (combined direct/indirect inguinal hernia), and 8 recurrent hernias after open anterior hernia repair. The immediate postoperative outcomes as well as the short-term outcomes (mainly recurrence and incidence of chronic pain) were studied. Results. There was no conversion from TAPP repair to anterior open repair. The mean operation time was 109 minutes (range, 40–132) for unilateral hernia repair. Scrotal seroma was diagnosed at the operation site in 5 patients. No patient had operation-related orchitis, testicle edema, trocar site infection, or chronic pain during follow-up. Conclusions. The use of Polysoft mesh for TAPP inguinal hernia repair does not seem to adversely affect the quality of repair. The use of this mesh is therefore feasible and safe and may reduce postoperative pain.

Laparoscopic Transabdominal Preperitoneal Hernia Repair. Early experience of 37 patients

Abstract Introduction: Inguinal hernia repair is one of the most frequently performed procedures in surgery and many different techniques have been suggested. This report reviews our experience with 39 transabdominal preperitoneal (TAPP) hernia repairs in 37 patients. Methods: Thirty-seven patients have been admitted for inguinal hernia repair in Benghazi Medical Center and in Aljala hospital, Benghazi-Libya. Laparoscopic TAPP repair was considered for all reducible inguinal hernias aged (18–70 years). Data was prospectively collected from January 2009 to December 2013,including age, sex, BMI, hernia characteristics, complications, mean operative time and mean hospital stay. Patients with irreducible, obstructed or scrotal hernias, previous lower abdominal surgery, BMI more than thirty fiveand an American Society of Anesthesiologists (ASA) grade higher than II were excluded. Results: There were 34 males and 3 females, with a mean age of 33.4 ± 13.0 years and BMI of 24.6 ± 1.9. Mean operative time was 75 ± 18.6 minutes .The mean hospital stay was one day ± 0.27. There was no conversion, mesh infection, bladder or vascular injury, death or recurrence after a median follow up for six months. Four minor complications occurred with two seroma formation, one wound bruising and one chronic groin pain due to tackers treated conservatively. Median return to normal activities was 10 days. One fourth of patients required no postoperative analgesia. Conclusion: Laparoscopic inguinal hernia repair was found in our study to be feasible, safe, with less postoperative pain, shorter hospital stay, and early return to normal activities.

What are TEP technique advantages in laparoscopic inguinal hernia repair?

Aim: Endoscopic inguinal hernia repair,totally extraperitoneal(TEP) and transabdominal preperitoneal(TAPP) approach are widely accepted alternatives to open surgery.The search for the \'gold standard\' repair method still continues.This retrospective clinic trial was done to compare the TEP and TAPP techniques of laparoscopic inguinal hernia repair.\r\nMaterial and Methods:This retrospective clinic study was conducted between January 2014 and december,2014 and included 62 patients suffering from uncomplicated primary groin hernia.Patients were in two groups;TEP and TAPP.The parameters were O2 saturation and end tidal CO2 values,operation time,adverse effects,postoperative assessment of pain,hospital stay and return to work period,early and late complications,patient satisfaction,recurrence and chronic pain value.\r\nResults: Sixty two patients were included into the study(TEP;26 TAPP;36).Both groups were comparable in terms of demographic and hernia characteristics.The average operation time was longer in TAPP group (p <0,001).The pain scores at 1 h,6 h,12 h and 24 h after surgery and at the 3rd-month follow-up were significantly higher in the TAPP group (p<0.05).Group TAPP had lower partial O2 saturation values compared to group TEP at 10th,20th,30th minutes and at the end of operation.End tidal CO2 values at 10th, 20th and 30th minutes were significantly higher (p<0.001).The average follow-up was 15.5 months.In the TEP group,15.38% of patients had seroma compared to 5.55% in the TAPP group (p = 0.021). However, there was a higher incidence of scrotal edema in the TAPP group (7 vs. 2, p = 0.282).There was one recurrence in TAPP group follow-up period.Generally,the patients were more satisfied with TEP rather than TAPP (p<0.05).\r\nConclusions: In the present study,TEP had a significant advantage of significantly reduced postoperative pain up to 3 months,which resulted in a better patient satisfaction score over TAPP.By manipulating CO2 insufflation appropriately,a safe laparoscopic TAPP and TEP techniques can be performed.\r\nKeywords: Inguinal Hernia,TAPP,TEP,ETCO2,

A comparative study of transabdominal preperitoneal verses totally extra-peritoneal mesh repair of inguinal hernia

Background: Transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) mesh repair are two common procedures which are nowadays commonly performed during laparoscopic approaches for inguinal hernias. This randomized prospective study was aimed to compare these two, TAPP and TEP laparoscopic approaches for inguinal hernia repair in terms of various outcomes. Materials and Methods: Patients were randomly picked and 30 (50%) were operated by laparoscopic TAPP hernioplasty and the 30 (50%) by laparoscopic TEP hernioplasty. Results: Both TEP and TAPP mesh repair techniques were comparable in terms of operative time, intraoperative complications, conversion to open, post-operative pain, time to resume normal activity, and recurrence. Duration of hospital stay was significantly more in TAPP group than TEP group. Conclusion: Laparoscopic repair of inguinal hernias is associated comparable results in both techniques TAPP and TEPP and choice between TAPP and TEPP is a personal choice of the concerned surgeon.

Medium-Term Recurrence and Quality of Life Assessment Using the Hernia-Specific Carolinas Comfort Scale Following Laparoscopic Inguinal Hernia Repair

To determine the long-term outcomes and quality of life (QoL) following laparoscopic mesh repair of inguinal hernias using the hernia-specific Carolinas Comfort Scale(®) (CCS) questionnaire (Carolinas Laparoscopic and Advanced Surgery Program, Carolinas HealthCare System, Charlotte, NC). All patients who underwent elective primary or recurrent laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair from January 2005 to May 2010 were identified from a prospectively maintained clinical database. Baseline patient characteristics were recorded, including occupation, in addition to mean operating time, hernia recurrence rates, and postoperative CSS. Four hundred fifty-nine patients underwent surgery during the study period. The median follow-up interval from the date of operation to the date the questionnaire sent was 23 months (interquartile range, 32 months), and the total number of valid responses was 250. The median age of patients was 58 years (interquartile range, 21 years). The median operating time was 42 minutes (interquartile range, 21 minutes). Thirty-five patients (15%) and 15 patients (12%) had bilateral and recurrent hernia repairs, respectively. Three patients (1.1%) were confirmed to have hernia recurrence. Analysis of the CSS scores revealed that 41 patients (16%) reported pain, 44 (18%) reported mesh sensation, and 25 (10%) reported movement limitation. However, severe or disabling mesh-related symptoms were present in 5 patients (2%) for the pain category, in 8 patients (3%) for the mesh sensation category, and in 9 patients (3%) for the movement limitation symptom. The number of patients who were completely asymptomatic in all three symptom categories was 190 (24%). The only significant risk factor for developing mesh-related symptoms was young age at the time of surgery. Patient-reported medium-term symptoms following laparoscopic inguinal hernia repair appear common; however, the prevalence of severe or disabling symptoms is low.

A comparison of post operative pain and hospital stay between Lichtenstein's repair and Laparoscopic Transabdominal Preperitoneal (TAPP) repair of inguinal hernia: A randomized controlled trial.

Objective:To compare the open Lichtenstein repair and laparoscopic mesh repair for direct inguinal hernias in terms of immediate post operative pain and length of hospital stay.Methods:This randomized control trial was conducted at Benazir Bhutto Hospital Rawalpindi from January 2009 to June 2010. All patients presenting in the surgical OPD with direct inguinal hernia, ASA I/II, were randomly divided in two equal groups. Group-I, patients underwent Lichtenstein’s repair and Group-II had hernioplasty by laparoscopic method (TAPP). Post operative pain intensity assessed by VAS and hospital stay measured in hours.Results:A total 60 patients of direct inguinal hernia were studied. The mean age was 61.48±7. The range of postoperative pain experienced was 5.55 as per VAS among all patients. In group-I (open hernioplasty) majority of patients (53.33%, n=16) experience severe type of pain where as in group-II, moderate severity of pain was reported by large number of patients (63.34%, n=19). The mean post operative pain intensity as per VAS was 6.23 in group-I and 4.43 in group-II patients. The mean length of hospital stay was slightly less (35.10 hrs) in group-I as compared to group-II (38.70 hrs).Conclusion:There is definitely less post operative pain after laparoscopic repair but hospital stay is same in both the procedures but laparoscopic procedure does increase the cost.

Laparoscopic transabdominal preperitoneal approach for recurrent inguinal hernia: A randomized trial.

INTRODUCTION:The repair of the recurrent hernia is a daunting task because of already weakened tissues and distorted anatomy. Open posterior preperitoneal approach gives results far superior to those of the anterior approach. Laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair is an evolving technique associated with advantages of a minimally invasive approach. The present work aimed at comparing these three approaches for repair of recurrent inguinal hernia regarding complications and early recurrence.MATERIALS AND METHODS:A total of 180 patients were divided randomly into three equal groups: A, B, and C. Group A patients were subjected to open posterior preperitoneal approach , those of group B were subjected to transinguinal anterior tension-free repair and group C patients were subjected to TAPP. The primary end point was recurrence and the secondary end points were time off from work, postoperative pain, scrotal swelling, and wound infections.RESULTS:The mean hospital stay, the mean time to return to work and the mean time off from work were less in group C then A and B. Chronic postoperative pain was observed in eight patients in group A (13.33%), in 18 patients in group B (30%) and six patients in group C (10%). The overall complication rate was 19.7% in both groups A and C and 34.36% in group B.CONCLUSION:In recurrent inguinal hernia, the laparoscopic and open posterior approaches are equally effective in term of operative outcome. The open preperitoneal hernia repair is inexpensive, has a low recurrence rate. Postoperative recovery is short and postoperative pain is minimal. This approach gives results far superior to those of the commonly used anterior approach. However, while laparoscopic hernia repair requires a lengthy learning curve and is difficult to learn and perform, it has advantages of less post-operative pain, early recovery with minimal hospital stay, low post-operative complications and recurrence.Trial RegistrationACTRN12613001050741

Needlescopic Surgery Versus Single-port Laparoscopy for Inguinal Hernia.

Background and Objectives:In recent years, 2 modifications of laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair—needlescopic (nTAPP) surgery and single-port (sTAPP) surgery—have greatly improved patient outcomes over traditional approaches. For a comparison of these 2 modifications, we sought to investigate and compare the extent of surgical trauma and postoperative consequences for the abdominal wall in these two procedures.Methods:In a retrospective study, 50 nTAPP and 35 sTAPP procedures occurring at a community hospital from November 1, 2009, through July 31, 2012 were reviewed. Intraoperative data, including length of the umbilical skin incision and operative time, were recorded. A follow-up evaluation included investigation of hernia recurrence, postoperative pain, abdominal wall mobility, cosmetic satisfaction, and period of sick leave.Results:The mean umbilical skin incision was 13 ± 4 mm in nTAPP vs 27 ± 3 mm in sTAPP (P < .001). The nTAPP procedure required less operating time than the sTAPP procedure (54.8 ± 16.9 minutes vs 85.9 ± 19.7 minutes; P < .001). The mean immediate postoperative pain score on the visual analog scale was 2.7 ± 2.1 in the nTAPP group and 4.4 ± 1.9 in the sTAPP group (P = .016). In addition, patients who underwent nTAPP had a shorter period of sick leave (11.2 ± 8.4 days vs 24.1 ± 20.1 days; P = .02). At the follow-up evaluation after approximately 30 months, abdominal wall mobility and cosmetic satisfaction were equally positive, with no hernia recurrence.Conclusion:In patients with uncomplicated inguinal hernia, the nTAPP procedure, with less surgical trauma and operating time, has distinct advantages in reduction of immediate postoperative pain and sick leave time.