Outcomes Of Laparoscopic Repair Research Articles

Outcomes of laparoscopic repair in complicated groin hernia: A single institutional based cohort study in Nepal

IntroductionLaparoscopic hernia repairs have comparable recurrence rate with less persisting pain and numbness and quicker return to usual activities as compared to open mesh repair. The excellent outcomes of minimally invasive surgery encourage us to extend the laparoscopic technique to complicated groin hernia. MethodA total of 22 patients with complicated groin hernia who presented to our institute from September 2017 to September 2018 were included in this prospective cohort study. Inclusion criteria were patients with age greater than 18 years and clinically diagnosed as complicated groin hernia. Patients with peritonitis, those with previous abdominal surgery and unfit for general anesthesia were excluded from our study. ResultsThe most common age group was 51–60 (31.8%) years.17 cases were repaired with totally laparoscopic approach (12 TEP, 5 TAPP). Laparoscopic repair with additional procedure was needed in 3 cases and 2 cases were converted to open for completion of the procedure. The mean operating time was 154.8 ± 51.6 (range: 90 to 230) minutes. The average length of hospital stay was 3.8 ± 3 (range: 1 to 12) days. Bleeding from the inferior epigastric and testicular vessels were the major intra-operative complication (11.8%). Seroma and surgical site infection were seen in 2 (11.8%) patients. ConclusionLaparoscopic approach in cases of complicated groin hernia can achieve desirable patient outcomes without major complications, provided good patient selection and expertise. The evidence for laparoscopic repair as the choice of procedure in complicated groin hernia can be established from further comparative studies.

Đánh giá kết quả sớm của phẫu thuật TAPP trong điều trị thoát vị bẹn tái phát

Tóm tắt Đặt vấn đề: Đánh giá kết quả của phẫu thuật nội soi đặt lưới trước phúc mạc, đường vào qua phúc mạc (Trans-Abdominal Pre-Peritoneal: TAPP) điều trị thoát vị bẹn tái phát và so sánh với phương pháp Lichtenstein Phương pháp nghiên cứu: Nhóm nghiên cứu: 11 người bệnh (NB) (nam) được thực hiện phẫu thuật TAPP điều trị thoát vị bẹn tái phát sau mổ mở; nhóm chứng: 8 người bệnh thoát vị bẹn tái phát được thực hiện phẫu thuật Kết quả: Các đặc điểm về tuổi, chỉ số khối cơ thể (BMI), số bệnh lý kèm theo, đường kính cổ bao thoát vị và thời gian tái phát của người bệnh giữa 2 nhóm có sự tương đồng; ở nhóm phẫu thuật TAPP thời gian phẫu thuật dài hơn (TAPP 103,6 và Lich 86,9 phút, p = 0,223); thời gian sử dụng giảm đau sau mổ ngắn hơn (TAPP 1,9 và Lich 2,8 ngày, p = 0,009); thời gian nằm viện ngắn hơn (TAPP 4,2 và Lich 5,9 ngày, p = 0,009); thời gian trở lại công việc sớm hơn (TAPP 19,2 và Lich 26,0 ngày, p = 0,035); nhóm nghiên cứu không có biến chứng trong khi nhóm chứng có 2 trường hợp nhiễm trùng vết mổ và 2 trường hợp đau sau mổ. Kết luận: Phẫu thuật TAPP có hiệu quả tốt trong điều trị thoát vị bẹn tái phát sau mổ mở, sau mổ người bệnh ít đau hơn, giảm thời gian nằm viện, giảm biến chứng sau mổ Abstract Introduction: This study is to evaluate the early results of laparoscopic repair with mesh hernia by Trans-Abdominal Pre-Peritoneal (TAPP) compared with Lichtenstein Materials and Methods: 11 male patients were reoperated with TAPP repair for the recurrent inguinal hernia after open repair enrolled in research group; Control group including 8 patients were reoperated with Lichtenstein technique. Results: The characteristics of patients such as ages, body mass index (BMI), comorbid pathologies, size of neck of the inguinal sac and the recurrent times were similar in both groups; in research group, the operating time was longer (TAPP 103,6 vs Lich 86,9 mins, p=0,223) however the time for pain medication used was shorter (TAPP 1,9 vs Lich 2,8 days, p=0,009), the length of hospital stay was shorter (TAPP 4,2 vs Lich 5,9 days, p=0,009) than control group; in research group, there were no postoperative complication while in control group, there were two patients with postoperative surgical site infections, and two patients with postoperative pains. Conclusion: TAPP repair is an effective option for the treatment of recurrent inguinal hernia; shorter hospital stay, less pains as well as complications. Keywords: Recurrent inguinal hernia, TAPP, Lichtenstein

Short-term Outcomes of Laparoscopic Repair of Paravaginal Defects

Short-term Outcomes of Laparoscopic Repair of Paravaginal Defects

A 1-Year Randomized Controlled Study to Compare Laparoscopic Repair vs. Open Repair for the Treatment of Hollow Viscus Perforation

In patients with hollow viscus perforation of the abdomen, open surgery is considered as the standard approach; however, the use of laparoscopy for diagnostic purposes and treatment appears to be a safe alternative with many advantages. The present study was conducted to compare the results of laparoscopic repair versus open repair in patients with hollow viscus perforation. A total of 60 patients with hollow viscus perforation undergoing either laparoscopic (group A = 30) or open repair (group B = 30) were included in the study. Demographic data, history, and clinical characteristics of all patients were noted. The primary outcomes such as time required for surgical procedure and resumption of normal activities were noted. The mean ages of groups A and B were 48.30 ± 18.23 and 49.30 ± 15.27 years, respectively, with male preponderance. In clinical characteristics, duration of vomiting (p = 0.001) and total leukocyte count (p = 0.032) were associated significantly with incidence of hollow viscus perforation. The mean Mannheim peritonitis index score was comparable in groups A and B (22.07 ± 4.65 vs. 21.47 ± 5.39; p = 0.646). The mean duration of surgery was significantly low in group A (105.13 ± 9.57 min) compared to group B (141.67 ± 20.19 min; p < 0.001). The mean duration of resumption of daily activities was significantly low in group A (4.53 ± 0.73 days) compared to group B (11.87 ± 2.93 days; p < 0.001). Laparoscopic repair is a beneficial procedure for the management of hollow viscus perforation in terms of lower surgical time and early resumption of daily activities.

A Comparative Study between the Outcome of Laparoscopic Repair and Open Repair of Pediatric Inguinal Hernia

A Comparative Study between the Outcome of Laparoscopic Repair and Open Repair of Pediatric Inguinal Hernia

A Comparative Study between the Outcome of Laparoscopic Repair and Open Repair of Paediatric Inguinal Hernia

Purpose: Inguinal hernia is one of the commonest conditions in paediatric surgical practice that requires surgical repair. Open repair is a conventional procedure. With the advance of minimally invasive surgery, laparoscopic repair of childhood inguinal hernia has been attempted. Now many centres practice it routinely. From different studies, reported advantages are excellent visual exposure, minimal dissection, and thus fewer trauma to the inguinal canal and its content, detection, and repair of contralateral hernia (if present) in same setting, less post-operative pain, early recovery, and better cosmesis. To date, despite increased interest in laparoscopic repair, there is no published study focusing on paediatric inguinal hernia in Bangladesh. So the present study is designed to assess the above mentioned clinical benefits of this method and to compare the laparoscopic repair and open repair of paediatric inguinal hernia. Materials and Methods: This prospective comparative interventional study was carried out in the Department of Paediatric Surgery, DMCH, Dhaka, during the period of May 2009 to June 2012. Total 60 patients were included in this study. Among them 30 patients in Group-L were repaired by laparoscopic procedure and another 30 patients in Group-O were repaired by open procedure. Both groups were followed-up for 3 months. The early post-operative complications were almost same and there was no recurrence in any groups. Results: It was found that laparoscopic repair is superior to open repair with regards to early pain relief and cosmesis. Moreover, on laparoscopy, detection of contralateral hernia or contralateral patent processus vaginalis and repair is possible in the same setting. Conclusions: Laparoscopic repair is superior with regard to early pain relief and cosmesis, but needs to be evaluated on wider group of patients and long period of follow-up. DOI: http://dx.doi.org/10.11593/bje.2013.0102.0014 Bangladesh Journal of Endosurgery Vol.1(2) May 2013: 29-34

Laparoscopic Repair for Choledochal Cyst in Children: Current Status

Objectives: To determine feasibility and outcome of laparoscopic repair of choledochal cyst in pediatric age.Materials and methods: A literature search was performed on choledochal cyst and laparoscopic repair in children using PubMed database to extract data related to age, gender, technical details, operative time, conversion rate, intraoperative complications, hospital stay, early and mid-term complications and outcome.Results: There were 710 patients with a median follow-up of29.1 months; the median age was 4.3 years and 73.4% were women. The choledochal cysts were classified as type I of Todani�s classification in 74% of cases and in all of them a laparoscopic excision and hepaticoenterostomy was carried out. The mean operative time was 265 minutes and the conversion rate to open surgery was 2.4%. The mean postoperative hospital stay was 6.5 days and the early and late complications were6.9 and 4% respectively.Conclusion: The laparoscopic repair of choledochal cyst is safe and feasible in children with early- and mid-term complication rates similar to open surgery.

Results of Laparoscopic Repair of Primary and Recurrent Incisional Hernias at a Single UK Institution

In this study incisional hernia repairs at a single UK institution between 1994 and 2008 were analyzed with respect to short-term and long-term results. Prospectively collected data were analyzed retrospectively to ascertain outcomes, complications, and recurrences. Two hundred and twenty-seven operations were performed with 35% of the operations being for recurrent hernias. A self-centering suture technique was used. Median operating time was 55 minutes. There were 8 conversions and median hospital stay was 1 night. There were 52 complications (23%) including 3 postoperative bleeds, 3 mesh infections, and 4 small bowel obstructions. Median postoperative follow-up was 53 months. There were 25 recurrences (11%) being detected, a median of 17 months after initial operation. In this large series, laparoscopic incisional hernia repair is safe and is associated with a short hospital stay. Recurrences after repair remain a concern prompting the development of strategies to try and minimize the likelihood of this occurring.

Laparoscopic Treatment of Recurrent Inguinal Hernias: Experience from 281 Operations

The results of laparoscopic repair of 281 recurrent inguinal hernias in 260 patients are presented. One hundred sixty-eight totally extraperitoneal (TEP) and 113 transabdominal preperitoneal (TAPP) procedures were performed. Four major complications occurred in the early postoperative period, three of them in the TAPP group. After 2-4 years, the results were controlled by questionnaires and clinical reexaminations, if necessary. Eleven percent of the TAPP patients and 2% of the TEP patients experienced a recurrence. About 20% of the patients reported occasional discomfort and pain in the operated groin. We conclude that laparoscopic herniorrhaphy provides acceptable results in reoperative hernia surgery.