Peritoneal Tear Research Articles

Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair Under Combined Spinal Epidural Anesthesia Versus General Anesthesia

Background: Inguinal hernia repair is one of the most frequently used elective surgical operations in the world. General anesthesia (GA) has risks and routine postoperative complications, such as nausea, vomiting, throat irritation, and postoperative pain. Regional anesthesia (RA) has many advantages over GA, such as faster recovery, less postoperative pain, nausea, and vomiting, and less hemodynamic compromise. We aimed to investigate the efficacy and safety of combined spinal and epidural anesthesia (CSEA) in preventing shoulder pain in patients undergoing totally extraperitoneal herniorrhaphy (TEP). Materials and Methods: The files of patients who had undergone the TEP method under GA and CSEA due to inguinal hernia between April 2020 and November 2021 at the Bakirköy Dr. Sadi Konuk Training and Research Hospital were reviewed retrospectively. Results: A total of 81 patients were included in the study. The number of patients operated on GA (group 1) was 40, and the number of patients operated under CSEA (group 2) was 41. There was no significant difference in the demographic characteristics of the patients. The surgical time was 42.9 and 42.5 minutes in groups 1 and 2, respectively (P=0.970). The mean operative time was recorded as 60.1 and 80.2 minutes in groups 1 and 2, respectively, and it was statistically significantly shorter in group 1 (P<0.001). A peritoneal tear was seen in 18 patients (43.90%) in the GA group and 16 patients (40%) in the CSEA group, but no significant difference was found between the groups (P=0.823). Mild shoulder pain that did not require intervention was observed in 1 patient (2.5%) in the CSEA group. In group 2, the VAS scores at all times and the need for postoperative analgesia were statistically significantly lower (P<0.001). In terms of anesthesia complications, headache was not observed in group 1, while it was seen in 6 (15%) patients in group 2 (P=0.012) Conclusions: In laparoscopic TEP surgeries, CSEA may be an alternative anesthesia method to GA anesthesia due to the low VAS score, less need for analgesia, and fewer postoperative pulmonary complications.

Risk factors of conversion of laparoscopic totally extraperitoneal repair of inguinal hernia

Background: Inguinal hernia occurs in 1 to 5% of the general population. The development of laparoscopic inguinal hernia repair techniques as an alternative to conventional open surgery has improved results such as less postoperative pain, shorter hospital stays, and faster recovery. This study was conducted to assess the risk factors of conversion of laparoscopic totally extraperitoneal repair of inguinal hernia. Method: A total of 200 patients who were scheduled to undergo TEP were enrolled. Complete demographic and clinical details of all the patients was obtained. A Performa was made and detailed intraoperative findings were evaluated. Baseline hemodynamic and biochemical profile was evaluated. Separate assessment of patients was done who were converted to open surgery. Comparison of patients was done among those with and without conversion. Various risk factors were evaluated which were responsible for conversion. All the results were recorded in Microsoft excel sheet and were subjected to statistical analysis using SPSS software. Results: Mean age of the patients was 49.2 years. 60.5 percent of the patients were of rural residence. Mean BMI of the patients was 24.8 Kg/m2. Incidence of conversion was 6.5 percent. Geriatric age, obesity, higher ASA grade, larger hernial defects, larger peritoneal tear and previous hernia surgery history was found to be significant risk factors for conversion. Conclusion: Laparoscopic totally extraperitoneal (TEP) repair of inguinal hernia is an effective technique, but conversion to open surgery occurs in 6.5% of cases. Significant risk factors for conversion include geriatric age, obesity, higher ASA grade, larger hernial defects, larger peritoneal tear, and previous hernia surgery history. Identifying these risk factors can help optimize patient selection and improve outcomes for TEP repair.

The Effect of Combined Spinal Epidural Anesthesia on Shoulder Pain in Laparoscopic Extraperitoneal Hernia Surgery.

Shoulder pain is a condition that seriously discomforts patients and develops caused by a peritoneal tear in laparoscopic extraperitoneal hernia repair (TEP) surgeries. Although surgeons generally prefer general anesthesia for the TEP technique, many studies have been carried out on the use of regional anesthesia in recent years. In our study, we aimed to investigate the efficacy and safety of the combined spinal/epidural anesthesia (CSEA) method to prevent shoulder pain in the TEP technique. The patients who operated with the TEP procedure were divided into 2 groups; SA (group 1) and CSEA (group 2). The 2 patient groups were compared in terms of sex, age, body mass index, duration of surgery, total operation time, patient satisfaction, pain scores, length of hospital stay, adverse effects, intraoperative, and postoperative complications. The number of patients in group 1 was 42 and group 2 was 40. The mean operation time was recorded as 55.9 and 80.2 minutes in groups 1 and 2, respectively, which was statistically significantly shorter in group 1 ( P <0.001). Postoperative pain was significantly less in group 2 for the 4th hour ( P <0.0001) and the 12th hour ( P =0.047). There was no difference between the 2 groups in terms of peritoneal tear ( P =0.860). Intraoperative and postoperative shoulder pain was significantly less in group 2 ( P =0.038, P =0015, respectively). CSEA is an effective and safe anesthesia method for preventing shoulder pain that develops after TEP surgeries.

Influence of different peritoneal incision closure methods on the operative outcomes and prognosis of patients undergoing laparoscopic inguinal hernia repair.

The aim was to investigate the effect of different peritoneal tear closure methods on the operative outcomes and prognosis of patients undergo-ing laparoscopic inguinal hernia repair (LIHR). Ninety patients who underwent LIHR in our hospital from August 2019 to December 2020 and had peritoneal tears during the operation were selected, and the patients were divided into a control group (CG) and the observation group (OG) according to different treatment plans, with 45 cases in each group. Patients in the CG were treated with absorbable sutures to repair the peritoneal tears, while patients in the OG were treated with bipolar coagulation to close and repair the peritoneal tears. The surgical conditions, postoperative pain scores, quality of life scores, com-plications, and recurrence were compared between the CG and OG groups. The operation time and hospital stay in the OG were shorter than those in the OG (p&lt;0.05). The pain scores in the OG at 24 hours after operation were lower than those in the CG (p&lt;0.05), and the pain scores of the two groups were not significantly different at two hours and 12 hours (p&gt;0.05). Postoperative complications were not significantly different between the groups (p&gt;0.05). The scores of material life, physical, social, and psychological function in the OG were higher than in the CG (p&lt;0.05). There were no recurrences in the two groups during the 1-year follow-up. Closing repair of peritoneal rupture with bipolar coagulation reduces the operation time of patients with peritoneal rup-ture during TEP (total extraperitoneal hernioplasty) operations, reduces pain, and improves their quality of life. The treatment outcome is safe, effective, and has an excellent clinical application effect.

P-052 RISK FACTORS FOR PERITONEAL TEARS DURING LAPAROSCOPIC EXTRAPERITONEAL HERNIA REPAIR

Abstract Background Peritoneal tears (PTs) are not uncommon during the course of laparoscopic total extraperitoneal (TEP) repair of groin hernias. There are several mechanisms involved in the occurence of PTs during the course of the operation. There are many studies about the causes of peritoneal tears. Detection of independent risk factors in peritoneal tear formation may identify patients who will benefit from elective inguinal hernia repair in laparoscopic extraperitoneal hernia surgery. Methods Between April 2018 and december 2022, 518 consecutive patients undergoing 575 TEP repair surgery were recruited by the retrospective study. They were divided into two groups as with and without peritoneal tear. Patient characteristics, operative data, and postoperative outcomes were compared between patients with and without peritoneal tear. Risk factors for peritoneal tear were evaluated by univariate and multivariate analyses. Results The overall incidence of peritoenal tear was 19.7% (n=97). The median age was 45 years (18 to 83) and body mass index was 25.7 kg/m2 (15.67 to 35.20). Significant clinical factors associated with peritoneal tear included such as hernia type, previous hernia surgery, large hernial defects, presence of scrotal hernia, and the defect size of inguinal hernia. Multivariate analysis identified independent risk factors for peritoneal tear as indirect hernia type and previous hernia surgery. Conclusion Peritoneal tears is a major complication seen during TEP repair surgery and its incidence varies depending on many factors. Previous hernia surgery and indirect inguinal hernia the risk for peritoneal tears from during TEP repair.

P-005 SINGLE-PORT VS. MULTI-PORT TOTALLY EXTRAPERITONEAL (TEP) INGUINAL HERNIA REPAIR: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Abstract Objective The value of single-port totally extraperitoneal inguinal hernia repair (STEP) when compared to the conventional multi-port approach (TEP) is still a matter of controversy. We conducted a meta-analysis of randomized controlled trials comparing the feasibility and safety of the above-mentioned techniques. Materials and Methods A systematic literature search for randomized controlled trials (RCTs) comparing the outcome STEP and TEP in patients with inguinal hernia was conducted. Data regarding postoperative outcomes were extracted and compared by meta-analysis. The Odds Ratio and Standardized Mean Differences with 95% Confidence Intervals (CI) were calculated. Results Six RCTs were identified, involving a total of 636 cases (STEP: n=328, TEP: n=308). There was a statistically significant difference noted between the two groups regarding return to everyday activities favoring the STEP group (SMD=-0.23; 95% CI [-0.41, -0.06]; p=0.009; 4 studies; I2=9). For the remaining primary and secondary endpoints, intra- and postoperative morbidity, conversion rate, peritoneal tears, major intraoperative bleeding, postoperative haematoseroma, operative time, postoperative pain, chronic pain, cosmetic satisfaction, hernia recurrence and in-hospital length of stay no statistically significant difference was noted between the two study groups. Conclusions Current evidence suggests that patients who underwent STEP had similar outcomes to the traditional TEP technique with the exception of time to return to everyday activities, which was reported to be shorter in the STEP group.

OC-108 THE EFFECT OF COMBINED SPINAL EPIDURAL ANESTHESIA ON SHOULDER PAIN IN LAPAROSCOPIC EXTRAPERITONEAL HERNIA SURGERY

Abstract Background Shoulder pain is a condition that seriously discomforts patients which develops due to peritoneal tear in laparoscopic extra peritoneal hernia repair (TEP) surgeries. Although surgeons generally prefer general anesthesia for the TEP technique, many studies have been carried out for the use of regional anesthesia in recent years. In our study, we aimed to investigate the efficacy and safety of the combined spinal/epidural anesthesia (CSEA) method in order to prevent shoulder pain in the TEP technique. Method The patients which operated with TEP procedure were divided into two groups; SA (Group 1) and CSEA (Group 2). The two patient groups were compared in terms of sex, age, body mass index, duration of surgery, total operation time, patient satisfaction, pain scores, length of hospital stay, adverse effect, intra operative and postoperative complications. Results The number of patients in group 1 was 42 and the group 2 was 40. The mean operation time was recorded as 55.9 and 80.2 minutes in groups 1 and 2 respectively, which was statistically significantly shorter in group 1 (p&amp;lt;0.001). Postoperative pain was significantly less in group 2 for the 4th hour (p&amp;lt;0.0001) and the 12th hour (p: 0.047). There was no difference between the two groups in terms of peritoneal tear (p:0.860). Intra operative and postoperative shoulder pain was significantly less in group 2 (p: 0.038, p:0015 respectively). Conclusion CSEA is an effective and safe anesthesia method in preventing shoulder pain that develops after TEP surgeries.

Development of a laparoscopic technique for inguinal hernioplasty in standing horses.

Most previously described techniques for laparoscopic inguinal hernioplasty (IH) in horses require advanced laparoscopic skills. Our objective was to describe a new laparoscopic IH technique using a surgical anchoring system. Standing laparoscopic IH was performed unilaterally in eight experimental stallions, using the contralateral inguinal canal (IC) as a control. A polyether ether ketone harpoon was anchored in the craniolateral aspect of the vaginal ring, and an extracorporeal knot was used to fix the device. Clinical evaluation, including testicular palpation and lameness examination, was conducted before and for 4 weeks after surgery. Repeat laparoscopy was performed 28 days later. Standing laparoscopic IH was performed in all horses with a surgical time of 38 ± 12.85minutes. In two animals, a small peritoneal tear occurred that did not require repair. No other complications were recorded. On repeat laparoscopy, all devices were in place, and the IC remained partially closed in all horses. The procedure was performed on normal experimental horses and has not been employed on horses that have had an inguinal hernia. This new standing laparoscopic hernioplasty technique provides another potential method for simple partial closure of the IC in stallions at risk of or with history of inguinal herniation.

Single-port versus multi-port totally extraperitoneal (TEP) inguinal hernia repair: A meta-analysis of randomized controlled trials.

The value of single-port totally extraperitoneal inguinal hernia repair (STEP) when compared to the conventional multi-port approach (TEP) is still a matter of controversy. We conducted a meta-analysis of randomized controlled trials comparing the feasibility and safety of the above-mentioned techniques. A systematic literature search for randomized controlled trials (RCTs) comparing the outcome STEP and TEP in patients with inguinal hernia was conducted. Data regarding postoperative outcomes were extracted and compared by meta-analysis. The Odds Ratio and Standardized Mean Differences with 95% Confidence Intervals (CI) were calculated. Six RCTs were identified, involving a total of 636 cases (STEP: n = 328, TEP: n = 308). There was a statistically significant difference noted between the 2 groups regarding return to everyday activities favoring the STEP group (SMD = -0.23; 95% CI [-0.41, -0.06]; P = .01; 4 studies; I2 = 9). For the remaining primary and secondary endpoints, intra- and postoperative morbidity, conversion rate, peritoneal tears, major intraoperative bleeding, postoperative haematoseroma, operative time, postoperative pain, chronic pain, cosmetic satisfaction, hernia recurrence and in-hospital length of stay no statistically significant difference was noted between the 2 study groups. Current evidence suggests that patients who underwent STEP had similar outcomes to the traditional TEP technique with the exception of time to return to everyday activities, which was reported to be shorter in the STEP group.

Extraperitoneal tissue retraction technique: An effective assistant of extraperitoneal pure single-port robotic-assisted radical prostatectomy with the da Vinci Si surgical system.

The limitations of tissue retraction and the amount of surgical working space have a great impact on extraperitoneal single-port robotic-assisted radical prostatectomy (sp-RARP) with the multiport robotic surgical system. We used an extraperitoneal tissue retraction technique to achieve tissue exposure and working space expansion. This study evaluated the safety, feasibility, and efficacy of the extraperitoneal tissue retraction technique in extraperitoneal pure sp-RARP with the da Vinci Si surgical system. Data from 42 patients were analyzed retrospectively from December 2018 to February 2020. The extraperitoneal tissue retraction technique was not used in 20 patients (group I) and was used in 22 patients (group II). Preoperative, intraoperative, and postoperative data were collected. The oncological and functional data during late follow-up were recorded. All patients successfully underwent extraperitoneal pure sp-RARP. No patients required conversion to a multiport surgery or placement of additional assistant ports. The two groups were similar regarding baseline features. The median operation time in group I was significantly longer than that in group II (P < 0.001). The estimated blood loss volume in group I was significantly higher than that in group II (P < 0.001). There were no serious complications in either group. There were four cases of peritoneal tears in group I and none in group II (P = 0.043). The surgical margin and lymph nodes were negative in both groups. The oncological and functional outcomes were similar between the two groups 6 months after the procedure. The extraperitoneal tissue retraction technique is safe and feasible. The technique promotes tissue exposure and expands the surgical working space, which is important for achieving extraperitoneal pure sp-RARP with the da Vinci Si surgical system, especially for beginners. The short-term oncological and functional outcomes were within acceptable ranges. The long-term effects of this technique need further evaluation.

Mesh size may not affect recurrence in laparoscopic totally extraperitoneal repair of inguinal hernias

A mesh is usually employed to cover defects when performing laparoscopic totally extraperitoneal repair (TEP) of inguinal hernias. However, there is insufficient evidence for an appropriate mesh size. Therefore, we aimed to compare the recurrence rate between large- and medium-mesh laparoscopic TEP. Patients who underwent laparoscopic TEP for primary inguinal hernias from January 2012 to March 2020 were included. We retrospectively reviewed electric medical records. The primary outcome was the difference in recurrence rate between the large and medium meshes. The large mesh was 10.3 × 15.7 cm, and the medium mesh was 7.9 × 13.4 cm or 9 × 13 cm. In total, 446 patients were included in the study. Of these patients, 177 were in the large-mesh group, and 269 were in the medium-mesh group. The average ages of the large- and medium-mesh groups were 58.4 and 56.9 years, respectively (P = .361). In both groups (large vs medium), males were dominant (93.2% vs 93.6%, P = .850), and indirect hernias (87.0% vs 88.1%, P = .740) were dominant. There was no difference in body mass index (P = .883) or hernia side (P = .770). Peritoneal tearing as an intraoperative complication occurred frequently in the large-mesh group (13.6% vs 3.3%, P < .001). During the mean follow-up period of 28 months, recurrence occurred in 3 (1.7%) and 13 (4.8%) patients in the large- and medium-mesh groups, respectively. However, there was no statistical significance (P = .262). Mesh size may not affect recurrence after laparoscopic TEP of primary inguinal hernias.

Risk Factors for Conversion in Laparoscopic Totally Extraperitoneal Inguinal Hernioplasty.

Conversion is a surgical concern because the surgical technique can change during surgery. Surprisingly, there is no study in the literature on the causes and risk factors leading to conversion in laparoscopic total extraperitoneal inguinal repair (TEP). There is also no consensus on the prevention and causes of this condition in TEP. The aim of this study was to evaluate the risk factors underlying the development of conversion during TEP. We recruited 962 consecutive patients who underwent TEP between May 2016 and May 2021. All data were collected retrospectively. The outcomes of patients who converted to open surgery were compared with those without conversion. Multivariate analysis identified independent risk factors for conversion. The overall incidence of conversion was 4.05% (n=39). The median age was 42 years (18 to 83) and body mass index was 25.2 kg/m2 (15.67 to 32.9). Significant clinical factors associated with conversion included old age, American Society of Anesthesiologists (ASA) score, large peritoneal tear (PT), Charlson comorbidity index, previous surgery, large hernial defects, presence of scrotal hernia, and the defect size of inguinal hernia. Multivariate analysis identified independent risk factors for conversion: large hernial defect, large PT, previous lower abdominal surgery, previous hernia surgery, and scrotal hernia. Conversion is a minor complication seen during TEP and its incidence varies depending on many factors. Previous lower abdominal surgery and a large PT carries a 6-fold increased risk for conversion from laparoscopic to open surgery during TEP.

The extended-view totally extraperitoneal (eTEP) approach for incisional abdominal wall hernias: results from a single center.

The extended-view totally extraperitoneal (eTEP) approach is a promising technique for abdominal wall hernias and has increased in popularity among hernia surgeons in recent years. This study aims to present the results of applying the laparoscopic eTEP approach for incisional abdominal wall hernias (IAWHs). This study is a retrospective analysis of a prospectively collected dataset of 30 patients who underwent laparoscopic eTEP for IAWHs between October 2018 and March 2021 (median follow-up of 15months). Thirty patients (8 male, 22 female) with a mean age, mean body mass index, and median ASA score of 53.5, 30.8, and 2, respectively, underwent the eTEP procedure for incisional abdominal wall hernias. In total, 11 (36.7%) patients had a recurrent IAWH. Seventeen (56.7%) patients were treated with eTEP RivesStoppa (eTEP-RS), whereas 10 (33.3%) patients needed the eTEP transversus abdominis release (eTEP-TAR) procedure. In three patients, conversions to other procedures (laparoscopic intraperitoneal onlay mesh-plus (IPOM-Plus) and open RivesStoppa) were needed due to intraoperative complications: iatrogenic perforation to the intestine and large peritoneal tear causing loss of the working space. The mean operative time and mean length of stay (LOS) were 203.5min and 1.5days for eTEP-RS and 291.5min and 1.6days for eTEP-TAR, respectively. Two patients developed asymptomatic seromas, and one patient developed an asymptomatic hematoma; all were treated conservatively. Only one recurrence was observed over the course of the follow-up period. The eTEP approach is a safe and feasible option for IAWH repair and a valuable addition to the armamentarium of hernia surgeons.

Perioperative complications of the modified Stoppa approach for the treatment of pelvic bone fractures: a single-institution review of 48 cases.

The current study aimed to report the perioperative complications of the modified Stoppa approach for the treatment of pelvic bone fractures. We analyzed 48 consecutive operations in 45 patients who were treated with internal fixation using the modified Stoppa approach between March 2016 and July 2018. This included three revision operations. The mean age of the patients was 54.5 years, and the patients included 35 male patients and 10 female patients. All fractures occurred as a consequence of high-energy trauma and 70.3% had associated injuries at the time of the fracture. The mean Injury Severity Score was 9.03±5.60. The perioperative complications found during and immediately after surgery were recorded and were classified into three categories: vascular injuries, nerve injuries, and other complications. Overall, 14 perioperative complications (29.2%) in 14 cases were identified. The most common complications were nerve injuries, which occurred in seven cases, all involving the obturator nerve. Uncontrollable vascular injuries occurred in six cases, which required additional incisions and support of vascular surgeons or postoperative interventions. Additionally, one case of peritoneal tearing occurred, which required help from an abdominal surgeon. While the modified Stoppa approach seems to be a viable method to treat pelvic fractures, significant perioperative complications may occur, suggesting that surgeons should pay careful attention to minimize the damage to other structures and that appropriate support from other surgical departments is paramount.

V11-09 ROBOTIC MODIFIED BALLOON-LESS RETROPERITONEAL APPROACH FOR POSTERIOR RENAL MASSES

You have accessJournal of UrologyRenal Oncology II (V11)1 Sep 2021V11-09 ROBOTIC MODIFIED BALLOON-LESS RETROPERITONEAL APPROACH FOR POSTERIOR RENAL MASSES Thomas Lowrey, Jacob Allen, Daniel Parker, Andrew McIntosh, and Sanjay Patel Thomas LowreyThomas Lowrey More articles by this author , Jacob AllenJacob Allen More articles by this author , Daniel ParkerDaniel Parker More articles by this author , Andrew McIntoshAndrew McIntosh More articles by this author , and Sanjay PatelSanjay Patel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002073.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: This video demonstration will describe an efficient modified robotic retroperitoneal approach for posterior renal masses, avoiding the need for balloon dilation and extensive defatting in the traditional approach. METHODS: The patient is placed in the 90 degree flank position. A 5 mm laparoscope is placed 4 cm superior to the umbilicus at the midclavicular line, which will aid in visualizing placement of the working robotic ports. The reflection of the peritoneum at the white line of Toldt is identified in order to mark the robotic camera port site 2 fingerbreadths above the iliac crest. Two medial 8-mm robotic ports are placed 2 fingerbreadths above the iliac crest and 8 cm apart using the robotic camera port as reference. Next, with laparoscopic scissors and Kittner Dissector, the lateral side wall attachments to the colon are taken down creating space to safely place the camera port and lateral most trocar. Using a 30 degree upward scope, the peritoneum along white line of Toldt and lateral kidney attachments are incised up to the splenic flexure or hepatic flexure. Complete incision of the peritoneum allows the kidney to naturally flop medially thereby doubling the working space as compared to the traditional approach. Once the white line of Toldt is mobilized, the 4th arm lifts the kidney to place the hilum on traction. After Gerota’s fascia is incised and the hilum identified, standard partial nephrectomy is performed. RESULTS: A total of 15 patients underwent this new technique without any Clavien 1-4 complications. The technique allows for efficient port placement without the need for: blind finger entry, balloon dilation, tedious dissection and sweeping of the peritoneum required for port placement, and extensive defatting of the pararenal fat to create the retroperitoneal space. The port location in this technique is the same as the traditional retroperitoneal approach, thus affording the same view with increased working space and improved visualization of landmarks. Insufflation is also more consistent given less air leaks from inadvertent peritoneal tears and from the balloon dilating port site. CONCLUSIONS: This modified retroperitoneal approach allows for quick, efficient, and safe port placement resulting in larger working space and excellent visualization of anatomical landmarks without the need for complicated retroperitoneal balloon dilation, sweeping of peritoneum for port placement, and defatting of the pararenal fat. Since the development of this technique, we have abandoned the traditional robotic retroperitoneal approach with balloon dilation at our institution. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e860-e860 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Thomas Lowrey More articles by this author Jacob Allen More articles by this author Daniel Parker More articles by this author Andrew McIntosh More articles by this author Sanjay Patel More articles by this author Expand All Advertisement Loading ...

Short-term comparative study of three-dimensional and two-dimensional laparoscopic surgery for total extraperitoneal primary inguinal hernia repair.

PurposeThe aim of this study was to compare the short-term outcomes of two-dimensional (2D) and three-dimensional (3D) laparoscopic surgery for total extraperitoneal (TEP) primary inguinal hernia repair.MethodsThis was a single-center, retrospective, observational database study of 38 patients who underwent laparoscopic TEP inguinal hernia repair from March 1, 2019 to August 30, 2019 at Kyung Hee University Hospital at Gangdong in Seoul, Korea.ResultsThere was no significant difference in sex ratio, age, or body mass index between the two groups. The 2D group had two patients with direct hernia and 18 patients with indirect hernia. The 3D group had five patients with direct hernia, 11 patients with indirect hernia, and two patients with femoral hernia. The mean operation time was 38.2 minutes in the 2D group compared with 37.2 minutes in the 3D group. There was no severe intraoperative bleeding in either group. During the operation, peritoneal tearing occurred in 12 out of 20 patients in the 2D group compared with five out of 18 patients in the 3D group (p = 0.02). The average length of hospital stay was 1.3 days in both groups. The numeric rating scale score was 3.3 and 3 in the 2D group and the 3D group, respectively. In the 2D group, two patients revisited the outpatient clinic because of the postoperative occurrence of seroma and varicocele.ConclusionA 3D laparoscopic surgery is feasible and safe for inguinal hernia repair and showed less peritoneal tearing compared with 2D laparoscopic surgery for primary inguinal hernia repair.

Polypropylene mesh versus double face mesh in totally extraperitoneal laparoscopic inguinal hernia repair

Background Inguinal hernia is the commonest type of hernia. Repair of the inguinal hernia is one of the most widely recognized surgeries done all over the world. With the advancement in knowledge, laparoscopic hernioplasty has become very popular, accounting for ∼15–20% of hernia repair, with great results. Objectives In this study, we have tried to determine if there is a significant difference between using conventional polypropylene mesh and double face mesh (polypropylene+vicryl) in totally extraperitoneal (TEP) laparoscopic hernia repair. Patients and methods This study had been conducted on 20 patients with inguinal hernia, who were divided into two groups. Group A represented patients who underwent TEP repair of an inguinal hernia using polypropylene mesh, and group B represented patients who underwent TEP repair of inguinal hernia with double face mesh. Results Regarding operative time, same operative time was seen in both groups. Nevertheless, much longer time was noticed in case of the peritoneal tear in group A. There were no intraoperative complications encountered in both groups, such as bleeding, visceral injuries, and conversion to transabdominal preperitoneal or open technique; however, peritoneal tear occurred in both groups. Regarding the postoperative period, there was no difference in the postoperative parameters between both groups, including pain, hospital stay, and recurrence. Nevertheless, the cost in the double face mesh group is significantly higher than polypropylene mesh group. Conclusion TEP approach is an acceptable procedure for inguinal hernia repair with less visceral and vascular injuries. There was no difference in outcome between TEP repair of inguinal hernia either using the polypropylene or double face mesh. Randomized studies on a larger number of patients are needed to confirm the results.

Early Outcomes of “Extended View Total Extraperitonial (eTEP)” Procedure for Inguinal Hernia

Laparoscopic inguinal hernia repair has become popular as an alternative to open surgery. The classical TEP technique is the laparoscopic technique of hernia repair which is considered closest to ideal for inguinal hernia repair, but this technique has several drawbacks such as limited space for dissection and mesh placement, restricted port placement, a low tolerance of accidental pneumoperitoneum, and difficulty in teaching and learning the technique. Extendedview modification, the eTEP technique, which overcomes several of these drawbacks. The eTEP approach can quickly and easily create an extraperitoneal space, enlarge the surgical field, provide a flexible port setup adaptable to many situations, allow unencumbered parietalization of the cord structures , ease the management of the distal sac in cases of large inguinoscrotal hernias, and improve tolerance of pneumoperitoneum, which is a common complication. The purpose of this study was to evaluate the safety and effectiveness of eTEP procedure with placement of polypropylene mesh and fixation by tackers.&#x0D; Method : It was a observational study of 25 cases. The study was conducted in Shaheed Suhrawardy Medical College Hospital, Dhaka from July 2018 to June 2019. Sociodemographic status, operation time, peroperative blood loss, unwanted events like peritoneal tear, vessel injury, nerve injury, duration of hospital stay, postoperative pain and urinary retention were recorded. All the patients were followed up for at least 3 times at the end of 1st week, 1st month and 3rd month. Any surgical site infection, mesh infection, seroma, scrotal swelling, severity of pain according to visual analogue scale, haematoma and recurrence within this time was recorded. All the data were analyzed on SPSS.&#x0D; Result : Among the 25 patients average time of operation was 1 hour and 35 minutes, peroperative blood loss was below 20 ml in all patients, peritoneal tear occurred in 2 patients, 1 vessel injury but no nerve injury was observed during the procedure. One patient had mild chronic pain even after the end of 3rd month. One patient developed scrotal swelling which subsided by the end of 1st week. No SSI, mesh infection, seroma, wound hematoma, and recurrence found within this period.&#x0D; Conclusion : This study showed that, eTEP procedure is cost effective, has minimum complication with easier learning. In the hands of an experienced surgeon, eTEP repair can be safe and effective. New study can be done to find out it’s effectiveness in incisional hernia in lower abdomen and bilateral inguinal hernia.&#x0D; J Shaheed Suhrawardy Med Coll, December 2019, Vol.11(2); 96-100

COMPARISON BETWEEN MESH FIXATION USING TACKS AND NON-MESH FIXATION DURING TOTAL EXTRA PERITONEAL (TEP) LAPAROSCOPIC INGUINAL HERNIA REPAIR

Background: Inguinal hernia repair is the most common procedure in general and visceral surgery worldwide. Over the past two decades, laparoscopic inguinal hernia repair has become more and more popular. Objective: To enhance outcome of TEP, test feasibility, and count the cost of mesh fixation using staples and non-mesh fixation. Patients and methods: This study was conducted in Theodor Bilharz Research institute [TBRI] and Al-Azhar University Hospitals during the period from December 2017 to April 2019.This study included 40 patients with inguinal hernia underwent TEP repair. Patients were divided in to two equal groups: Group A include patients underwent TEP repair with no mesh fixation, and Group B underwent TEP repair using tack fixation of mesh. Results: Regarding operative time, it was slightly longer in mesh fixation group. No intraoperative complications have been encountered in groups including bleeding, peritoneal tear or visceral injuries. Regarding postoperative period, there was no difference in the postoperative parameters between both groups including pain, hospital stay and recurrence. Conclusion: Totally extra-peritoneal approach (TEP) was an acceptable procedure for inguinal hernia repair with less visceral and vascular injuries. No difference in outcome between mesh fixation and non-mesh fixation in TEP repair of inguinal hernia.

Closing peritoneal tear during laparoscopic inguinal hernia repair: simple and effective technique.

Peritoneal tears occurring during TAPP and TEP are common, and can cause difficulty in continuing surgery, or, if left open can cause postoperative complications. A number of techniques to close the tear in the peritoneum have been described. These techniques are difficult and add to the operating time, and may not be successful in closing the opening in the peritoneum. We describe a simple, effective, fast technique of repairing these tears using the bipolar diathermy. We have used bipolar diathermy to seal inadvertent peritoneal tears occurring during TAPP/TEP repairs. This method of sealing the peritoneum has been used by us since 2015. We decided to review our results of sealing the tears in the peritoneum at TAPP/TEP from 01 Jan 2017 to 31 Dec 2019. A total of 152 laparoscopic inguinal hernia repair (TAPP/TEP) procedures were done by the authors from 01 January 2017 to 31 December 2019, and of these, 101 cases had some degree of peritoneal tear. All peritoneal tears were very simply sealed using bipolar diathermy. Peritoneal tears occurring inadvertently during Laparoscopic TAPP/TEP procedure for repair inguinal hernia can be effectively sealed with simple bipolar diathermy.