Previous Laparoscopic Repair Research Articles

OC-049 ROBOTIC RE-TAPP: A MINIMALLY INVASIVE ALTERNATIVE FOR THE FAILED POSTERIOR REPAIR

Abstract Aim To describe the use of the robotic platform in inguinal hernia recurrence after a previous laparoscopic repair. Material and Methods patients with recurrent inguinal hernias following a laparoscopic repair who have undergone robotic transabdominal preperitoneal between December 2015 through may 2022 were identified in a prospectively maintained database. Outcomes of interest included demographics, hernia characteristics, operative details and rates of 30-day surgical site occurrence (SSO), surgical site occurrences requiring procedural interventions, surgical site infection and hernia recurrence were abstracted. Results thirty patients (96,7% male, mean age 56,5 years, mean body mass index 28) had 41 hernias repaired (N=11 bilateral). Average operative time was 165 ± 51.9min (range 90–300). There were three intraoperative complications all of them were bleeding from the inferior epigastric vessel injuries. Four SSOs occurred (N=3 seromas and N=1 hematoma. After a median 56 months follow-up [IQR 22–77], no recurrence has been diagnosed. One patient developed chronic postoperative inguinal pain. Conclusions on a small number of selected patients and experienced hands, we found that the use of the robotic platform for repair of recurrent hernias after prior laparoscopic repair appears to be safe, feasible and effective despite being technically demanding. Further studies in larger cohorts are necessary to determine if this technique provides any benefits in recurrent inguinal hernia scenario.

Robotic re-TAPP: a minimally invasive alternative for the failed posterior repair.

to describe the use of the robotic platform in inguinal hernia recurrence after a previous laparoscopic repair. patients with recurrent inguinal hernias following a laparoscopic repair who have undergone robotic transabdominal preperitoneal between December 2015 through September 2020 were identified in a prospectively maintained database. Outcomes of interest included demographics, hernia characteristics, operative details and rates of 30-day surgical site occurrence, surgical site occurrences requiring procedural interventions, surgical site infection and hernia recurrence were abstracted. nineteen patients (95% male, mean age 55 years, mean body mass index 28) had 27 hernias repaired (N=8 bilateral). Average operative time was 168.9 ± 49.3min (range 90-240). There were two intraoperative complications all of them were bleeding from the inferior epigastric vessel injuries. Three SSOs occurred (N=2 seromas and N=1 hematoma. After a median 35.7 months follow-up (IQR 13-49), no recurrence has been diagnosed. One patient developed chronic postoperative inguinal pain. on a small number of selected patients and experienced hands, we found that the use of the robotic platform for repair of recurrent hernias after prior laparoscopic repair appears to be feasible, safe and effective despite being technically demanding. Further studies in larger cohorts are necessary to determine if this technique provides any benefits in recurrent inguinal hernia scenario.

A delayed diagnosis of obturator hernia hoodwinked by previous laparoscopic inguinal hernia repair.

Obturator hernia is a rare and diagnostically challenging type of pelvic hernia with associated high morbidity and mortality. It is frequently seen in frail, elderly female multiparous patients with non-specific symptoms and signs that may be clouded by multiple gastrointestinal or musculoskeletal comorbidities. This report discusses the case of an 84-year-old woman with refractory groin pain and previous laparoscopic inguinal hernia repair that was misdiagnosed leading to a delayed diagnosis and mortality. Previous laparoscopic repair was a misleading factor that hoodwinked clinicians and surgeons until computed tomography (CT) imaging proved otherwise. In emaciated, elderly female patients presenting with non-specific abdominal or hip pain, early CT imaging can assist in diagnosis when signs or symptoms are unclear. Clinical vigilance and serial examination are important in elderly patients who are often under the care of geriatricians allowing early discovery and treatment of this hernia.

Laparoscopic repair for recurrent inguinal hernia after previous laparoscopic approach

Background and aim Relaparoscopic repair of recurrent inguinal hernia carries a lot of challenges. The encountered complex surgical technique is assumed to have greater possibilities of surgical complications with consequent higher recurrence rates. The aim of this study was to evaluate the feasibility, safety, and reliability of laparoscopic approach for recurrent inguinal hernia after previous laparoscopic repair. Patients and methods Records of 33 patients with 34 recurrent inguinal hernias after previous laparoscopic management have been retrospectively revised. The performed procedure for second repair was transabdominal preperitoneal repair for all the cases. Data of perioperative complications, immediate postoperative course, and hernia recurrence were collected and analyzed. Results No intraoperative complications were encountered. Postoperative pain was recorded as moderate. The mean follow-up period ranged from 14 to 40 months with a mean of 24.82±6.9. During the follow-up period, three (9%) cases developed groin seroma and one (3%) case had transient thigh numbness. Of the patients, 85% returned to normal daily activities within 14 days postoperatively. Two patients had rerecurrence of the hernia and they were managed by Lichtenstein repair. Conclusion Relaparoscopic repair of recurrent inguinal hernia is safe and applicable. The procedure should be performed with experienced hands.

Laparoscopic reoperation for pediatric recurrent inguinal hernia after previous laparoscopic repair.

Recurrence is a concerning area in pediatric inguinal hernia repair. Various laparoscopic repair methods are available to treat recurrent pediatric inguinal hernia. We analyzed previous laparoscopic hernia repairs and report the outcomes of laparoscopic inguinal hernia reoperations in patients with recurrent inguinal hernia. Fifty-one patients who presented for recurrent inguinal hernia after laparoscopic hernia repair from September 2012 to May 2017 were retrospectively evaluated. Previous laparoscopic procedures were analyzed with respect to sac removal (removal vs. leaving in place), suture material (absorbable vs. nonabsorbable), and high ligation method (purse string vs. multiple stitches). We removed the hernia sac from all patients and performed suture repair of the muscular arch of the internal inguinal ring using nonabsorbable material. All patients (38 male, 13 female) had indirect inguinal hernias. No conversion to open surgery occurred. Forty-three (84.3%) patients developed recurrence within 1year after the previous operation [mean 8.7 ± 6.9 (range 3-33)months]. Twenty patients had concurrent hydroceles (39.2%); 16 were cord hydroceles and 4 were canal of Nuck hydroceles. In the previous operations, the hernia sac was not removed in 100% (51/51) of patients, absorbable suture material was used in 58.8% (30/51), and purse string high ligation was performed in 88.2% (45/51). No re-recurrence developed during a mean follow-up of 25.0 ± 12.6 (range 13-54) months. Laparoscopic reoperation with hernia sac removal and suture repair of the muscular arch of the internal inguinal ring with nonabsorbable material is an effective operation with few recurrences and complications.

Management of Recurrent Inguinal Hernias After Total Extraperitoneal (TEP) Herniorrhaphies

The laparoscopic repair offers clear advantages in recurrent inguinal hernias after open herniorrhaphy. Less clear is the role of laparoscopy for recurrences after previous laparoscopic inguinal herniorrhaphies. In this paper, we present our experience with both laparoscopic and open inguinal hernia repair of laparoscopic recurrences. All patients who had undergone repair of recurrences after previous laparoscopic hernia repair from July 2004 to July 2007 were included in this study. Charts were reviewed for all these patients. Six patients were diagnosed with 7 recurrent inguinal hernias after laparoscopic repairs. All the initial laparoscopic repairs, except for one, were total preperitoneal (TEP) with the placement of lightweight polypropylene mesh. The average time from the initial repair to the diagnosis of recurrence was 20 months (range 3-84). Four of the 7 recurrences were treated with a laparoscopic approach. The other three recurrences were repaired in an open fashion as per the preoperative plan. In 2 of the laparoscopic cases, the peritoneal flap was not able to cover the mesh, so a tissue-separating mesh with fibrin sealant was utilized to cover the myopectineal orifice. No intra- or postoperative complications were recorded. There were no recurrences at an average follow-up of 14 months (range, 11-17). Laparoscopic repair can be offered to those patients with a recurrence after a previous laparoscopic repair. Further studies comparing laparoscopic repair versus open repair of recurrences after laparoscopic inguinal hernia repair will be helpful in defining the best approach when encountering these recurrences.