TAPP Group Research Articles

INGUINAL HERNIA REPAIR: TRANSABDOMINAL PREPERITONEAL (TAPP) VERSUS LICHTENSTEIN HERNIOPLASTY

Abstract Background Inguinal hernias are one of the most common surgical pathologies in digestive surgery. The classical Lichtenstein repair (LR), long-considered as the gold standard, has been challenged since the 1990s by a minimally-invasive laparoscopic technique (TAPP). The aim of this study was to compare the short- and medium-term postoperative outcomes between LR and TAPP. Methods We conducted a cross-sectional study including tunisian patients followed up for inguinal hernia repair in the digestive surgery department, over a period of a year. The study population was prospectively randomized between January 2020 and December 2020 to receive either LR or TAPP. The main outcome measure was hernia recurrence. Chronic postoperative pain and quality of life were the secondary outcome measures. Results Twenty-five patients underwent TAPP repair and 31 underwent LR. The average age of patients was 53.2 years. In the TAPP group, the operative time was significantly longer (p = 0.002) and the recovery was faster (p = 0.005). The LR group had higher visual analogue scale scores in the early postoperative (p <0.001), higher morbidity rate (p = 0.003) and complications such as hematomas (p = 0.022) and seromas (p = 0.043). Chronic postoperative pain was more prevalent in the LR Group than the TAPP group (p = 0.022). Both the LR and TAPP had no recurrences of hernia. Conclusion The TAPP procedure, despite the longer operative time, provided patients with postoperative comfort, fast recovery, less complications and reduced postoperative pain.

Management of groin hernias in emergency setting: differences in indications and outcomes between laparoscopic and open approach. A single-center retrospective experience

PurposeThe use of minimally invasive groin hernia repair techniques in an emergency setting is still debated and its widespread is limited.The aim of this study is to evaluate the safety and efficacy of the laparoscopic transabdominal preperitoneal (TAPP) technique in the treatment of inguinal and femoral hernias in emergency setting based on our experience, comparing indications and outcomes with the open technique.MethodsA retrospective analysis was performed including all patients with incarcerated and/or strangulated groin hernia who underwent emergency surgery from November 2019 to September 2022.Perioperative variables and short- and long-term outcomes were examined.Statistical analysis was performed using chi-square test for nominal variables and Student’s t test for continuous ones. A p value < 0.05 was considered statistically significant.ResultsSixty-six patients were included: 29 patients were treated with TAPP technique (Tapp group) and 37 with open technique plus diagnostic laparoscopy (Open group). Patients in the TAPP group were younger, had less severe clinical scenarios, and had a trend for lower Charlson Comorbidity Index, whereas ASA score and BMI were similar. The small bowel was more frequently herniated in the open group.Bilateral hernia repair was performed in 20.69% of patients in the Tapp group versus 0% in the Open group (p = 0.004). Bowel resection was more frequent in the open group (48.65% vs 0% of the Tapp group, p < 0.001) length of surgery was comparable in the two groups. In the Tapp group, the length of hospitalization was significantly shorter (2.59 ± 2.28 days vs. 9.08 ± 14.48 days; p = 0.023).Postoperative complications, according to Clavien-Dindo, were more severe in Open group where there were two deaths. There were no differences in the number of readmission and re-operations at 30 days and in the recurrence rate.ConclusionsEmergency repair of inguinal and femoral hernias using TAPP is a valuable option, safe and feasible in selected patients. In this series, indications for TAPP were reserved to younger patients with less comorbidities and less severe clinical scenario. Future randomized studies are needed to compare TAPP with open emergency hernia surgery in all settings. Potential advantages of TAPP are the reduction of postoperative complications, earlier recovery, and the possibility of bilateral treatment.

Impact of titanium-coated polypropylene mesh on functional outcome and quality of life after inguinal hernia repair

ObjectiveThis study aims to compare the clinical outcomes of complications, quality of life, and chronic pain between titanium-coated polypropylene mesh and polypropylene mesh after Lichtenstein or TAPP surgery. MethodsA retrospective cohort study was conducted, involving patients who underwent inguinal hernia repair using Timesh light®, Optilene LP®, or 3DMax™ meshes between January 2020 and May 2022. Based on the surgical method, patients were divided into Lichtenstein and TAPP groups, and further categorized according to the type of mesh used. The primary endpoints assessed postoperative complications, postoperative pain, and postoperative quality of life. Secondary endpoints included postoperative sensation in the surgical area and postoperative recurrence rate. ResultsA total of 180 Lichtenstein procedures and 478 TAPP procedures were included in the analysis after propensity score matching. The findings revealed that patients with titanium-coated polypropylene mesh did not exhibit significant advantages in perioperative data. Within three months to one year after TAPP surgery, patients with the titanium-coated polypropylene mesh reported improved foreign body sensation during activities (P = 0.002) and a lower incidence of chronic pain (P = 0.008). However, after one year, these advantages of titanium-coated polypropylene mesh were no longer significant during activity or at rest. In the TAPP group, the titanium-coated polypropylene mesh depicted advantages in the single score of the SF-36 questionnaire. ConclusionsThe utilization of titanium-coated polypropylene mesh resulted in reduced foreign body sensation and chronic pain in activity within one year after TAPP surgery, significantly enhancing certain aspects of the patient's quality of life compared to polypropylene mesh.

A FEATURE OF LAPAROSCOPIC TREATMENT OF IRREDUCIBLE AND LARGE INGUINAL HERNIAS

Summary. Introduction. The inguinal hernia is one of the most common surgical problems around the world. Patients with large inguinal and inguinal hernias are a certain group. At present, there are no final convincing evidence of the advantage of laparoscopic hernia repair of complex forms of inguinal hernias, indications and contraindications to various methods of this operation, the technology of performing surgical interventions for various types of complex inguinal hernias has not been completed.&#x0D; Aim. Perform perioperative complications in surgical treatment of unrecognizable and large inguinal hernias with laparoscopic modified TAPP method, classic Laparoscopic TEP laparoscopic technique and inguinal canal plastic according to Lichtenstein.&#x0D; Materials and methods. Surgical treatment of 42 patients with unrecognizable and large inguinal hernias was performed. All of them were performed incapacitated plastic with the use of a prone grid. In 12 patients, the Lichtenstein (Lichtenstein group) was performed, 18 patients with a modified technique (TAPP group) and 12 — TEP (TEP group). Modification was a high resection of the hernia sac in patients with inguinal-callous hernia, and the techniques of digestion of the peritoneum with a fixed gut in cases where the intestine is tightly fictoned in a large length to the peritoneum in the area of the hernia sac.&#x0D; Results of the research. Application in the performance of transabdominal preperitoneal hernia repair of the technique of high resection of the hernia sac in patients with inguinal-potassium hernia, and methods Surgery, reduce the frequency of hematoma and inflammatory processes in the TAPP surgery area is likely (p &lt; 0.05), and reduce the number of conversions in the TAPP group.&#x0D; Conclusions. Diagnostic laparoscopy is a necessary highly informative stage of diagnosis and determination of surgical tactics for complex types of inguinal hernias. Laparoscopic hernia repair of complex forms of inguinal hernias is a method of choice, which provides low trauma, asepticity, good conditions for wound healing. Modified technique of transabdominal preperitoneal hernia repair of complex inguinal hernias, which reduced the trauma of the operation and thus reduce intra and postoperative complications that are manifested by the formation of hematoma and inflammatory processes in the surgery.

CHOICE OF INGUINAL HERNIA REPAIR PROCEDURE

Introduction. Modern surgical approaches to inguinal hernia repair are laparoscopic (TAPP and TEP) and open (Lichtenstein procedure), which are based on prolene mesh prosthetics. Despite the widespread use of these methods of hernia repair in surgical practice, the frequency of typical postoperative complications: hematoma of the scrotum and inguinal region, false recurrence, paresthesias, neuralgia, etc.&#x0D; Aim. To compare TAPP, TEP, and Lichtenstein based on analysis of long-term treatment outcomes.&#x0D; Materials and methods. We performed surgical treatment of inguinal hernia in 211 patients. All of them underwent tension-free hernia repair using a prolene prosthesis. Lichtenstein procedure was performed in 65 patients (Lichtenstein group), TAPP (TAPP group) in 81 patients and TEP (TEP group) in 65 patients. In 30 patients of different groups, the blood flow in the vessels of the testis was studied after the procedures performed within 45–60 days.&#x0D; Results. Probably (p&lt;0.001) faulty recurrence was observed more often in the Lichtenstein group. Seromas that persisted for more than 30 days (p&lt;0.01) and seromas that required surgical intervention — puncture (p&lt;0.05) were more likely to be noted in the TEP group. Indicators such as hernia recurrence (up to one year) and the intensity and frequency of chronic postoperative neuralgia in the Lichtenstein, TAPP and TEP groups differed improbably. The systolic velocity of blood flow in the vessels of the testis in patients of the Lichtenstein group before the operation was (19.70±3.53). In the postoperative period, an incredible decrease in blood flow was observed (19.28±3.41). In patients of the TAPP group, the preoperative systolic velocity was (19.83±3.27) and improbably decreased to (19.47±3.44) within 45–60 days. A similar improbable decrease was observed in the TEP group — (19.80±3.56) and (19.63±3.51)&#x0D; Conclusions. The Lichtenstein procedure and endoscopic methods of inguinal hernia correction (TAPP and TEP) are safe procedures in terms of long-term complications and do not likely affect the systolic blood flow velocity in the testicular arteries.

Clinical Data Analysis for Treatment of Adult Inguinal Hernia by TAPP or TEP.

BackgroundTransabdominal preperitoneal (TAPP) repair and totally extraperitoneal (TEP) repair are the primary surgical methods for the treatment of adult inguinal hernia, but it remains necessary to consider which one to choose in clinical practice. Our study seeks to compare the efficacy of laparoscopic TAPP and laparoscopic TEP in the treatment of adult inguinal hernia and to explore which surgical method is a better choice.MethodsA retrospective analysis of 686 adult patients with inguinal hernia admitted to our hospital from the period January 2016 to December 2020 was conducted. According to different surgical methods, they were divided into two groups: a TAPP group (n = 361) and a TEP group (n = 325). These two groups of patients were statistically analyzed, and the operation time, postoperative pain, postoperative hospital stay length, postoperative complications, and recurrence rate were compared between them.ResultsThere were no significant differences in postoperative hospital stay, complications, and the recurrence rate between the two groups (p > 0.05). The duration of operation in the TEP group was significantly shorter than that in the TAPP group, and the difference was statistically significant (p < 0.001); in terms of postoperative pain, the TEP group fared better than the TAPP group, and the difference was statistically significant (p < 0.001).ConclusionTAPP and TEP are safe and effective surgical methods in the treatment of adult inguinal hernia. However, compared with TAPP, TEP can significantly shorten the operative time, reduce intraoperative trauma, and limit postoperative pain in the treatment of adult inguinal hernia. Furthermore, it does not increase the rate of complications or recurrence, so it is worth popularizing.

CHOICE OF INGUINAL HERNIA REPAIR PROCEDURE

Although many surgeons now prefer the Lichtenstein operation, the optimal technique for inguinal hernia repair remains controversial. Although many studies have compared Lichtenstein, TAPP and TEP operations, there is no single solution. Therefore, in our work, we considered and analyzed the effectiveness of the treatment of inguinal hernias with these three currently recommended methods.&#x0D; Aim. To compare TAPP, TEP, and Lichtenstein based on analysis of immediate treatment outcomes.&#x0D; Materials and methods. We performed surgical treatment of inguinal hernia in 211 patients. All of them underwent tension-free hernia repair using a prolene prosthesis. Lichtenstein procedure was performed in 65 patients (Lichtenstein group), TAPP (TAPP group) in 81 patients and TEP (TEP group) in 65 patients.&#x0D; Results. The time of operation in patients of different groups differed improbably, although this indicator was the highest in the TEP group. Length of hospital stay was lowest in the Lichtenstein group and highest in the TEP group, although no statistical significance was observed. The terms of outpatient treatment were improbably the lowest in the TAPP group and the highest in the TEP group. The lack of statistical probability between these analyzed indicators allowed us to state that all procedure for inguinal hernia did not differ in terms of operation time and terms of postoperative medical, social and physical rehabilitation. The frequency of inguinal hematoma, subcutaneous emphysema, and seroma was probably (p&lt;0.05) highest in the TEP group. Shoulder scapular pain syndrome occurred more often in the TAPP group (p&lt;0.001). The frequency of development of other complications between patients of all three groups differed improbably. When TAPP was performed, in comparison with only TEP, shoulder scapular pain syndrome probably developed more often (OR 10.06, 95 %, CI 1.26–80.10, p = 0.019; χ2 = 5.43), however, the frequency of subcutaneous emphysema (OR 0.57, 95 %, CI 0.24–1.36, p=0.29; χ2=1.10) and hernia recurrence (OR 1.62, 95%, CI 0.14–18.28, p = 0.84; χ2 = 0.04) differed improbably.&#x0D; Conclusions. We did not notice significant differences in the duration of the operation, the frequency of postoperative complications, the length of stay in the hospital, and the recovery of work capacity and quality of life when using the currently recommended methods of inguinal hernia repair. This makes it possible to choose a method of hernia treatment, focusing more on anesthetic contraindications and concomitant diseases.

Enhancing magnetite quartzite processing efficiency at Karelsky Okatysh

The article focuses on increasing efficiency of ferrous quartzite processing at Karelsky Okatysh JSC. The processing technology currently in use at Kostomuksha GOK is characterized by higher losses of fine magnetite (-0.02 mm) and by insufficient dissociation of aggregates, due to ore over-grinding and extended circulation of middlings along the process chain of the concentrator. To increase the production efficiency, it is proposed to withdraw the concentrate at each stage of grinding using the expanded-front fine screening and subsequent combined magnetic/gravity separation. This approach to improving the process flow chart takes into account the mineral and material composition of ore, the features of ore pretreatment and separation operations, and ultimately can ensure the production of a concentrate with the quality of 70% Fetotal at the concurrent increase in the technical and economic performance owing to the rational use of energy in the ore pretreatment processes. To implement the technology of stage-wise concentrate withdrawal, it is proposed to use TAPP Group&rsquo;s Banan-type AURY high-performance multicyclone screens for the preliminary classification of crushed ore and Derrick Corporation&rsquo;s Superstack fine vibrating screens in combination with magnetic gravity separators MGS-2.0 to produce the finished concentrate. The proposed technology is based on the general principles formulated by Academician L. A. Vaisberg, to whom this article is dedicated.

A new self-made electric hook for laparoscopic inguinal hernia repair

Background: Current investigation was conducted to explore the clinical application of self-made electric hook in laparoscopic indirect inguinal hernia repair.Methods: Randomized controlled trial was conducted that compared two groups of patients who underwent laparoscopic inguinal hernia repair from 2013 to 2017 at our institution. A laparoscopic indirect inguinal hernia repair with beak-like electrocoagulation instrument as modified trans-abdominal preperitoneal prosthesis was performed on 42 patients. As a comparison, 40 patients with traditional TAPP were collected and analyzed. In the end, we compared the operation time, blood loss, complications, and recurrence of two groups.Results: 82 patients have successfully completed surgery without conversion to open inguinal hernia repair. Patients were follow-up visited for 18 to 78 months, and no recurrence was found. 1 case of scrotal edema occurred using a self-made electric hook in modified TAPP, and cured by conservative treatment. In traditional TAPP group, there was 1 case of postoperative seroma, which cured by conservative treatment. There was no significant difference between these 2 groups in terms of complications and recurrence (p&gt;0. 05). However, the differences in operation time and blood loss were significant (p&lt;0. 05).Conclusions: Self-made electrical hook showed in laparoscopic inguinal hernia repair of indirect inguinal hernia has the advantages of shortening operation time, reducing bleeding, easing the difficulty of operation, and improving the safety of surgery, it is worthy of further clinical application.

Comparison of trans-abdominal preperitoneal repair with Lichtenstein tension-free hernioplasty

Background: The concept of hernial repair underwent evolution from Bassini's repair to Lichtenstein tension-free repair with the introduction of polyethylene mesh. Recently, some of the prosthetic biomaterials have been combined to form composite mesh to minimize undesirable side effects. Mesh placement can be achieved by both open and laparoscopic techniques. Although many studies have explored the relative merits and potential risks of laparoscopic surgery for the repair of inguinal hernia, most individual trials have been too small to show clear benefits of one type of surgical repair over another. Materials and Methods: A randomized comparative study, was conducted for duration of 18 months. Patients of Unilateral Uncomplicated Inguinal hernia between the age group of 18-60 years, was randomized between two groups. Patient were operated by Surgeons having requisite experience of TAPP repair and Lichtenstein repair. Results: A total of 110 patients included in this study were male with unilateral uncomplicated inguinal hernia. The mean operative time for open Lichtenstein mesh repair and TAPP was 52.85 min and 64.27 min, respectively. The postoperative pain score (as per visual analog scoring) was statistically significantly less in laparoscopic TAPP group as compared to that of open Lichtenstein group (P Conclusion: The results support the view that laparoscopic TAPP mesh repair is as safe and efficient as Lichtenstein inguinal hernia repair and should be an available option for all patients requiring elective hernioplasty.

Inguinal hernia repair – TEP or TAPP?? A comparative analysis between both the laparoscopic procedures in a tertiary care center

Background: Inguinal hernia surgery is one of the most common elective procedures performed by the surgeons and has evolved from open to the laparoscopic technique.&#x0D; Aims and Objectives: This prospective study was conducted to find out intra-operative and post-operative outcomes in patients undergoing TEP and TAPP for inguinal hernia repair.&#x0D; Materials and Methods: A prospective study was conducted on 50 adult patients who underwent laparoscopic inguinal hernia repair between November 2017 to November 2018. It was a randomized study and equal number of patients were allocated to TAPP and TEP group based on the surgeon’s preference.&#x0D; Results: Operative time [p&lt;0.0001], intensity of pain (VAS) was significantly higher in TAPP compared to TEP in the immediate post-operative period (6 hours) and during hospital stay [p=0.0299]. No significant difference observed in VAS between TEP and TAPP during follow up [after 1 week (p=0.2298), 2 weeks (p=0.2337), and 4 weeks (p=0.3944)]. Both TEP and TAPP were comparable in terms of Intra-operative and Post-operative complications {seroma [during hospital stay (p=0.1573), after 1 week (p=0.6375), after 2 weeks (p=0.5513)]; haematoma [during hospital stay (p=0.1492), after 1 week (p=0.3125)]} and Conversion (p=0.3125), and Length of hospital stay (p=0.3960). Time to resume normal work [p&lt;0.0001] was significantly more in TAPP than TEP.&#x0D; Conclusion: TEP has a definite edge over TAPP taking into consideration the lesser intensity of post-operative pain during hospital stay, shorter duration of surgery and relatively early return to normal work associated with the former procedure. TEP should therefore be regarded as the procedure of choice for inguinal hernia repair.

Propensity score analysis of outcomes between the transabdominal preperitoneal and open Lichtenstein repair techniques for inguinal hernia repair: a single-center experience

The mechanism of persistent chronic pain after TAPP and OLR remains controversial. Therefore, more prospective and well-designed studies are needed to determine the predictive risk factors that will lead to better pain prevention and possibly elimination. The aim of the present study was to investigate the risk factors of chronic pain after TAPP repair and OLR in a single institution. A single-center, retrospective study of propensity score-matched patients who underwent TAPP or OLR surgery between 2008 and 2018 was conducted. To overcome selection bias, we performed 1:1 matching using 6 covariates to generate the propensity score. A total of 400 patients treated with TAPP and 424 patients treated with OLR were balanced to 400 pairs of matched patients. The patients' age (P < 0.001), BMI (P < 0.001), foreign body sensation within 3months after surgery (P < 0.001), and persistent sensation loss (P = 0.002) were different between the two groups. The OLR group had a shorter operative time than did the TAPP group (P < 0.001). The univariate analysis of factors predicting a difference in VAS between the preoperative assessment and the assessment 3months after surgery showed that the type of surgery (P = 0.004), hernia grade (P = 0.001), type of mesh (P < 0.001), presence of scrotal invasion (P = 0.024), and foreign body sensation within 3months (P = 0.047) were risk factors. The multivariate analysis revealed that only hernia grade III (CI - 8.524, - 2.783; P < 0.001), OLR operation type (CI 1.069, 4.987; P = 0.002), and the use of polypropylene mesh (CI - 5.400, - 1.489; P = 0.001) were independently associated with chronic pain. These results suggest that compared to OLR, TAPP leads to less postoperative pain and a better long-term quality of life.

A Comparative Study Between Totally Extraperitoneal (tep) and Trans Abdominal Pre Peritoneal (tapp) Laparoscopic Inguinal Hernia Repair Techniques

Objective: The study was undertaken to compare the efficacy, safety and patient satisfaction between the two techniques of laparoscopic inguinal hernia repair. Methodology: This was a comparative study carried out at a tertiary care hospital from August 2017 to July 2019. Diagnosis of inguinal hernia was made based on history and clinical examination and ultrasound scan of the abdomen. 50 patients enrolled in the study for laparoscopic hernia repair were equally divided into 2 groups, Group A - TEP group and Group B - TAPP group. Results: The outcomes were compared between both groups. The mean operative time required for TEP was 68 minutes and that for TAPP was 81 minutes. No major complications were noted in either TEP group or TAPP group .Minor complication rate was 28 % for Laparoscopic TEP group and 24 % for Laparoscopic TAPP group. The hospital stay in TEP was (2.36 ± 1.43) & that of TAPP was (2.32± 1.47), so it was statistically not significant. Conclusion: Laparoscopic repair of inguinal hernia has a prolonged learning curve but once mastered it can be done with decreased operative time, early post operative recovery and faster return to work. TEP and TAPP both are methods of choice for Laparoscopic inguinal hernia repair and it is difficult to establish the superiority of one over the other. Choice between TEP and TAPP depends on the preference and proficiency of the individual surgeon.

Laparoscopic transabdominal preperitoneal versus open mesh lichtenstein repair of inguinal hernia: a comparative analysi

Background: Inguinal hernia repair is a commonly performed surgery usually managed by open surgical mesh repair. Nowadays many patients are demanding laparoscopic hernia repair. Laparoscopic hernioplasty has a shorter rehabilitation, but it is a technically difficult procedure. It is unclear if it has advantages over open tension-free mesh repair. Methodology: This prospective study of 80 patients is done at Jawaharlal Nehru Medical College Hospital, A.M.U., Aligarh from January 2012 to November, 2014. 50 patients underwent Lichtenstein tension free mesh repair while on 30 patients TAPP was performed. Results: Out of 80 patients 7 patients were lost to follow up at 2 weeks. 47 patients in Lichtenstein group and 26 patients in TAPP group were followed for 6 months. Average operation time was 39.3±16.4 minutes for the Lichtenstein group and 51.4±15.8 minutes for the TAPP group. Postoperatively, pain score was 6.5±3.5 in lichtenstein group as compared to 5.8±1.5 in TAPP group. Because of lesser postoperative pain, the TAPP patients got significantly fewer analgesics than the Lichtenstein patients (2.4 ± 1.0) versus (3.5 ± 1.3) doses. TAPP patients needed significantly fewer admission days than Lichtenstein patients (2.5±0.6 versus 1.8±0.5 days, respectively). TAPP patients returned to work earlier as compared to Lichtenstein group (11.7±4.9 days versus 14.8±4.2 days respectively). Short term and long complications were similar in both groups. Conclusion: Laparoscopic hernioplasty (TAPP) is superior to Lichtenstein tension-free hernioplasty in terms of postoperative pain, hospital stay and return to daily activity.

Prospective randomized trial comparing laparoscopic transabdominal preperitoneal (TAPP) and laparoscopic totally extra peritoneal (TEP) approach for bilateral inguinal hernias

IntroductionBilateral inguinal hernias form a part of the complex spectrum of weakness in the region of the myopectineal orifice. Laparoscopic surgery is one of the standard approaches for bilateral hernias. We describe the results of a randomized trial that was undertaken to compare and evaluate TAPP and TEP repair for bilateral inguinal hernias. MethodsSixty patients were randomized into two groups. Group I (TAPP) and Group II (TEP) were compared in terms of procedure related variables, conversion, post-operative recovery and complications. Analysis was done using SPSS software version 17. ResultsSeventy-seven patients were assessed for fitness to include in the study. Seventeen patients had to be excluded due to either not meeting the inclusion criteria's or for not giving consent. The median age (52yrs) was comparable in both groups. In Group II (TEP) mean operating time was 120.89 ± 29.28 min compared to 108.16 ± 16.10 min in Group I (TAPP). Post-operative pain scores were less in Group I(TAPP) at all levels of recording (8 h–48 h), though most patients required injectable analgesic for 32 h in both groups (p-value 0.029). Subcutaneous emphysema was more commonly noted in the Group II (TEP) (p-value 0.038). In Group I (TAPP) mean hospital stay was 52.0 ± 14.21 h while in Group II (TEP) it was 52.29 ± 9.36 h (p-value 0.427). Mean time for return to work was 11.8 ± 2.35 days in Group I (TAPP) and 12.41 ± 2.22 days in Group II (TEP) (p-value 0.339). ConclusionThe procedures though different in approach were quite similar in outcome. Mean operating time was increased in the TEP repairs along with immediate post-operative pain scores. The pattern of some complications like subcutaneous emphysema was significantly more in the TEP group while minor vascular injury though not significant was different in both groups. The indirect cost incurred from consumables did not vary other than need for more tacks in the TAPP group.

Transcatheter Arterial Infusion with Heated Saline Changes the Vascular Permeability of Rabbit Hepatic Tumors

The vascular permeability of tumors can be changed by transarterial infusion heat, but the mechanisms remain unknown. The aim of this study was to analyze the underlying causes of changes in tumor vascular permeability after heated perfusion via two different modes. Thirty rabbits with VX2 hepatic tumors were randomly divided into three groups of 10 rabbits each. The hepatic artery was selectively catheterized via a femoral approach, and unheated saline (control group) or heated saline (60°C) was then injected in either a continuous (transcatheter arterial continuous perfusion [TACP]) or a pulsed (transcatheter arterial pulsed perfusion [TAPP]) manner. Changes in vascular permeability in the tumors were assessed using the following markers and methods: (1) qualitative assessment by visual estimation on digital subtraction angiography performed after the heat infusion procedure on live animals and quantitative assessment by spectrophotometry using Evans blue dye extravasation on tumor and liver tissue after animals were sacrificed and (2) kinase domain receptor or vascular endothelial growth factor (VEGF), expressed in vascular endothelial cells, assessed by immunohistochemical staining, Western blot analysis, and reverse transcription polymerase chain reaction. Tumor staining increased in the TAPP group more than in the TACP group, but not in the control group, assessed on digital subtraction angiography. Extracted dye was higher in tumors in the TAPP group than in those in the TACP group; extracted dye in both groups was higher than in the control group. Kinase domain receptor protein and messenger ribonucleic acid expression were both higher in the TAPP group than in the TACP and control groups. VEGF protein expression was lower in the TAPP and TACP groups than in the control group, but VEGF messenger ribonucleic acid expression was higher in the TACP group than in the TAPP and control groups, and VEGF messenger ribonucleic acid expression was lower in the TAPP group than in the control group. The vascular permeability of rabbit VX2 tumors significantly increased after arterial pulsed heated infusion, and the protein kinase domain receptor may play a key role in this increase of tumor vascular permeability.

Discomfort five years after laparoscopic and Shouldice inguinal hernia repair: a randomised trial with 867 patients. A report from the SMIL study group

In recent years long-term discomfort after inguinal hernia surgery has become an issue of great concern to hernia surgeons. Long-term results on discomfort from large randomised studies are sparse. One-thousand one-hundred and eighty-three patients were randomised in a multicentre trial with the primary aim of comparing recurrence rates after laparoscopic TAPP and Shouldice repair. Evaluating late discomfort and its possible risk factors were secondary objectives, and are reported here. The patients were clinically examined after 1 and 5 years, and answered questionnaires 2 and 3 years postoperation. Of 1,068 operated patients, 867 were eligible for analysis after 5 years (81.2%). The percentage of patients experiencing discomfort of any kind were 8.5% in the TAPP group and 11.4% (p = 0.156) in the Shouldice group. Although discomfort was usually mild it was severe for 0.2 and 0.7%, respectively. Severe pain the first postoperative week was a risk factor for late discomfort in the Shouldice group (OR 2.25, P = 0.022) but not in the TAPP group. No other risk factor for late discomfort was found. There was no difference between late discomfort at five-year follow-up after laparoscopic TAPP and Shouldice repair. Discomfort was mostly mild and pain during the first postoperative week was a prognostic variable for late discomfort in Shouldice patients.

Surgical outcome and hospital cost analyses of laparoscopic and open tension-free hernia repair.

Surgeons who favor the laparoscopic repair of groin hernias must limit the additional costs associated with this technique, which is not universally acknowledged to be superior to other less expensive open tension-free repairs. This retrospective study compared outcome and costs between laparoscopic and open tension-free hernia repair in 320 patients with inguinal hernias. Patients underwent either (a) transabdominal preperitoneal procedure (TAPP; 60 patients, 72 procedures), (b) totally extraperitoneal procedure (TEP; 174 patients, 202 procedures), or (c) open tension-free procedure (86 patients, 105 procedures). Regarding important postoperative complications there were two (3.3%) recurrences in the TAPP group and one (0.6%) in the TEP group, and six (9.9%) transient neuralgias in the TAPP group and one (1.2%) in the tension-free group. There were no deaths, no testicular atrophies, and no wound or mesh infections. The mean hospital postoperative stay was the same in the three groups (1 day). Mean operating time was shorter in the tension-free group concerning the unilateral cases and shorter in the TEP group concerning the bilateral cases. Fewer patients required analgesia during the first 6 h after the operative procedure in the TEP group than in the other two groups. The mean total costs were 483.90 euros in the open tension-free repair, 763.20 euros in the TAPP repair, and 572.50 euros in the TEP repair. The open procedure was the cheaper for the hospital. Laparoscopic hernia repair and tension-free repair as described by Gilbert are comparable in postoperative complications. TEP hernia repair is associated with less postoperative pain and earlier return to normal activities, but it is more expensive and continues to be a difficult procedure. Open tension-free repair is the least expensive method and is easier to learn than the other two procedures.