TAPP Inguinal Hernia Repair Research Articles

Tumescent Technique for Transabdominal Preperitoneal Inguinal Hernia Repair (TAPP) versus Conventional TAPP

Abstract Background Laparoscopic hernia repair is more difficult technically than open surgery and there is evidence of learning curve in its performance and many complications reported from laparoscopic procedure. But also, laparoscopic approach has its benefits as rapid recovery, quicker return to work, less acute pain complication, better quality of life outcomes. Objective To compare between the conventional and tumescent technique in TAPP inguinal hernia repair as regards operative technique, intra & post-operative complications, early post-operative pain, hospital stay, restriction of physical activity, incidence of recurrence and post-operative chronic groin pain. Methods This was a prospective, randomized, comparative study, that was conducted at El-Demerdash hospital over one and a half years (October/2021 - March/2023). The 60 patients who were included divided into two groups, 30 for each. Group A; tumescent technique, Group B; conventional technique. Results Follow up started from the first day after operation and then visits at surgery outpatient clinic were arranged as follows, two weeks postoperative, then after one month. Interpretation of results revealed that there was significant difference between the two groups in operative time and early post-operative pain which decreased in tumescent group. There was no significant difference between the two groups as regards postoperative complications, the most reported complications were post- operative urinary retention and seroma formation. No reported cases of hernia recurrence and chronic groin pain in both groups. Conclusion Tumescent TAPP inguinal hernia repair appears to offer technical and clinical improvements to conventional TAPP, with small learning curve makes it easy procedure for unexperienced surgeons to use it for hernia repair and to learn it quickly. In general, TAPP inguinal hernia repair is considered both safe and effective for surgeons skilled in laparoscopic surgery; as all perioperative complications are well tolerated by patients and mostly there was no need for a second operative intervention, also the short-term treatment results were satisfactory.

Comparative study of mesh fixation versus without mesh fixation in laparoscopic inguinal hernia repair by TAPP approach

Background: An inguinal hernia is a protrusion of abdominal contents through the inguinal canal. Laparoscopic TAPP inguinal hernia repair without mesh fixation is comparitively easy and safer than TAPP with mesh fixation with no increase in recurrence rate. Hence the current study was conducted to analyse complications after laparoscopic inguinal hernia repair (TAPP) with mesh fixation vs without mesh fixation in patients with inguinal hernia. Patients has provided informed consent for publication. Methods: It was an observational cohort study, comparing the outcome in 60 patients undergoing laparoscopic TAPP for inguinal hernia, where patients were randomly allotted into two groups as 30 with mesh fixation and 30 without mesh fixation over a period of two years October 2020 to September 2022. Results: In the current study, we observed that recurrence was reported among 3.33% study subjects without mesh fixation. While Recurrence reported among 6.67% study subjects with mesh fixation. However, the difference in the observations was statistically not found to be significant and there is significant reduction in postoperative pain, operation duration and hospital stay duration in laparoscopic TAPP without mesh fixation group. Conclusions: It was observed that laparoscopic TAPP repair without mesh fixation does not increase recurrence rate but reduces operative duration, hospital stay duration and decreases the incidence of postoperative pain compared to laparoscopic TAPP with mesh fixation.

Economic analysis of the robotic approach to inguinal hernia versus laparoscopic: is it sustainable for the healthcare system?

IntroductionThere has been a rapid proliferation of the robotic approach to inguinal hernia, mainly in the United States, as it has shown similar outcomes to the laparoscopic approach but with a significant increase in associated costs. Our objective is to conduct a cost analysis in our setting (Spanish National Health System).Materials and methodsA retrospective single-center comparative study on inguinal hernia repair using a robotic approach versus laparoscopic approach.ResultsA total of 98 patients who underwent either robotic or laparoscopic TAPP inguinal hernia repair between October 2021 and July 2023 were analyzed. Out of these 98 patients, 20 (20.4%) were treated with the robotic approach, while 78 (79.6%) underwent the laparoscopic approach. When comparing both approaches, no significant differences were found in terms of complications, recurrences, or readmissions. However, the robotic group exhibited a longer surgical time (86 ± 33.07 min vs. 40 ± 14.46 min, p < 0.001), an extended hospital stays (1.6 ± 0.503 days vs. 1.13 ± 0.727 days, p < 0.007), as well as higher procedural costs (2318.63 ± 205.15 € vs. 356.81 ± 110.14 €, p < 0.001) and total hospitalization costs (3272.48 ± 408.49 € vs. 1048.61 ± 460.06 €, p < 0.001). These results were consistent when performing subgroup analysis for unilateral and bilateral hernias.ConclusionsThe benefits observed in terms of recurrence rates and post-surgical complications do not justify the additional costs incurred by the robotic approach to inguinal hernia within the national public healthcare system. Nevertheless, it represents a simpler way to initiate the robotic learning curve, justifying its use in a training context.

Outcomes of Laparoscopic TAPP Inguinal Hernia Repair without Mesh Fixation

Inguinal hernia repair is one of the commonest general surgical procedures performed worldwide. Laparoscopic repair is associated with faster recovery, less post operative pain and comparable rates of recurrence. Using the stapling devices increases post TAPP chronic groin pain. We conducted a prospective trial for laparoscopic TAPP inguinal hernia repair on 43 patients in which we did not fix the mesh. The primary purpose of this study was to examine the rate of recurrence and chronic groin pain in patients undergoing TAPP mesh hernia repair for inguinal hernia. We observed that our rates of recurrence and chronic groin pain are comparable to those described previously in the literature. We concluded that laparoscopic inguinal hernia repair by TAPP approach can be done with acceptable rates of recurrences and decreased rates of post operative chronic groin pain.

Closure of peritoneal in inguinal hernia transabdominal preperitoneal by intracorporeal suturing versus tackers

Background: Hernia surgeries are among the most frequently carried out surgical procedures. Minimal recurrence rates, great patient comfort, rapid return to work, and low cost should all be characteristics of the optimal hernia treatment method. Objective of this study was to investigate whether tacker and suture materials used for peritoneal closure after mesh placement in the laparoscopic TAPP inguinal hernia repair technique. Methods: Present study is a retrospective, observational &amp; comparative study conducted in Department of General Surgery in a tertiary care hospital from January 2021 to December 2021. Institutional ethical committee clearance was obtained. Patient identity was kept confidential. According to the type of peritoneal closure, patients were separated into two groups: group S (which underwent closure with sutures) and group T (which received closure with tackers) 48 and 52 during the study period. SPSS was used for analysis. Results: The study was male preponderance comprising 94% of study participants, while the most common age group was found to be 61-70 years in both groups S and T (32%). most patients in the suture fixation group (39%) had left-sided hernias, but right-sided hernias (40%) were more typical in the tacker fixation group. Conclusions: Our research revealed no differences between the two peritoneal closure approaches in terms of VAS score at day 30, hernia recurrence rate, hospital stay, or complication rate. VAS score on day 1 and cost of operation were in favor of the suture group.

P-029 A NOVEL USE OF FULLY ABSORBABLE PHASIXTM MESH FOR LAPAROSCOPIC INGUINAL HERNIA REPAIR

Abstract Background An inguinal hernia is repaired usually with synthetic non-absorbable mesh resulting in collagen formation leading to chronic inflammation, and fibrosis with significant reductions in hernia recurrence. However, chronic pain may affect quality of life. The new mesh introduced to minimize complications. Poly-4-hydroxybutyrate (P4HB) mesh starts to degrade in 12–18 months. We are reporting our results of TAPP inguinal hernia repair using P4HB mesh (PhasixTM Bard in, Murray Hill, NJ). Method A pilot study is carried-out for laparoscopic TAPP repair for inguinal hernia using P4HB mesh assessing the recurrence rate and chronic pain for 30 months with IRB approval (E-19–3735). The study was conducted from 24 Jan 2016 to July 2017. The study included postoperative pain, reactions, mesh sensation, discomfort, and recurrence. Results Laparoscopic TAPP inguinal repair using P4HB mesh for 15 patients. 14 male and 1 female patient were involved, average age 55.8 years old,and an average BMI of 27.4 kg/m2. No recurrence or mesh sensation encountered except one patient has mild chronic inguinal pain for one year without affecting his usual activity. Conclusion Laparoscopic TAPP inguinal hernia repair using PhasixTM mesh is safe to use in combined direct (medial) and indirect (lateral) inguinal hernia with no recurrence. The use of P4HB absorbable mesh led to less chronic pain and discomfort. However, longer follow-up and a higher number of patients are needed to allocate the status and the place of P4HB in the world for inguinal hernia repairs.

OC-026 PERFORMING A SLIT ON THE MESH TO ENCIRCLE THE CORD STRUCTURES DURING LAPAROSCOPIC INGUINAL HERNIA REPAIR - A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Aim There are several modifications in the technique for the placement of mesh during laparoscopic inguinal hernia repair. The present study aimed to provide stronger evidence in establishing whether the slit mesh technique is superior to the non-slit technique (the most common practice). The primary outcome was recurrence and secondary outcomes were postoperative groin pain, bleeding, seroma formation and duration of surgery. Material &amp; Methods Eligible studies had to compare the two methods of mesh placement slit Vs non slit in laparoscopic TEP or TAPP inguinal hernia repair. Databases searched were Embase, Medline, Cochrane collaboration, NICE guidelines search. The meta-analysis was conducted using Review Manager software 5:4. The outcomes were expressed in odd ratios with their 95% confidence intervals. Where significant heterogeneity existed (I2&amp;gt;75%) a random effects model was used otherwise a fixed effects model was used. Results Five studies included, all were single centre studies, 4 retrospective and one prospective observational studies. 1076 patients included, 633 in the slit group and 434 in the non-slit group. The male to female ration was 9:1. There were 10 (1.5%) recurrences in the slit group compared to 12 (2.5%) in the non-slit group 0.62, 95% CI (0.27–1.41). There was no difference in the incidence of post-operative bleeding (1.21, 95%CI 0.4–3.66), seroma formation (1.5, 95% CI 0.81–2.76), or post-operative neuralgia (0.98, 95%CI 0.11–8.92). Conclusion There is no advantage in performing a slit on the mesh to encircle the cord structures during laparoscopic inguinal hernia repair.

Modified Abdelhamid technique (modified TAPP with external fixation)

Purpose Better fixation of the mesh with better application to the posterior inguinal wall. Background: Stapling of the mesh is costly, that is why in Abdelhamid technique we are fixing it to outside, reducing the cost and port sizes without jeopardizing the outcome .Our technique can adjust the tension applied to the mesh with better justification of the size of the mesh. Patients: The study was conducted at Beni _ Suef university hospitals, between April 2018 and April 2020. Included in the study were 30 patients with unilateral primary inguinal hernia. Methods: A prospective trial was conducted modifying Abdelhamid technique for laparoscopic. TAPP inguinal hernia repair in which we fixed the mesh to the anterior abdominal wall using two prolene threads that passed to the exterior and were tied in place but the mesh was applied under the cord. Results: The operative time ranged from 40 to 60 min and follow up was for 12–16 months, during which time there was no hernia recurrence, nor TAPP pain. The procedure showed better application of the mesh on the posterior inguinal wall with reduced port sizes and was also associated with reduced cost. Conclusion: Direct application of the mesh to the posterior inguinal wall is associated with better fixation with completely abolishing the disparity in the size between the mesh and the posterior abdominal wall.

Initial Report of a Novel Approach: Robotic Single Port (SP) TAPP Inguinal Hernia Repair

Bianco, Francesco MD; Gruessner, Stephan MD MBA; Pavelko, Yevhen MD; Mangano, Alberto MD; Esteban Bustos, Roberto MD; Cristoforo Giulianotti, Pier MD, FACS Author Information

Changing the innate consensus about mesh fixation in trans-abdominal preperitoneal laparoscopic inguinal hernioplasty in adults: Short and long term outcome. Randomized controlled clinical trial.

Inguinal hernioplasty is the standard treatment for inguinal hernia in adults. Mesh fixation was used to keep mesh in place for which various mesh fixation techniques have been used in laparoscopic inguinal hernia repair in adults, but their effectiveness has remained inconclusive. to evaluate non fixation method of mesh laparoscopic inguinal hernioplasty as safe and effective as regard short and long term outcomes. Over the period from July 2013 to July 2018, 798 patients with oblique inguinal hernias undergoing Trans abdominal preperitoneal technique (TAPP) were randomized into 3 groups: Group A; mesh non fixation 266 patients. Group B; tacker mesh fixation 266 patients Group C: Cyanoacrylic tissue glues (Histoacryl) mesh fixation 266 patients. Clinical effects were assessed by the following variables: intraoperative data, postoperative outcome as regard recurrence rate, postoperative pain [on visual analogue score (VAS)], analgesic consumption, operation time, hospital stay, and patient costs. Follow up was 18 months. There was no statistical difference between groups (A) and Group (C) regarding operative time, postoperative complications, and length of hospital stay and risk of chronic groin pain, postoperative pain score. In Group (B): the postoperative pain and complications were higher. There were 5 cases of hernia recurrence in all groups, but no significant differences among the three groups. Tacker Mesh fixation increased the risk of chronic groin pain. Pain score was higher with tacker mesh fixation. Laparoscopic TAPP inguinal hernia repair without tacker mesh fixation was safe and feasible with no significant increase in recurrence rates. Furthermore, mesh fixation with tacker procedure increased the risk of postoperative complications and patient costs. All ethical approval was given by our Faculty of Medicine medical ethical committee.

Laparoscopic TAPP Single Access Hernioplasty with Simultaneous Appendectomy for Chronic Appendicitis

Aim. To investigate the technological features and immediate results of simultaneous laparoscopic hernioplasty of inguinal hernia and appendectomy in chronic appendicitis.Methods. Was performed the analysis of the initial data, complications, duration of surgery and hospitalization in patients after simultaneous appendectomy and TAPP inguinal hernia repair in comparison with isolated TAPP.Results. Simultaneous appendectomy during laparoscopic hernioplasty does not significantly affect the performance of TAPP inguinal hernia repair, but it increases the duration of the intervention due to additional manipulations. This does not affect the incidence of complications and the length of hospital stay.Conclusions. Simultaneous laparoscopic appendectomy for TAPP hernioplasty is advisable in patients with chronic appendicitis and inguinal hernias.

What are the influencing factors for chronic pain following TAPP inguinal hernia repair: an analysis of 20,004 patients from the Herniamed Registry

BackgroundIn inguinal hernia repair, chronic pain must be expected in 10–12% of cases. Around one-quarter of patients (2–4%) experience severe pain requiring treatment. The risk factors for chronic pain reported in the literature include young age, female gender, perioperative pain, postoperative pain, recurrent hernia, open hernia repair, perioperative complications, and penetrating mesh fixation. This present analysis of data from the Herniamed Hernia Registry now investigates the influencing factors for chronic pain in male patients after primary, unilateral inguinal hernia repair in TAPP technique.MethodsIn total, 20,004 patients from the Herniamed Hernia Registry were included in uni- and multivariable analyses. For all patients, 1-year follow-up data were available.ResultsMultivariable analysis revealed that onset of pain at rest, on exertion, and requiring treatment was highly significantly influenced, in each case, by younger age (p < 0.001), preoperative pain (p < 0.001), smaller hernia defect (p < 0.001), and higher BMI (p < 0.001). Other influencing factors were postoperative complications (pain at rest p = 0.004 and pain on exertion p = 0.023) and penetrating compared with glue mesh fixation techniques (pain on exertion p = 0.037).ConclusionsThe indication for inguinal hernia surgery should be very carefully considered in a young patient with a small hernia and preoperative pain.

Robotic radical prostatectomy with concomitant repair of inguinal hernia: is it safe?

Robotic radical prostatectomy (RARP) is well established as a safe and effective treatment for prostate cancer. According to published studies, patients undergoing RARP are at increased risk of being diagnosed with an inguinal hernia after RARP and are four times more likely to have an inguinal hernia repair (IHR) following RARP. Several studies have demonstrated the effectiveness and safety of IHR during RARP. Overall, it has been observed that IHR adds on average, 12-15min in total surgical time and there were no significant differences between RARP with or without IHR with respect to postoperative complications. This study analyzes a large series of patients undergoing RARP (1100) and compares them to a group that underwent RARP with IHR (39). Between December 2008 and January 2015, 1139 patients underwent RARP at Florida Hospital in Celebration, FL. Of the total patients, 39 underwent concomitant IHR. All procedures were performed by the same surgeons (urologist and general surgeon), using the same techniques of RARP and TAPP inguinal hernia repair. After 30days, the differences were evaluated between groups regarding surgical time, EBL and postoperative complications. The average age of patients undergoing the procedure was 61.65years. The mean procedure time was approximately 120min (min), with an additional period of 68min for IHR (mean=188; p=0.0001). There was a significant difference in BMI between the groups, 28.3kg/m2 for patients undergoing RARP and 26.8kg/m2 for those who underwent RARP and IHR (p=0.028). The EBL averaged 110.87mL, with no significant difference between groups (p=0371). There was no significant association between clinical stage of the patient and the type of procedure performed (p=12:35). There was no significant difference in the presence of comorbidities and the operation preformed. There were 61 events recorded postoperatively, 57 (5.2%) among patients who underwent only RARP and 4 (10.26%) among those who had both. Taken together, the small amounts of complications in both groups prevent statistical significance. This study compared two groups of patients undergoing RARP: those with IHR and those without. Our study demonstrated an increase in surgical time; however, there was no increase in postoperative complications. From the data presented, we suggest that the performance of both procedures concomitantly is feasible and safe.

Long-term quality of life and outcomes following robotic assisted TAPP inguinal hernia repair.

Laparoscopic TAPP inguinal hernia repair is an established alternative to open hernia repair, which offers equivalent outcomes with less postoperative pain and faster recovery. Unfortunately, it remains technically challenging, requiring advanced laparoscopic skills which have limited its popularity among surgeons. The robotic platform has the potential to overcome these challenges. The objective of this study was to examine the long-term quality of life and outcomes following robotic assisted TAPP inguinal hernia repair, since these data have not been reported up to now. From October 2012 to October 2015, 159 inguinal hernias in 82 consecutive patients were repaired with 3D mesh (BARD) using da Vinci Si Surgical System (Intuitive Surgical, Sunnyvale, CA, USA). The patients' demographics and intraoperative data were documented. Patients were seen 2 and 6weeks after the surgery and the complications were recorded. Patients were assessed 6weeks after the surgery by a survey using a universal pain assessment tool to document their post-operative pain, narcotic use and time of return to work and exercise. A modified short form 12 (SF 12) was also sent out to the patients 12-36months after the surgery to measure their health-related quality of life prior to surgery and at the 12- to 36-month follow-up, and to document any evidence of recurrence. Postoperative health-related quality of life scores were compared to the pre-operative baseline quality of life scores using the unpaired t test. Over the course of 3years, 159 robotic assisted TAPP inguinal hernia repair were performed in 82 patients, 73 men and 9 women by one surgeon as an outpatient basis. The mean age was 53 and mean body mass index was 26. There were no intraoperative complications or conversions. The average operative time was 99min. Four patients developed urinary retention post-operatively and one patient developed postoperative bowel obstruction requiring laparoscopic lysis of adhesion with no long-term complications. All patients completed the pain assessment survey and the median pain score, 3days after the surgery was 3. Narcotics were used for an average of 3.1days. The modified SF 12 survey assessing for quality of life before and 12-36months after surgery was completed and returned by 29 patients (response rate of 35.4% and median follow-up of 32months). Only one recurrence was reported which was repaired with open technique. The analysis of the SF 12 survey that evaluated patient's quality of life, pain score and the ability to perform activities of daily living before and after surgery revealed a significant improvement in those measures 12-36months after the surgery compare to their baseline. Hernia recurrence, chronic pain and physical impairment are the major long-term concerns after any type of inguinal hernia repair. Our results demonstrate that robotic assisted TAPP inguinal hernia repair appears to be a technically feasible, reproducible and safe minimally invasive alternative with low recurrence, low chronic pain and high health-related quality of life in the long term.

Patients Satisfaction Post Laparoscopic Transabdominal Preperitoneal Inguinal Hernia Repair with External Fixation Versus Post Internal Fixation

Laparoscopic transabdominal preperitoneal inguinal hernia repair wth external fixation is a new technique in which there is a marked reduction in the cost without affecting the outcome The issue of mesh fixation in laparoscopic repair of inguinal hernia repairs remains unsolved. The need for fixing the mesh arises from the fear of increasing recurrence rates. However, specific complications have emerged as a result of mesh fixation. The aim was to find out which is more satisfactory to the patients external fixation or internal fixation. In 80 patients the mesh were fixed from the interior using staples while in the other 80 patients it is fixed to the exterior using prolene threads (Abdelhamid Technique). We conducted A prospective study for laparoscopic TAPP inguinal hernia repair on 160 patients between September 2008 until May 2014 and we follow the patients till May 2015. In 80 we fixed the mesh to the exterior and in another 80 from the interior. There were 90 patients with direct inguinal hernia 45 done through external fixation (gp1) another 45 through internal fixation of the mesh (gp2), 70 patients with indirect inguinal hernia 35 external fixation (gp3) 35 internal fixation (gp4). We follow the patients for recurrence, impulse on cough, inguinal pain and sense of discomfort. The operative time ranged from 35 – 70minutes for external fixation, 30 -60 minutes for internal fixation. During this period we did not encounter any recurrence, but in group 1 there is one patient complained of impulse on cough and in group 2 there were three had the same complain. Regarding pain non of the external fixation patients complained of groin pain while in group 2 there were two and in group 4 there were two patients complained of groin pain. We concluded that in addition to much reduction in the cost as we did not use stapler nor tucker, external fixation is safe easy to learn, external fixation is associated with no groin pain compared to internal fixation and much less incidence of impulse of cough making this technique more acceptable to the patients.

Tacks, staples, or suture: method of peritoneal closure in laparoscopic transabdominal preperitoneal inguinal hernia repair effects early quality of life.

TAPP inguinal hernia repair (IHR) entails the development of a peritoneal flap (PF) in order to reduce the hernia sac and create a preperitoneal space in which to place mesh. Many methods for closure of the PF exist including sutures, tacks, and staples. We hypothesized that patients who had PF closure with suture would have better short-term QOL outcomes. A prospective institutional hernia-specific database was queried for all adult, TAPP IHRs from July 2012 to August 2013. Unilateral and bilateral patients were included and each hernia was analyzed separately. The main outcome of interest was quality of life (QOL) at two- and four-week follow-up, as measured by the Carolinas Comfort Scale. There were 227 patients who underwent TAPP, with 99 bilateral and 128 unilateral IHR, for a total of 326 IHR. PF closure was performed using tacks in 45.1%, suture in 19.0%, and staples in 35.9%. Patient characteristics were statistically similar between the tack, suture, and staple group. There were 32.9% direct, 46.5% indirect, and 20.6% pantaloon hernias, which were not significantly different when compared by PF closure method. Post-operative complications and length of stay were same for the three groups. There were no hernia recurrences. Post-operative activity limitation at two weeks was significantly better in the suture group when compared to the stapled group (p = 0.005). Additionally, sutured PF closure had less early post-operative pain when compared to the tack group (p = 0.038). Following TAPP IHR, suture closure of the PF significantly improves 2-week post-operative movement limitation compared to stapled and tacked PF closure. Continued randomized studies are needed to determine the best surgical hernia repair methods for ideal post-op QOL.

Transabdominal Pre-Peritoneal Mesh for Inguinal Hernia Repair with External Fixation versus Mesh Stapling

Background: It is unknown whether stapling the mesh affects recurrence rate, incidence of neuralgia, and port-site hernia. We chose to fix it to the exterior reducing port size, cost and pain, at the same comparing this with traditional mesh stapling. Methods: We conducted a prospective trial for laparoscopic TAPP inguinal hernia repair on 120 patients in which we fixed the mesh to the anterior abdominal wall using either two prolene threads that passed to the exterior and tied in place or traditional mesh stapling. Results: The operative time is ranged from 35 to 70 minutes for external fixation, 30 to 60 minutes for mesh stapling, and 4 to 51 months for follow-up, and no recurrence occurred in both groups during the procedure. Two cases with post TAPP pain in mesh stapling patients are discussed with reduction of the cost and port size in external fixation patients. Conclusion: It is not necessary to secure the mesh during laparoscopic TAPP inguinal hernia repair from the interior and it is fixed only to the exterior allowing a reduction in size of the ports and considerable reduction in cost with elimination of TAPP associated post operative pain.