TAPP Repair 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.

To close, not to close, or to act bigger? Managing the defect of large direct inguinal hernia to reduce the risk of recurrence during laparoscopic TAPP repair: a retrospective cohort study

Hernia recurrence is a common complication after inguinal hernia repair. Recent studies suggest that laparoscopic mesh repair with closure of direct hernia defects can reduce recurrence rates. Our study examines the effectiveness of this approach. A retrospective, multi-center cohort study was conducted on cases performed from January 2013 to April 2021. Patients with direct inguinal hernias (M3 according to EHS classification) undergoing TAPP were included. Three groups were present: closed-defect group, non-closed placing a standard-sized mesh group or non-closed placing an XL-sized mesh group. A 2-year follow-up was recorded. A total of 158 direct M3 inguinal hernias in 110 patients who underwent surgery were present. After propensity score matching at a 1:1 ratio, 22 patients for each group were analyzed. The mean age of patients was 62 years (41–84); with the majority being male (84.8%). 22 patients (40 hernias) underwent closure of the defect; 22 patients (39 hernias) did not undergo closure and used a standard-sized mesh; 22 patients (27 hernias) did not undergo closure and used an XL-sized mesh. There were 5 recurrences at 1 year post-operatively: all in the non-closure group with standard-sized mesh. This difference was statistically significant (p = 0.044). There were 7 recurrences (6.6%) at 2 years post-operatively: 6 in the non-closure group with standard-sized mesh and 1 in the non-closure group with XL-sized mesh (p = 0.007). Closing large direct inguinal hernia defects has shown promise in reducing early recurrence rates. However, conducting larger RCTs in the future could provide more conclusive evidence that might impact the way we approach laparoscopic inguinal hernia repair.

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.

464 Incidence of recurrent inguinal hernias and their repairs at a large DGH

Abstract In the UK 100,000 hernia operations are performed annually – this includes umbilical/epigastric/incisional etc. Options of inguinal repair are either open or laparoscopic (TAPP vs TEP). Recurrence rates for Liechtenstein repairs are quoted as 5.6%. Median recurrence rates for TAPP repair are quoted as 2.3% and for TEP 0.6%. However, several meta-analyses comparing TEP/TAPP to open repairs found no significant difference in recurrence rates. At our trust, 331 inguinal hernia operations were performed between August 2021- August 2022 (post-COVID). The aim of this project was to look at the incidence of recurrent hernias and their initial repairs at our trust. We obtained a list of all inguinal hernia repairs in our trust (across all sites) between August 2021- August 2022. We looked at the number of patients that underwent an operation for a recurrent hernia and whether that patient’s primary repair was done laparoscopically or open. 76% of total inguinal hernia repairs were performed open, compared to 24% laparoscopic repairs (72% TEP repairs). About 10% of total repairs were for recurrent hernias. 56% of those had a primary open repair and 44% had a primary laparoscopic repair. 75% of the recurrent hernias underwent a second open repair and 25% underwent a second laparoscopic repair. We aim to repeat this study with more data (i.e. looking at pre-COVID years) and encourage our laparoscopic hernia surgeons to look into their own practice.

OC-102 NUCK HYDROCELE DURING INGUINAL HERNIA REPAIR IN ADULT FEMALES. REPORT OF TWO CASES

Abstract Aim To present both the open and laparoscopic technique when encountering a Nuck hydrocele during an inguinal hernia repair in females. Methods Two cases of incidentally encountered cysts of Nuck during elective inguinal hernia repair in females are presented. Results Hydrocele of Nuck is a type of primary idiopathic hydrocele. It can occur due to partial remaining of the physiologically obliterated Canal of Nuck. In females, cysts of Nuck are frequently clinically misdiagnosed as inguinal hernias. A 42-year-old woman was subjected to a left TAPP repair for a symptomatic inguinal bulge. Intraoperatively a cystic lesion was attached to the round ligament of the uterus. The cyst contained clear fluid and was progressively dissected from the round ligament, excised and sent for a pathological examination. A typical TAPP repair with mesh ensued. A second case of a 45-year-old woman was submitted to a laparoscopic exploration of an ultrasonographically identified cystic lesion inside the inguinal canal. Intraabdominal reduction of the cyst was not possible, so conversion to open surgery was decided. A clear-fluid cyst was then excised and a typical Lichtenstein repair was performed. Conclusions Symptomatic inguinal bulge especially in women may warrant ultrasound examination for preoperative clarification of the underlying pathology and intraoperative management. The surgeon should be aware of the existence and pathogenesis of this rare entity.

OC-079 LAPAROSCOPIC TAPP APPROACH FOR A RECURRENT INGUINAL HERNIA

Abstract Aim To analyze the safety, feasibility, and effectiveness of a systematized laparoscopic transabdominal preperitoneal approach for a recurrent inguinal hernia. Material & Methods A retrospective observational analysis of a database between July 2012 and July 2022. Inclusion: all patients with a standard laparoscopic tapp approach to treat a recurrent inguinal hernia. The variables were compared with our results in primary inguinal hernias: laparoscopic finding (cause and type using the EHS classification) conversion rate, cause of conversion, complications, and quality of life outcomes. Demographic analysis of the population Age, BMI, and a number of recurrences. Results In this period, 5452 patients underwent a tapp laparoscopic approach to treat an inguinal hernia. 372 (6.82%) were registered as recurrent hernias. Men (98.4%). BMI: (26). When comparing the patients with a previous anterior approach: 316 patients (90%), there were no differences with the results of the primary hernia. Patients with the antecedents of the posterior approach were 39 patients (10,4%). Reviewed case by case, the effectiveness in diagnosis was (100%), and the conversion rate of 8 patients (20,5%). The cause of conversion was severe mesh adhesions to the vascular triangle and vesical preperitoneal space. There were no significant differences when comparing the results between patients who underwent tapp repair in primary and recurrent hernias. There was also no significant difference according to the number of recurrences. Conclusions The laparoscopic systematized approach in recurrent hernias shows effective rates in providing safe diagnosis and treatment while maintaining the quality of life standards.

OC-110 LAPAROSCOPIC RETROMUSCULAR INGUINAL HERNIA (LRMIHR) REPAIR USING PHASIX TM AND POLYPROPYLENE MESH: 5 YEARS OUTCOME

Abstract Background and objective Inguinal hernia routinely repaired with synthetic non-absorbable mesh. However, chronic pain may affect the success of flow recurrence. In contrast, using absorbable mesh and keeping its integrity for nine months as Phasix TM may be a suitable replacement for the synthetic non-absorbable mesh. This work assesses the results and cost of TAPP repair using Phasix TM & lightweight Polypropylene mesh. Methods Laparoscopic retromuscular inguinal hernia repair (LRMIHR) was performed from January 2015 to January 2023 with Institutional review board approval for 58 patients, 1 female and 57 males. The average age is 55.8, with a 27.5 mean BMI. The study was done in the hospital by one surgeon. Studying post-operative pain, reaction, mesh sensation discomfort, recurrence, and cost. Results In 5 years follow-up, the outcome is comparable without the non-significant advantage of absorbable mesh. Moreover, the cost of absorbable mesh (Phasix ST) is higher. Conclusion No clinical advantage of absorbable mesh in repairing the inguinal hernia. However, using phasix TM may have a place in repairing female and sports hernias. Further work is needed to evaluate phasix in hernia inguinal in a prospective multicenter trial.

INGUINAL ABSCESS FOLLOWING TRANS-ABDOMINAL PREPERITONEAL MESH REPAIR FOR INGUINAL HERNIA

Introduction – Introduction of synthetic mesh was a landmark breakthrough in management of hernia repair and has signicantly reduced recurrence rates. But in addition to benets, some more problems have come in picture major being 'mesh infection'. Prolene mesh has shown promise when used in abdominal and inguinal hernia repair, especially when used in planned surgeries. Being a foreign material, slightest breach in asepsis can lead to favourable environment for bacterial proliferation and form a 'biolm'. It appears that laparoscopic hernia repair is a promising method but having chances of mesh infection owing to difcult approach and lack of uniformity in sterilization of laparoscopic instruments. Improper sterilization or protocols might lead to such a large ventral wall sinus or abscess increasing morbidity and cost of treatment. Case Report A 39 year old male patient presented to OPD with abdominal pain since 15 days, low grade fever , anorexia and weight loss 1.5 months following TAPP repair of bilateral inguinal hernia 1.5 months ago. Work-up showed acute diverticulitis with diverticula perforation involving descending colon and adjacent sigmoid colon in left iliac fossa with collection in left iliac fossa. Lower Midline Exploratory laparotomy was performed. Around 100 cc pus was drained around mesh beneath parietal peritoneum, the infected mesh was removed. Post operatively patient recovered excellently. TAPP is a safe procedure for treat groin hernias, unless, mesh complications Conclusion like foreign body reaction, deep-seated infection, mesh migration and perforation into viscera can occur even 20 years later of the procedure with no dened incidence. The chance of recurrence of hernia following management of infected mesh should always be considered

Incarerated femoral hernia in women – A critical view on approach options

Introduction and importanceIn the literature there is few information on femoral hernias while best surgical approach to groin hernia in women is in recent discussion ([1], [2]). Focused on femoral hernia our purpose is to present a possible pathway for incarcerated female hernia approach demonstrated on four cases. Case presentationFour female patients (77–90 y) with suspected incarcerated inguinal unilateral hernia undergoing repair at our department between December 2017 and December 2018 are presented. In three patients emergency laparoscopy by single port approach confirmed incarceration. Bowel was reduced and femoral hernia diagnosed. A TAPP repair was performed. The fourth patient had multiple previous abdominal operations due to anal carcinoma, so laparoscopic approach was not recommended. A transinguinal open approach also showed an incarcerated femoral hernia. Clinical discussionIn case of suspected incarcerated inguinal hernia accurate identification of a femoral hernia is necessary especially in female elderly patients. If possible endoscopic approach is preferred and offers exploration of both sides, checking bowel for vitality and fixing the hernia. If bilateral hernia is present, both sides should be addressed. Surgeons not used to TAPP should perform diagnostic laparoscopy with reduction of hernia sac and check of content and switch to TEP if experienced or open procedure. If open approach is necessary checking for femoral hernia is also mandatory and preperitoneal mesh placement is recommended with or without ligation of inferior epigastric vessels. ConclusionFemoral hernias in women are not rare and in open repair techniques easily overseen. The endoscopic approach is preferred. With open approach the exploration via transversalis fascia is mandatory.

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.

A COMPARISON OF LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL (TAPP) VERSUS LICHTENSTEIN REPAIR FOR INGUINAL HERNIAS

Background: Inguinal hernia, is undoubtedly the commonest type of hernia and has got a significant burden of morbidity and mortality posed by its symptoms and complications, especially if left untreated. Mesh hernioplasty is its well established cure commonly done by open method (Lichtenstein) and less so by laparoscopic method (TAPP).
 Objective: To compare the outcome of TAPP and Lichtenstein repair for inguinal hernias.
 Methods: In this randomized controlled trial carried out at the Dept of Surgery, LGH, Lahore, for full one year a total of 80 patients with mean ages of group-A (40.4±10.69) and group-B (40.52±11.03) years based on inclusion criteria were selected and equally divided in both groups randomly. In group A, TAPP repair was done. In group B, Lichtenstein repair was done. All research parameters were recorded and calculated to get results.
 Results: Mean operative time was significantly lower for Lichtenstein Repair as compared to TAAP i.e. 44.05 vs. 52.27, P-Value = 0.001. The mean hospital stay was significantly short for TAAP as that Lichtenstein repair i.e. 2.05 days vs. 3.02 days, p-value=0.000. However postoperative infection rate was higher in patients in Lichtenstein Repair group i.e. TAAP: 10% vs Lichtenstein: 17.5%.
 Conclusion: TAAP is more effective than Lichtenstein repair by offering the patients a shorter hospital stay and less postoperative infection for treating inguinal hernia but has a little longer operative time.

Three-point mesh fixation in robot-assisted transabdominal preperitoneal (R-TAPP) repair of 208 inguinal hernias: preliminary results of a single-center consecutive series.

The aim of this study was to assess the efficacy of our mesh fixation technique in robot-assisted transabdominal preperitoneal inguinal hernia repair (R-TAPP). The primary outcome was the recurrence rate. Secondary outcomes were postoperative pain, chronic pain, and return to normal activities. Between January 2018 and December 2019, we performed 208 consecutive R-TAPP in 161 patients and the mesh was fixed by three intracorporeal stiches using a Polyglactin 910 (Vicryl®) 3-0 suture. Patients were followed up at 10 and 30days after surgery with a clinical evaluation for detection of early complications, postoperative pain, need for analgesics, return to normal activities, and satisfaction rate. Patients were further followed up at study conclusion in February 2021 for recurrence and chronic pain detection. Painkillers were stopped by 57% of the patients after the first postoperative day and by 96% after 1week. Chronic pain (> 3months after surgery) was observed in three patients (1.8%) and only one of them was treated with percutaneous ilioinguinal-iliohypogastric nerve infiltration. After a mean follow-up of 24.0 ± 6.7months, only 1 recurrence (0.48%) was clinically detected and confirmed by a CT-scan. The 3-point mesh fixation technique is feasible during robot-assisted TAPP repair for inguinal hernia and seems to be a viable alternative to other fixation methods. Further long-term controlled investigations are needed to understand if this technique is effective in influencing recurrence and chronic pain rates.

P115 LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL (TAPP) HERNIA REPAIR IN DECOMPENSATED CIRRHOSIS

Abstract Aim To evaluate the possibilities, benefits and safety of laparoscopic treatment of inguinal hernias in patients with cirrhosis of the liver and ascites, in particular to evaluate the TAPP approach for the treatment of inguinal hernias in patients with cirrhosis of the liver and ascites. Material and Methods Group I - TAPP repair in 16 patients with liver cirrhosis and ascites. Group II - Lichtenstein type hernioplasty in 15 patients with liver cirrhosis and ascites. All patients underwent planned surgery after dosing preoperative laparocentesis and correction of liver function indices. Results In the first group of patients no complications developed, no suppurative complications were observed, no edema, no leakage of ascites fluid. Postoperatively, all patients recovered well, noticed less pain. Only 25 percent of patients required analgesics. Patients were discharged at home 3-5 days postoperatively. In group II - minor complications were observed: 1 local hematoma, 1 seroma. Postoperative pain syndrome was more pronounced. All patients required analgesics. Duration of hospitalization 4-6 days. During a 10-month follow-up, no patients had recurrence and chronic pain. Conclusions TAPP repair provided the opportunity to assess macroscopic changes in the liver and possibly to perform liver biopsies, if necessary. TAPP repair reduces days of hospitalization and postoperative recovery by reducing pain syndrome with a low percentage of analgesics. TAPP repair can be a useful treatment option for patients with liver cirrhosis accompanied by ascites.

P068 ROBOTIC REPAIR OF VENTRAL AND INCISIONAL HERNIAS: A STUDY ON 118 PATIENTS OPERATED BY RV-TAPP AND R-RIVES

Abstract Aim The purpose of this study is to compare the results of robotic ventral TAPP and robotic retrorectus repair for ventral and incisional hernias. Material and Methods The results of 118 consecutive rv-TAPP (88) and r-Rives (30) surgeries are presented. The study was approved by the ethics committee (Ref. No. 2019-02046). Primary ventral hernias were treated mainly by rv-TAPP approach, incisional hernias by r-Rives Technique. Patients were followed up six weeks postoperatively. Results In every third patient, an additional finding at the linea alba was found. Patients in the r-Rives group were significantly older (p = 0.001). Hernia gaps were significantly larger and meshes were significantly larger in the r-Rives group (p < 0.001). The ratio of mesh area to hernia gap area was comparable in both groups (p = 0.142). OR time was significantly shorter for rv-TAPP (82min) than r-Rives (109min). Hospital stay was shorter in the rv-TAPP group than in the r-Rives group (1.5 vs. 2.7 days, respectively) (p < 0.001). There was a significant clustering of type II seromas in the r-Rives group (p < 0.001), however, the total number of seromas was comparable. Conclusions rv-TAPP and r-Rives have the advantages of minimally invasive procedures (low complication rate) and most of the advantages of open procedures (morphological reconstruction). Both techniques allow consistent extraperitonealization of meshes. Umbilical and epigastric hernias (<4cm) are treated as rv-TAPP; incisional hernias, large hernia gaps (4-7cm), as well as in case of planned suturing of the linea alba, the r-Rives is indicated. Concomitant hernia gaps of the linea alba are also treated. Both procedures have few complications and are suitable for residents training.

VP028 TAPP REPAIR FOR INCISIONAL LUMBAR HERNIA

Abstract Aim “Incisional hernias are very common and can present even after minimally invasive surgery for other pathologies. Laparoscopic ventral hernia repair first described by LeBlanc in 1992, gained great popularity, because of its known advantages over the open techniques. In the last decade because of increasing concerns about the future risks of using an intra-peritoneal mesh, several minimally invasive techniques using a mesh outside abdominal cavity have been described. We report the use of a TAPP technique.” Material and Methods “48 yo female patient, that underwent a laparoscopic right adrenalectomy, for myelolipoma, in 2015, with subsequent incisional lumbar hernia (L4W1) in the extraction incision.” Results “The patient was submitted to a laparoscopic TAPP repair in ambulatory surgery with extended recovery. The hernia defect was closed with a barbed suture and it was used a 15x15cm medium weight polypropylene mesh without traumatic fixation. For pain control it was done a TAP block guided by laparoscopy. The duration of surgery was 90 minutes. The patient had no complications. No recurrence on follow-up (4 months).” Conclusions “New minimally invasive procedures for the repair of incisional hernias avoid the intraperitoneal mesh position and maintain all the advantages of the minimally invasive approach. Some of these techniques may be complex and have a long learning curve. TAPP seems reproducible and a good option if a good extra-peritoneal dissection is possible. Larger series are needed, to accurately compare these new techniques with IPOM, open sublay and to select the best technique for each patient.”

Inguinal hernia TAPP repair using Senhance® robotic platform: first multicenter report from the TRUST registry.

The purpose of this article was to provide feasibility and safety results of robotic transabdominal preperitoneal inguinal hernia repair (Robotic TAPP). We included 271 cases of robotic inguinal hernia TAPP repair using the Senhance® robotic platform from four different centers between March 2017 and March 2020. Key data points were intraoperative and postoperative complication rate, operating time, length of hospital stay, postoperative pain score and time required to get back to a daily routine that were inserted in the TransEnterix European Patient Registry for Robotic assisted Laparoscopic Procedures in Urology, Abdominal Surgery, Thoracic and Gynecologic Surgery (TRUST). We report 203 cases of unilateral and 68 cases of bilateral inguinal hernia repairs. Mean operative time was 74 ± 35min (range 32-265min), postoperative complications occurred in five (1.85%) cases, the intraoperative complication rate was five (1.85%). The average subjective patient-related pain score after the procedure was 3 ± 1.9 (range 1-9), length of hospital stay was 39 ± 28h (range 4-288h), and recovery time was 9.65 ± 8days (range 1-36days). Robotic inguinal hernia TAPP repair shows inspiring results. It is a safe and doable procedure. However, cost analysis should be performed in future to show the superiority over other techniques.

Laparoscopic Totally Extraperitoneal (TEP) Groin Hernia Repair in Patients After Contralateral TEP Groin Hernia Repair.

The totally extraperitoneal (TEP) repair for groin hernia is considered difficult in patients with a healed surgical scar in the lower abdomen. We reported the feasibility of repair in those patients and found that the most frequent previous procedure in patients for whom the procedure was changed intraoperatively was a contralateral TEP after TEP repair. We now report an expanded patient cohort with a suggested unified treatment strategy. From 2006 to 2020, 443 patients underwent laparoscopic TEP groin hernia repair. A contralateral TEP after TEP repair was performed in 35 patients. The conversion rate after TEP was compared with that after other operations. Patients were divided into completed contralateral TEP after TEP repair (N=28) and changed procedure groups (N=7). Clinical characteristics were compared including age, body mass index, location and type of hernia, and interval after previous surgery. Multivariate analysis was performed to evaluate risk factors for conversion of the TEP procedure. Patients undergoing contralateral TEP after TEP repair were significantly overrepresented among patients for whom the procedure was changed compared with other previous operations (P<0.01), with an odds ratio of 19.91. Comparing completed TEP after TEP repair and changed procedure groups, there were no significant differences regarding age (mean: 67 vs. 69 y old), body mass index (22.4 vs. 22.5 kg/m2), type of hernia (indirect or direct), or duration after previous TEP repair (median: 642 vs. 470 d) and identified no significant risk factors. The contralateral TEP after TEP repair for groin hernia is feasible. However, dense adhesions may be present if balloon dissection was performed at the previous TEP repair, and it is necessary to carefully dissect being ready to convert to other procedures such as TAPP repair or an anterior approach.

EXTERNAL OBLIQUE HERNIOPLASTY AN EARLY EXPERIENCE IN TERTIARY CARE UNIT

Background: The most frequent general surgical operation is the correction of an inguinal hernia. The most oftenused method for open inguinal hernia surgery is Lichtenstein tension-free repair. The gold standard for inguinal herniarepair is the endoscopic surgery known as TEP, TAPP, and Lichtenstein repair. The posterior wall of the inguinalcanal is strengthened via external oblique hernioplasty, which uses the Apo neurosis of the external oblique muscle.The study’s objectives were to document the problems of the novel procedure and evaluate the outcomes against goldstandard practices.Objectives: To evaluate the viability and effectiveness of external oblique hernioplasty compared to conventionalinguinal hernia repair techniques. It also attempts to compare the results of this new operation with well-establishedmethods like TEP, TAPP, and Lichtenstein procedures, concentrating on recovery timeframes, long-term success rates,and postoperative discomfort.Study design: A descriptive studyDuration and place of study: MMC Mardan from June 2015 till June 2016Materials and Methods: The descriptive research design was used, and it took place at MMC Mardan betweenJune 2015 and June 2016. An informed consent was obtained about the surgery. Following studies, the patient’scircumstances were optimized before surgery. The trial covered all individuals who were deemed suitable for generalanaesthesia. A single surgeon operated on each patient, and any postoperative problems were noted. Every patient wasmonitored for one month.Results: All 57 patients who had surgery for inguinal hernias were men. Urinary retention affected 14% of patientsin the first postoperative week. 7% of patients reported having SSI, while 14% of patients reported having chronicdiscomfort.Discussion: The best option is still mesh repair. A deeper comprehension of the issue has led to an improvementin failure rates. Male patients are often affected by inguinal hernias. There have been conflicting reports on urinaryretention and discomfort during the first postoperative week. In mesh repairs, seromas are more frequent. The rates ofscrotal oedema were higher than those of mesh repairs.Conclusion: Regarding the immediate postoperative period, the procedure’s outcomes are similar to mesh repairs.Long-term issues such as recurrence are anticipated.

Management of an obstructed recurrent inguinal hernia using a hybrid method: a case report

BackgroundFor recurrent incarcerated and strangulated hernias, the optimal treatment strategy for each case is needed.Case presentationThe study patient was a 70-year-old man. TAPP repair was performed for a left inguinal hernia (JHS Classification II-1) 7 years earlier. The patient experienced transient pain and swelling of the left inguinal region for 5 months and visited our emergency department for abdominal pain and vomiting. A CT scan showed a recurrent left inguinal hernia and small bowel incarceration, and emergency surgery was performed. Laparoscopic observation of the abdominal cavity revealed recurrent left inguinal hernia (Rec II-1) with small bowel incarceration. The small bowel was reduced after pneumoperitoneum, and no findings suggested intestinal tract necrosis. Adhesions around the herniated sac were dissected using an extraperitoneal approach and then shifted to mesh plug repair. No perioperative complications or hernia recurrence were observed in the 10 months after the surgery.ConclusionsThis report describes a novel, successful surgical treatment for a recurrent incarcerated hernia. In our patient, we could easily perform dissection and understand the positional relationship by hybrid surgery using the TEP method. Additionally, in patients with incarcerated hernias, we believe that performing hybrid surgery by combining the TEP method would be useful because bowel dilation caused by intestinal obstruction would not disturb the operative field.

Laparoscopic treatment (reTAPP) for recurrence after laparoscopic inguinal hernia repair

For inguinal hernia recurrences, the European Hernia Society guidelines recommend laparo-endoscopic repair (LR) following a previous open surgery (OS) and, conversely, OS following previous laparo-endoscopic repair. Laparoscopic treatment of recurrences after previous LR is controversial. The purpose of this study was to determine the safety, feasibility, and reliability of a repeated transabdominal preperitoneal laparoscopic repair (reTAPP) for a recurrent hernia. We analyzed and compared a series of patients with recurrent inguinal hernia after LR who underwent repair by a conventional approach with similar patients who underwent reTAPP between January 2010 and December 2018. Between January 2010 and December 2018, 2488 transabdominal preperitoneal laparoscopic inguinal hernia (TAPP) repairs were performed. Recurrence was observed in 46 (1.8%). Of these patients, 18 (39%; Group 1; G1) underwent conventional open repair (Lichtenstein technique) and 28 (61%; Group 2; G2) reTAPP. In G2, repair was successful in 24 patients (86%); however, four cases (14%) needed conversion to OS because of technical difficulties. Two patients re-recurred (4.3%), one in G1 which was resolved in a third approach with a reTAPP and the other in G2 which was resolved with OS. ReTAPP surgery for recurrences after previous TAPP repair proved to be safe and was associated with a shorter length of hospital stay and morbidity and recurrence rates comparable to OS at a highly specialized center. Randomized studies with a larger number of cases are necessary to confirm these findings and draw more robust and objective conclusions.