Technique For Inguinal Hernia Repair Research Articles

Review of inguinal hernia repair techniques within the Americas Hernia Society Quality Collaborative

As the ultimate procedure which each surgeon decides to perform for a unilateral uncomplicated inguinal hernia remains controversial, we queried the Americas Hernia Society Quality Collaborative (AHSQC) database to report the collective experience of surgeons in the United States whom contribute to AHSQC to provide a view of the surgical approaches performed. The AHSQC data registry was queried for all adult patients who underwent a primary, unilateral, elective, inguinal hernia repair. A retrospective review was conducted to analyze patient demographics, hernia characteristics, operative details, and post-operative outcomes. Our main outcomes of interest were 30-day surgical site infections (SSI), surgical site occurrences (SSO), 30-day patient-reported outcomes, and 1-year recurrence rates. 4613 patients met inclusion criteria. 1925 were repaired using an open technique (42%), 1841 were repaired using a laparoscopic technique (40%), and 847 were repaired using a robotic technique (18%). The Shouldice technique remains the most common tissue-based repair performed in the AHSQC. The Lichtenstein repair is the most common open mesh-based repair. Minimally invasive approaches to unilateral inguinal hernia repairs remained very common in our series. The robotic approach accounted for nearly one-third of the minimally invasive inguinal hernia repairs. In general, all of the repair techniques reported similar and low rates of 30-day complications. The AHSQC continues on-going efforts to improve long-term follow-up and looks forward to addressing long-term outcomes such as recurrence and chronic pain with increasing data acquisition.

Comparative study of totally extra-peritoneal hernia repair versus open Lichtenstein hernioplasty for the treatment of primary inguinal hernia

Aim: There is still controversy over which inguinal hernia repair technique has the best postoperative results. Totally extra-peritoneal hernia (TEP) repair was compared with conventional open Lichtenstein (OL) herniorrhaphy in terms of postoperative pain, return time to work, recurrence rates and complications.Methods: In this predesigned comparative study, total number of 97 patients who underwent TEP or Lichtenstein herniorrhaphy in Health Sciences University, Kanuni Sultan Süleyman Education and Research Hospital, in between January 2018 and September 2018 were evaluated and compared. Patients were divided in two groups as TEP group (n:50) and OL group (n:47). Demographic properties (age, sex), operation time, postoperative pain, hospital stay, return to work, recurrence rates and/or complications were analyzed and compared with each other. Results: The mean operation time was 55.7 (19.90) minutes in TEP group, while it was 39.44 (10.69) minutes in OL group (P=0.001). Postoperative pain with VAS in TEP group on the first postoperative day was 3.2 (1.12) (range: 2-6), while it was 5.6 (1.02) (range: 2-8) in the OL group (P=0.001). The average time return to their routine work ranged from 6-18 days (mean 9.2 (2.03) in TEP group while it was 7-26 days (mean 14.8 (3.1)) in OL group (P= 0.001). Postoperative complications as urinary retention, seroma, hematoma formation and paresthesia sensation were higher in OL group.Conclusion: In our study, TEP repair was superior to OL repair in terms of postoperative pain, early return to work, chronic pain, postoperative urinary retention, seroma formation and postoperative paresthesia sensation. More studies with large case series and longer follow-up periods are still needed to judge the role of laparoscopy in repairing inguinal hernias.

Comparison of tension free Desarda technique with Lichtenstein for inguinal hernia repair

Background: Inguinal hernia is common surgical problem for which mesh based technique, particularly Lichtenstein repair is considered gold standard. However it has its own limitation such as foreign body sensation, wound infection, cord fibrosis, chronic pain, etc. Desarda technique for hernia repair is emerging technique for inguinal hernia repair known for its low cost procedure, less recurrence rate and feasibility of the procedure. The objective of the study was to compare treatment of primary inguinal hernia repair with these methods in terms of various operative and post-operative parameters.Methods: 64 patients included in the study and operated after randomization. Intra-operative time, local complication, return to everyday activity, post-operative pain, foreign body sensation and early recurrence were analysed.Results: 51 patients were analysed with a minimum follow up period of 3 months and rest were lost on follow up. Operative time was less in Desarda’s repair (28.24 vs. 30.88 min). Desarda repair was cost effective, return to everyday activity was early in Desarda group, there was significantly (p<0.001) less post-operative pain measured on VAS on 2nd POD, 7th POD and 1 month. No recurrence observed.Conclusions: Desarda repair is easy to perform and takes less time to perform, it is also cost effective. Desarda repair when compared with Lichtenstein was superior in terms of postoperative pain, return to everyday activity and no foreign body sensation. Desarda repair is superior to mesh based technique in terms of outcome.

Evaluation of 335 inguinal hernia repair by Lichtenstein technique: a retrospective study

Aim: The aim of this retrospective study was to evaluate of 335 inguinal hernia repair by Lichtenstein technique in elective inguinal hernia management.Materyal and Methods: Three hundred fifty-five patients who administered to the General Surgery Clinic between Jan 2004 and Jan 2006 underwent inguinal hernia repair with the “Lichtenstein-tension-free” surgery technique were retrospectively evaluated in respect to demographics, recurrence and postoperative complications. Follow-up data were obtained from hospital charts, recurrence and late complications were evaluated in telephone interview.Results: 313 patients out of 355 were (88.2%) men and 42 (11.8%) were women. The mean age was 54 years (ranged 21-76 years). The hernia was on the right side in 241 patients (67.9%) and on the left side in 91patients (25.6%). 194 of 355 (54.7%) patients have indirect hernia. The postoperative mean hospital stay was 1.1 days (range 1-3 days). The most common postoperative early complication was urinary retantion. The late period complications including chronic pain in 3 patients (0.8 %), testicular atrophy in 2 patients (0.5 %), and recurrence in 4 patients (1.1%). Conclusion: this study shown that Lichtenstein technique for inguinal hernia repair is a safe and feasible surgery method in respect to 1.1% recurrence and 22.6% overall post-operative complication rate.

Meta-analysis of patient-reported outcomes after laparoscopic versus open inguinal hernia repair

Inguinal hernia repair is a common low-risk intervention. Patient-reported outcomes (PROs) are being used increasingly as primary outcomes in clinical trials. The aim of this study was to review and meta-analyse the PROs in RCTs comparing laparoscopic versus open inguinal hernia repair techniques in adult patients. A systematic review and meta-analysis was carried out in accordance with PRISMA guidelines. Only RCTs in peer-reviewed journals were considered. PubMed, Ovid Embase, Scopus and the Cochrane Library were searched. In addition, four trial registries were searched. The search interval was between 1 January 1998 and 1 May 2018. Identified publications were reviewed independently by two authors. The review was registered in the PROSPERO database (CRD42018099552). Bias was assessed using the Cochrane Collaboration risk-of-bias tool. Some 7192 records were identified, from which 58 unique RCTs were selected. Laparoscopic hernia repair was associated with significantly less postoperative pain in three intervals: from 2 weeks to within 6 months after surgery (risk ratio (RR) 0·74, 95 per cent c.i. 0·62 to 0·88), 6 months to 1 year (RR 0·74, 0·59 to 0·93) and 1 year onwards (RR 0·62, 0·47 to 0·82). Paraesthesia (RR 0·27, 0·18 to 0·40) and patient-reported satisfaction (RR 0·91, 0·85 to 0·98) were also significantly better in the laparoscopic repair group. The data and analysis reported in this study reflect the most up-to-date evidence available for the surgeon to counsel patients. It was constrained by heterogeneity of reporting for several outcomes.

Toward sutureless laparoscopic inguinal hernia repair in children?

We report our experience with a sutureless technique for laparoscopic inguinal hernia repair in children. Twenty-eight children, 12 girls and 16 boys, aged 3 months to 7 years, underwent sutureless laparoscopic inguinal hernia repair. In girls, we utilized simple cauterization of the internal inguinal ring with a single trocar technique. In boys denudation of the peritoneum was obtained utilizing a three-trocar technique. The peritoneum around the internal inguinal ring was peeled off and detached from the vas and the vessels, and then wrapped around the grasper, resulting in a large area of denudation. No perioperative complications were observed. No recurrences nor testicular damage were noted after a mean follow-up of 18 months (range 6-35 months). The mean operative time was 12 min (range 7-20 min) for girls and 19 min (range 15-30 min) for boys. A 6-year-old girl exhibited a lymphocele. The sutureless technique appears to be easy, safe, and effective, provided that the patients are carefully selected. In boys, special attention needs to be paid to preservation of the vas and the testicular vessels.

30: Application of an inguinal hernia repair technique to vaginal reconstruction

30: Application of an inguinal hernia repair technique to vaginal reconstruction

Sage wisdom or anecdotal dictum? Equivalent opioid use after open, laparoscopic, and robotic inguinal hernia repair

BackgroundPurported benefits of minimally-invasive inguinal hernia repair techniques include less postoperative pain, but objective data is lacking. We analyzed prescribing habits and opiate requirements to provide an objective comparison. MethodologyInguinal hernia repairs performed on patients aged 18–65 from October 2016 through February 2018 were examined. Patients with prior opiate use or complicated operative courses were excluded. Discharge prescriptions, morphine milligram equivalents(MME), and additional prescriptions within three months were evaluated. Results173 patients met criteria including 90 open(OMR), 34 laparoscopic(TEP), and 49 robotic(RTAPP) repairs. There was no difference in age or gender. There was no difference in average opiate prescriptions(OMR 230 MME, TEP 229 MME, RTAP 208 MME; p = 0.581), percentage prescribed acetaminophen(OMR 96.7%, TEP 97.1%, RTAPP 98.0%; p = 0.910), or percentage prescribed NSAIDs(OMR 43.3%, TEP 44.1%, RTAP 46.9%; p = 0.919). On follow up, there was no difference in repeat opiate prescriptions(OMR 10.0%, TEP 8.8%, RTAPP 8.2%; p = 0.934). ConclusionsPatients undergoing open, laparoscopic, and robotic inguinal hernia repairs showed no evidence of differing pain medication requirements. The implication that minimally-invasive techniques cause less pain may be inaccurate.

Evaluation of Mobility Status after Inguinal Hernia Surgery

Background: Many different studies have compared open and laparoscopic-endoscopic inguinal hernia repair techniques according to intraoperative and postoperative complications, recurrence rates, postoperative inguinal chronic pain, quality of life, and costs. Most of the researchers have compared these different inguinal hernia repair techniques using a visual analog scale, a short-form survey instrument, or patients’ return-to-normal-activity time, but there is a lack of objective data concerning pelvic function recovery after these procedures. Aim: To evaluate and compare real hip and leg function recovery times after the application of different inguinal hernia repair techniques using hip and leg mobility, strength, and stability testing for the first time. Patients and Methods: This prospective nonrandomized clinical study included 33 male patients aged 18–75 years hospitalized for primary inguinal hernia repair surgery. The patients were divided into two groups: group 1 (Lichtenstein hernia repair) and group 2 (laparoscopic-endoscopic transabdominal preperitoneal/totally extraperitoneal hernia repair). The two groups were compared in terms of intraoperative and postoperative complications, postoperative recovery time, and hip and leg mobility, strength, and stability functional analysis on the first postoperative day as well as 1, 2, and 4 weeks after surgery. Results: A total of 33 patients were included in the study: 13 in the open hernia repair group and 20 in the minimally invasive hernia repair group. There was no significant difference in early and late postoperative complications and recurrence rates. The surgery time and hospital stay were significantly shorter in the laparoscopic-endoscopic hernia repair group. All pelvic functions in the patients who underwent laparoscopic-endoscopic hernia repair recovered 2 or 3 weeks faster than after Lichtenstein repair. Conclusions: Hip and leg mobility, strength, and stability tests are useful to evaluate the recovery time after inguinal hernia repair and could be used as objective tools for estimating recovery after the application of other inguinal hernia repair techniques. Hip and leg mobility, strength, and stability recover faster after minimally invasive inguinal hernia repair. There is no significant difference between the groups in early and late postoperative complications or recurrence rates.

Evaluation of laparoscopic total extraperitoneal hernioplasty versus open hernioplasty in the management of uncomplicated inguinal hernia

Background: Inguinal hernia repair is one of the most common operations in general surgery. Inguinal hernias are among the most common of abdominal wall hernias accounting for almost 75% with lifetime risk of 27% in men and 3% in women. Laparoscopic techniques for inguinal hernia repair, shown to be superior to open repair in terms of postoperative pain and recovery.Methods: In this study, 54 patients with inguinal swelling were taken, 27 cases each for laparoscopic TEP repair and 27 for open mesh repair were studied and results were analyzed.Results: This study shows the maximum number of patients were in the age group of 51-60years in open repair whereas 41-50years in laparoscopic TEP repair. In both the groups, right sided hernia is common. Time duration of surgery varies from 47minutes to 90minutes in open hernia repair whereas in laparoscopic repair it was 85minutes to 136.67minutes. This longer duration of surgery was attributed to learning curve. The mean duration of hospital stay was 3.26days in laparoscopic TEP repair compared to 5.85days in open repair group.Conclusions: Laparoscopic TEP repair offers a significant advantage over open mesh hernia repair. It is associated with less postoperative pain and complications, early post-operative recovery and reduced hospital stay and early resumption of normal activity and better quality of life. However, operative time was prolonged in laparoscopic TEP repair as compared to open due to the learning curve in the institution.

КОМБИНИРОВАННАЯ ПЛАСТИКА ЗАДНЕЙ СТЕНКИ ПАХОВОГО КАНАЛА СЕТЧАТЫМ ИМПЛАНТОМ И АПОНЕВРОЗОМ НАРУЖНОЙ КОСОЙ МЫШЦЫ ЖИВОТА

Topicality: One of the negative sides of the inguinal canal plastics with a mesh implant is cicatricial changes in the structures of the spermatic cord in the place of its junction with the mesh.Purpose. Improvement of non-tension plastics of the posterior wall of the inguinal canal in patients with inguinal hernias.Material and methods. A technique of inguinal hernia repair with a combined plasty of the posterior wall of the inguinal canal with a polypropylene mesh and aponeurosis of the external oblique abdominal muscle was elaborated.The mesh implant is fixed on the posterior wall of the inguinal canal. From the upper flap of the aponeurosis its strip is cut out on two legs. After its fixation to the inguinal ligament, the internal oblique and transverse abdominal muscles, an aponeurotic posterior wall of the inguinal canal is formed.Results. In the elaborated operation of the inguinal hernia, the posterior wall of the inguinal canal is strengthened not only by the mesh implant, but also by the aponeurosis of the external oblique abdominal muscle. At the same time, the spermatic cord lies on the aponeurosis and not on the mesh, which is physiological and prevents the development of fibrous processes in the elements of the spermatic cord. All patients were discharged from the hospital on the 6thday in a satisfactory condition.Conclusions. The results of the elaborated operation for inguinal hernia indicate the absence of clinically significant complications in the early postoperative period. The proposed operation enables to avoid the negative effects of the mesh on the spermatic cord due to the inclusion of the latter in the “aponeurotic tunnel”.

Cost effective use of mosquito net mesh in inguinal hernia repair

Mesh hernia repair is one of the commonest open techniques of inguinal hernia repair. The main limiting factor in the use of new meshes is the cost. We carried out a prospective randomized double blind study and comprising of a hundred patients with 100 inguinal hernias admitted consecutively for elective surgery, divided into the polypropylene mesh (PPM) group and the mosquito net mesh (MNM) group each containing fifty patients. All cases were completed successfully and results revealed no difference in two groups. The results of the present study, in consistent with the published literature, reveal that the cheap indigenous mosquito mesh, which has similar properties of an imported mesh, can be safely used for tension-free inguinal hernia repair in adults. Further trials with a larger number of patients and longer follow-ups are justified and recommended.

How to teach and learn transabdominal preperitoneal effectively – Experience with introducing transabdominal preperitoneal repair in ten general hospitals in Slovenia (2013–2018)

INTRODUCTION: Laparoscopic inguinal hernia repair, according to indications, should be offered to every patient in developed countries nowadays. However, in Slovenia, before 2013, only two hospitals (among 13) performed laparoendoscopic procedures routinely for the treatment of inguinal hernias. Besides, until 2016, the Health Insurance Institute of Slovenia (ZZZS) refunded costs according to diagnosis and not procedure and therefore did not stimulate introduction of more costly surgical procedures, such as transabdominal preperitoneal (TAPP) into daily practice. Many hospitals avoided TAPP as a nonprofitable procedure. METHODS: In 2012, the Slovenian Hernia Society hosted Prof. Dr. Reinhard Bittner as invited guest for teaching laparoscopic and open techniques. The symposium was followed by workshops with hands-on possibility in different hospitals. Soon thereafter, many TAPP and other workshops followed in local hospitals, organized by tutors of the Slovenian Hernia Society (about five workshops a year). Official meetings between the Slovenian Hernia Society and the ZZZS were organized. RESULTS: Between the years 2013 and 2018, ten more hospitals (one clinical center and nine general hospitals) started with TAPP procedures on a daily basis after more workshops were organized in their own local surgical department. In every hospital, one or more surgeons were delegated to take responsibility for hernia surgery development in their own department. The health insurance system agreed to raise refund for bilateral inguinal hernia repair. CONCLUSIONS: Availability of laparoscopic inguinal hernia repair in the 3rd millennium should be a must in every EU country. TAPP was successfully introduced and consolidated as inguinal hernia repair technique in ten more hospitals across Slovenia in a relatively short period of 6 years (2013–2018).

Comparison of totally extraperitoneal groin hernia repair with and without mesh fixation

INTRODUCTION: Since the introduction of the laparoscopic technique for tension-free inguinal hernia repair, various mesh fixation techniques have been adopted. The need for mesh fixation during the surgery is still under debate. We conducted our study to compare the outcomes of laparoscopic totally extraperitoneal (TEP) inguinal hernia repair with (MF) and without (NMF) mesh fixation. PATIENTS AND METHODS: One hundred and fifty-seven patients underwent laparoscopic inguinal hernia repair without mesh fixation during 2010–2014. Of these, 113 (71.9%) agreed to participate in our trial, underwent physical examination, and filled out a questionnaire regarding their satisfaction with the surgery outcome. The data collected from medical records and results of the examination and the questionnaire were processed statistically and compared to the results of a previous study, which included patients who underwent TEP with mesh fixation. RESULTS: Mean follow-up was about 3 years in both groups. Duration of procedure and length of hospital stay were shorter in the NMF group. Patients without mesh fixation had less pain and earlier return to work and physical activity. There was no significant difference in recurrence rate between NMF and MF groups (5.6% and 4.6%, respectively). The majority of recurrences in the MF group were among patients in whom a nonsplit mesh was used. Surgery satisfaction, however, was significantly higher in the MF group. CONCLUSION: TEP without mesh fixation results in better surgical and postoperative outcome comparing with mesh fixation. Overall hernia recurrence rate was similar in patients with and without mesh fixation. Regular follow-up of at least 18 months is recommended to define true recurrence rate.

Comparison of inflammatory stress response between laparoscopic and open approach for pediatric inguinal hernia repair in children.

The aim of this study was to compare inflammatory stress response between laparoscopic percutaneous inguinal ring suturing (PIRS) and open modified Marcy technique for pediatric inguinal hernia repair. From May 2017 to April 2018, 32 male children with median age of 4.5years undergoing inguinal hernia repair were included in randomized controlled trial. The patients were divided in two groups, by using random number generator, depending on surgical approach. The blood was tested in three time frames for white blood cells count (WBC), C-reactive protein (CRP), Interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-α). Significant increase in concentration for all inflammatory biomarkers, that occur over time, has been found (p < 0.001 for all). Additionally, it was also found that the type of surgery significantly influenced the level of WBC, CRP, and IL-6 with Marcy showing a higher level of inflammatory response (WBC 11.4 ± 3.1 × 109/L; CRP 11.5mg/L; IL-6 11.0pg/mL) than the PIRS (WBC 7.6 ± 1.6 × 109/L; CRP 0.8mg/L; IL-6 2.0pg/mL) (p < 0.001 for all). Similar pattern was also found for TNF-α (Marcy 16.8pg/mL; PIRS 10.1pg/mL), but correlation between surgery type and concentration of this biomarker was significant only at the 0.1 level (p = 0.055). The mean operation time was significantly shorter (9 ± 2min) in PIRS group compared to Marcy group (25 ± 7min) (p < 0.001). Significantly lower median of visual analog scale score (VAS) was found in PIRS group (VAS = 2) compared to Marcy group (VAS = 6) (p < 0.001). Use of laparoscopic (PIRS) technique in children shows significantly lower surgical stress in comparison to open hernia repair.

Is laparoscopic totally extra peritoneal repair of hernia (TEP) superior than trans-abdominal preperitoneal (TAAP) mesh repair of inguinal hernia- our experience from a tertiary care hospital, Kolkata

Background: The most common laparoscopic techniques for inguinal hernia repair are transabdominal preperitoneal (TAPP) repair and totally extraperitoneal (TEP) repair. In TAPP a mesh is placed through peritoneal incision over possible sites of hernia by going into peritoneal cavity, where as in TEP the peritoneal cavity is not entered and a mesh is used to seal the hernia from outside the peritoneum.Aims and Objectives: The aim of the current study was to compare the outcome of Total Extra- peritoneal (TEP) versus Trans-abdominal Pre-peritoneal (TAPP) repair of inguinal hernia, where both can be done.Materials and Methods: The current randomized control study was conducted among eighty patients of inguinal hernia. Of these, the sampling was done through random allocation of patients for TEP (Group-I) and TAPP (Group-II), comprising forty patients in each group. All patients irrespective of group were observed for pain (by VAS Score), mean operative time, duration of hospital stay, days taken to resume their normal activities, intra-operative and early post-operative complications and recurrence if any.Results: The pain in both groups was insignificant until one day but highly significant differences (p&lt;0.0001) were observed by end of day 2 and 1 month, showing higher degree of pain in TAPP with respect to TEP procedure. The differences in mean operative time for surgery was highly significant (p&lt;0.0001) with mean time of 86.72 min (TAPP) and 99.72 (TEP). The duration of hospital stay was higher in TAPP (5.2 days) compared to TEP (2.6 days). The mean time to return to normal activities was 10.8 days (TAPP) and 6.2 days (TEP) which was highly significant (p&lt;0.0001). The recurrence though occurred only in one patient in TEP group which was negligible. The other post-operative complications was seroma (8 cases; TAPP) versus (1 case; TEP) and it was highly significant (p&lt;0.0001). The port site infection was in 20 % patients (8/40) in TAPP compared to 2.5% (1/40) in TEP group.Conclusion: The TEP is comparatively superior than TAPP procedure in terms of post-operative complications, duration of hospital stay and return to normal activities.Asian Journal of Medical Sciences Vol.9(6) 2018 20-24

Correlation between laparoscopic transection of an indirect inguinal hernial sac and postoperative seroma formation: a prospective randomized controlled study.

Seroma is the most common early minor complication of inguinal hernia repair. Seromas generally resolve spontaneously within a few weeks, but can sometimes cause other complications. The optimal ways to repair inguinal hernia and handle the hernial sac are still debatable. Large scale, prospective, randomized, controlled studies focusing on the correlation between transection of the hernial sac and seroma formation are scarce. A total of 159 adult male patients with primary indirect inguinal hernia who underwent laparoscopic transabdominal preperitoneal repair were recruited. The patients were randomized to undergo either complete dissection or transection of the hernial sacs. Patients were followed up at postoperative 7days, 1 and 3months, looking specifically for seroma. Seroma was diagnosed via physical examination, and a prestructured form was used to evaluate patient recovery and define the type of seroma present at each follow-up visit. There were 83 patients in the completely dissected group and 76 in the transected group. The overall incidence of postoperative seroma was 12.6% (n = 20). The χ2 test demonstrated that significantly more patients developed seroma in the transected group than in the completely dissected group (18.4% vs. 7.2%, p = 0.034); there were also significant differences between the two groups in the incidences of seroma at postoperative 7days (18.4% vs. 6.0%, p = 0.016) and 1month (14.5% vs. 4.8%, p = 0.037). Seroma formation was correlated with age, body mass index, use of anticoagulants, hernia type, hernia size, sac size, and operative time. There were no significant differences between the two groups in the degree of postoperative pain and time taken for the resumption of outdoor activities. When using the laparoscopic transabdominal preperitoneal technique for indirect inguinal hernia repair, the risk of postoperative seroma formation is greater after transection compared with complete dissection of the hernial sac.

Mesh versus non-mesh for inguinal and femoral hernia repair.

Mesh versus non-mesh for inguinal and femoral hernia repair.

Laparoscopic-Assisted Percutaneous Extraperitoneal Closure for Inguinal Hernia Repair in Children: An Initial Experience

Over the past two decades, laparoscopy has advanced and multiple techniques for inguinal hernia repair have been established. Laparoscopic-assisted percutaneous extraperitoneal closure (LAPEC) for inguinal hernia repair in children, is one of the most simple and reliable methods. The present study aimed to assess the safety and feasibility of the LAPEC of inguinal hernia in children.From January 2014 to January 2016, 21 conventional LAPEC procedures were performed prospectively at our center (Group 1). Over this period, 21 patients of the same age and the same gender had open inguinal herniorrhaphies (Group2). The choice of whether to perform a LAPEC procedure was made according to the surgeon preference. All operations were performed by the same surgeon. No significant differences were found between the 2 groups in terms of sex ratio, mean age, and operating time (p=0.19; student test). There were no operative complications in group 1. Two patients (9.5%) in group 2 presented inguinal hernia recurrence.Despite a relatively high recurrence rate, LAPEC may be a practical alternative to conventional open hernioraphy. Comparative studies must be conduced to test advantages and disadvantages of this procedure in comparison with standard open herniorrhaphy and conventional laparoscopic repair techniques in a more extensive trial.

Surgical technique and outcomes of transabdominal preperitoneal inguinal hernia repair after radical prostatectomy: dissection between the transversalis fascia and superficial layers of preperitoneal fascia.

The question as to whether laparoscopic surgery should be applied for inguinal hernia after radical prostatectomy remains a debate due to surgical difficulty arising from adhesions in the prevesical space. We report the surgical technique used in our department, its outcomes, and its safety and effectiveness compared with the surgical outcomes of primary transabdominal preperitoneal inguinal hernia repair (TAPP) cases. From February 2013 to January 2017, 30 patients with inguinal hernia were treated with TAPP after radical prostatectomy. At our institution, to avoid bladder injury, we dissect the prevesical space with the layer between the transversalis fascia and superficial layers of the preperitoneal fascia as the dissection plane. The practitioners were three qualified surgeons. Surgical outcome were compared with those of primary TAPP cases. For statistical analyses, we used t test to compare the mean operative durations and Chi square test to compare all other surgical outcomes. The median observation period was 19 months. Intraoperative and postoperative complications did not occur; no onset of recurrence and chronic pain was observed. The mean operative duration was 116.2min, which was significantly longer than that of primary TAPP patients (87.9min). However, the operative duration for the last 14 patients had reduced to 101.6min, which was not significantly different from that of primary TAPP patients. In TAPP for patients following prostatectomy, surgery can be performed safely and reliably without prolonging the operative duration by selecting a skilled practitioner and standardizing the technique.