Totally Extraperitoneal Research Articles

Navigating hernia sac management in minimally invasive inguinal hernia repair: to abandon or to reduce? An updated systematic review and meta-analysis.

Minimally invasive inguinal hernia repair has become increasingly accepted, demonstrating superior outcomes over open procedures in postoperative complications. However, certain postoperative complications, such as seroma, remain a dilemma, with many attributing it to the management of the hernia sac. We aimed to perform a systematic review and meta-analysis comparing the reduction versus abandonment of the hernia sac during laparoscopic inguinal hernia repair. Cochrane, Scopus, SciELO, and PubMed were searched for studies comparing reduction and abandonment of the hernia sac. Our primary outcome was seroma. Secondary outcomes were overall complications, postoperative pain, surgical site infection, recurrence, hospital length of stay (LOS), and operative time. We performed a subgroup analysis of transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) techniques. Statistical analysis was performed with R Studio. 2388 studies were screened, and seven studies were included, comprising 3153 patients, of which 916 (29%) were in the abandonment group. We found higher seroma rates for the abandonment group (RR 1.52; 95% CI 1.22 to 1.89; P < 0.001). No differences were found in overall complications (RR 0.88; 95% CI 0.55 to 1.42; P = 0.61), postoperative pain (RR 1.15; 95% CI 0.46 to 2.87; P = 0.76), recurrence (RR 2.67; 95% CI 0.51 to 14.05; P = 0.25), operative time (MD -4.45 min; 95% CI -12.77 to 3.86; P = 0.29), and LOS (MD -0.06 days; 95% CI -0.14 to 0.02; P = 0.14) between both groups. Subgroup analysis of seroma showed no differences between the groups when analyzing TAPP (19.3% vs. 13%; RR 1.65; 95% CI 0.91 to 2.99; P = 0.1) and TEP (9% vs. 4.3%; RR 1.69; 95% CI 0.62 to 4.6; P = 0.3) procedures. Our systematic review and meta-analysis support that hernia sac abandonment may be associated with increased early seroma rates following laparoscopic inguinal hernia repair, but limited data are available for technique-specific analyses.

Evolution and Adaptations of Robotic DIEP Flap Surgery: A Systematic Review.

The integration of robotic technology into surgical procedures has gained considerable attention for its promise to enhance a variety of clinical outcomes. Robotic deep inferior epigastric perforator (DIEP) flap harvest has emerged as a novel approach for autologous breast reconstruction. This systematic review aims to provide a comprehensive overview of the current techniques, outcomes, and complications of robotic DIEP flap surgery. A systematic literature search was conducted after PRISMA 2020 guidelines across databases including PubMed, Embase, Google Scholar, and Web of Science from 2000 to 2023. Articles exploring robotic DIEP flap harvest for breast reconstruction were assessed to compare operative techniques, clinical outcomes, and complications. The risk of bias was evaluated using ROBINS-I and the Newcastle-Ottawa scale. Fourteen studies involving 108 patients were included. Three studies used a totally extraperitoneal (TEP) technique, whereas 11 studies used a transabdominal preperitoneal (TAPP) approach. Preoperative planning utilized computed tomography angiography and magnetic resonance angiography imaging. The mean robotic operative time was 64 minutes, with total operative times averaging 574 minutes for TAPP and 497 minutes for TEP. The mean length of stay was 5 days, and the mean fascial incision length was 3cm. Overall complication rate was 14.9%, with no significant difference compared with conventional DIEP flap procedures. Robotic DIEP flap harvest is a promising technique that may reduce postoperative pain and limiting abdominal donor site morbidity. Potential limitations include longer operative times, variable hospital stays, and increased costs.

An Update on the Management of Femoral Hernias: Narrative Review Article

Femoral hernias are a rare presentation of groins hernias, but it is associated with an increased risk of complications like strangulation and obstruction. It is seen in older patients and the diagnosis is usually late. The surgical treatment of femoral hernias can be divided into open femoral hernia repairs that include the low, inguinal or preperitoneal approach. The laparoscopic methods include the transabdominal preperitoneal (TAPP) and the total extraperitoneal (TEP) repairs. As there is no consensus on what the best surgical procedure for femoral hernias is, we have conducted this review article to look at the surgical management of femoral hernias.

Effect of Laparoscopic Inguinal Hernia Repairs on Inflammatory Factors, Oxidative Stress Levels and Postoperative Recovery.

To unravel the effects of different laparoscopic inguinal hernia repairs (IHRs) on inflammatory factors, oxidative stress, and postoperative recovery of inguinal hernia (IH) patients. A total of 88 patients for laparoscopic treatment of IH were studied in a retrospective cohort, and were randomized into the transabdominal preperitoneal (TAPP) repair group (n = 44) and the total extraperitoneal (TEP) repair group (n = 44) according to the method of treatment. Patients in the TAPP group underwent laparoscopic TAPP IHR, while patients in the TEP group underwent laparoscopic TEP IHR. Visual analogue scores (VAS) were measured at 1, 3, and 7 d after repair. Gastrin (GAS), motilin (MTL), matrix metalloproteinase (MMP)-2, MMP-9, and tissue inhibitor of metalloproteinases-1 (TIMP-1) were assessed by enzyme-linked immunosorbent assay. Superoxide dismutase (SOD) was tested by spectrophotometry and malondialdehyde (MDA) and β-endorphin (β-EP) were examined by radioimmunoprecipitation. Total antioxidant capacity (T-AOC) was evaluated by chemical colorimetry, quality of life was evaluated by SF-36, and fibrinogen (FIB), C-reactive protein (CRP), antitrypsin (al-AT), and interleukin-6 (IL-6) levels were determined by immunoturbidimetry. Complications and postoperative recurrence were recorded. VAS scores in the TEP group were lower than those in the TAPP group. Operative time, hospital stay, time for postoperative activity out of bed, and time taken to exhaust were shorter in the TEP group than in the TAPP group. Intraoperative blood loss was less in the TEP group than in the TAPP group. GAS, MTL, SOD, and T-AOC were higher, and MDA, β-EP, CRP, FIB, alAT, IL-6, MMP-2, MMP-9, and TIMP-1 were lower in the TEP group than the TAPP group. Quality of life was improved in the TEP group compared with the TAPP group. There was no significant difference in the rate of postoperative complications and recurrence rates between both groups of patients. For IHs, laparoscopic TEP repair can effectively relieve pain, reduce inflammatory factors and oxidative stress indices, and facilitate postoperative recovery.

Is previous radical prostatectomy a contraindication to minimally invasive inguinal hernia repair? A contemporary meta-analysis.

Traditionally, radical prostatectomy (RP) has been considered a contraindication to minimally invasive inguinal hernia repair. Purpose of this systematic review was to examine the current evidence and outcomes of minimally invasive inguinal hernia repair after RP. Web of Science, PubMed, and EMBASE data sets were consulted. Laparoscopic transabdominal preperitoneal repair (TAPP), robotic TAPP (r-TAPP), and totally extraperitoneal (TEP) repair were included. Overall, 4655 patients (16 studies) undergoing TAPP, r-TAPP, and TEP inguinal hernia repair after RP were included. The age of the patients ranged from 35 to 85 years. Open (49.1%), laparoscopic (7.4%), and robotic (43.5%) RP were described. Primary unilateral hernia repair was detailed in 96.3% of patients while 2.8% of patients were operated for recurrence. The pooled prevalence of intraoperative complication was 0.7% (95% CI 0.2-3.4%). Bladder injury and epigastric vessels bleeding were reported. The pooled prevalence of conversion to open was 0.8% (95% CI 0.3-1.7%). The estimated pooled prevalence of seroma, hematoma, and surgical site infection was 3.2% (95% CI 1.9-5.9%), 1.7% (95% CI 0.9-3.1%), and 0.3% (95% CI = 0.1-0.9%), respectively. The median follow-up was 18 months (range 8-48). The pooled prevalence of hernia recurrence and chronic pain were 1.1% (95% CI 0.1-3.1%) and 1.9% (95% CI 0.9-4.1%), respectively. Minimally invasive inguinal hernia repair seems feasible, safe, and effective for the treatment of inguinal hernia after RP. Prostatectomy should not be necessarily considered a contraindication to minimally invasive inguinal hernia repair.

Comparison of postoperative chronic inguinal pain between the lichtenstein and laparoscopic techniques in the treatment of inguinal hernia: a systematic review and meta-analysis.

Currently, inguinal hernias are highly prevalent in the Brazilian population, accounting for 75% of all abdominal wall hernias. The recommended treatment to correct them is inguinal herniorrhaphy, which can be performed through open surgery, mainly using the Lichtenstein technique, or laparoscopically, primarily through Transabdominal Preperitoneal Repair (TAPP) or Total Extraperitoneal Repair (TEP) approaches. Like any surgery, these procedures have post-operative complications, with pain being the most common and debilitating. Currently, in European and Brazilian guidelines, the open Lichtenstein and endoscopic inguinal hernia techniques are recommended as best evidence-based options for repair of a primary unilateral hernia providing the surgeon is sufficiently experienced in the specific procedure. In that matter, the surgeon should make a choice based on assessment of the benefits and risks of performing each of them, and practice shared making decision with it patient. Therefore, the objective of this review was to assess the incidence of chronic postoperative pain by comparing the aforementioned surgical approaches to evaluate which procedure causes less disability to the patient. The search conducted untilMay 2024 was performed on Medline (PubMed), Cochrane (CENTRAL), and Lilacs databases. The selection was limited to randomized clinical trials, nonrandomized clinical trials and cohort studies comparing TAPP or TEP to LC, evaluating the incidence of chronic postoperative pain published between 2017 and 2023. Evidence certainty was assessed using the GRADE Pro tool, and bias risk was evaluated with the RoB 2.0 tooland ROBINS I tool. Thirteen studies were included. RESULTS: The meta-analysis showed a significant difference between the groups in both techniques, favoring the laparoscopic approach, which had a lower occurrence of postoperative inguinodynia with a relative risk of 0.49 (95% CI = 0.32, 0.75; I2 = 66% (P = 0.001); Z = 3.28 (P = 0.001) with low certainty of evidence. The presence of chronic postoperative pain was lower in laparoscopic TEP/TAPP techniques when compared to the open Lichtenstein technique, meaning that the former can bring more benefits to patients who requires inguinal herniorrhaphy. Nevertheless, further randomized clinical trials are needed to optimize the analysis, minimizing the bias.

Prospective randomized study comparing mesh displacement in enhanced-view totally extraperitoneal versus totally extraperitoneal laparoscopic inguinal hernia repair without mesh fixation.

In laparoscopic inguinal hernia repair, it is thought that the mesh can be displaced more in the enhanced-view totally extraperitoneal (eTEP) technique. The aim of this study was to compare eTEP and totally extraperitoneal (TEP) techniques without mesh fixation in terms of mesh displacement and hernia recurrence. Between December 2022 and April 2023, 60 consecutive patients with unilateral inguinal hernia were randomized into two groups; eTEP group (n = 30) and TEP group (n = 30). There was without mesh fixation in both groups. Study was registered at http://Clinicaltrials.gov (NCT06070142). The mesh was marked with three radiopaque clips. Pelvic radiographs were performed to evaluate the displacement of the mesh. The primary outcome of this study was mesh displacement. In addition, this is the first study in the literature to compare eTEP and TEP techniques in terms of mesh displacement without fixation in laparoscopic inguinal hernia. There was no significant difference between the groups in terms of mesh displacement, recurrence, postoperative VAS scores, length of hospital stay, hematoma, and seroma formation. The operation time was higher in the eTEP group and was statistically significant. Without mesh fixation, the eTEP technique does not increase the risk of mesh displacement and recurrence. The eTEP technique can be safely applied without mesh fixation in laparoscopic inguinal hernia repairs. ClinicalTrials number: NCT06070142.

Risk factors of conversion of laparoscopic totally extraperitoneal repair of inguinal hernia

Background: Inguinal hernia occurs in 1 to 5% of the general population. The development of laparoscopic inguinal hernia repair techniques as an alternative to conventional open surgery has improved results such as less postoperative pain, shorter hospital stays, and faster recovery. This study was conducted to assess the risk factors of conversion of laparoscopic totally extraperitoneal repair of inguinal hernia. Method: A total of 200 patients who were scheduled to undergo TEP were enrolled. Complete demographic and clinical details of all the patients was obtained. A Performa was made and detailed intraoperative findings were evaluated. Baseline hemodynamic and biochemical profile was evaluated. Separate assessment of patients was done who were converted to open surgery. Comparison of patients was done among those with and without conversion. Various risk factors were evaluated which were responsible for conversion. All the results were recorded in Microsoft excel sheet and were subjected to statistical analysis using SPSS software. Results: Mean age of the patients was 49.2 years. 60.5 percent of the patients were of rural residence. Mean BMI of the patients was 24.8 Kg/m2. Incidence of conversion was 6.5 percent. Geriatric age, obesity, higher ASA grade, larger hernial defects, larger peritoneal tear and previous hernia surgery history was found to be significant risk factors for conversion. Conclusion: Laparoscopic totally extraperitoneal (TEP) repair of inguinal hernia is an effective technique, but conversion to open surgery occurs in 6.5% of cases. Significant risk factors for conversion include geriatric age, obesity, higher ASA grade, larger hernial defects, larger peritoneal tear, and previous hernia surgery history. Identifying these risk factors can help optimize patient selection and improve outcomes for TEP repair.

A prospective study comparing intra-operative and postoperative complications in totally extra peritoneal repair vs extended totally extra peritoneal for inguinal hernia

Introduction: Inguinal hernia repair is one of the most common surgical procedures worldwide. Total extra peritoneal repair (TEP) and Extended-TEP (eTEP) are widely used minimally invasive methods. TEP involves creating a space in the preperitoneal plane without entering the abdominal cavity, whereas eTEP extends this approach, allowing for a broader operative field.This study compares the intra-operative and postoperative complications of TEP and eTEP, contributing to the optimisation of inguinal hernia management. Methods: It is a prospective study. A total of 60 patients who underwent TEP and e-TEP for inguinal hernia, who fulfilled the inclusion criteria. Patients were randomised by simple random sampling technique and were divided into two groups of 30 each (group A-TEP and group B-eTEP). Data of both groups were compared and analysed for statistical significance using Chi square test and Student ‘t’ test. Result: The comparative analysis between TEP and eTEP procedures shows no significant differences in demographic parameters. However, eTEP demonstrates significantly shorter operative time and hospital stay, quicker return to work. Both procedures have similar rates of low intra-operative and postoperative complications, indicating comparable safety profiles. Conclusion: Our study suggest that both techniques are associated with low complication rates and good patient outcomes, with eTEP showing potential advantages in terms of pain, recovery and wider access. These findings help to take better surgical decision, to make and helped optimize patient care in inguinal hernia management.

WP1.11 - Total Extra Peritoneal (TEP) Inguinal hernia repair is safe and feasible for recurrent inguinal hernia post Total Extra Peritoneal repair "TEP on TEP is possible”

Abstract This abstract share our experience in surgical management of recurrent inguinal hernia post total extra peritoneal (TEP) repair by utilizing the same approach TEP. Methods Two patients with recurrent inguinal hernia post TEP were consulted for laparoscopic VS open approach, and both opted for the laparoscopic approach, understanding the higher risk of conversion. Result The first case of 62y male with recurrent left inguinal hernia after bilateral TEP. The second case of 69y male with recurrent left inguinal hernia post lap TEP repair. Standard three lower midline ports technique, no balloon spacer was used. The first and most important step was developing the plane above the previous mesh. 20 ml of 1 % xylocaine and 1/200000 was instilled in the extra peritoneal space to minimize oozing. Separating the previous mesh from the inferior epigastric artery and posterior wall of rectus muscle, down into bony lard marks and cord structures was performed using suction and sharp dissection with minimal diathermy. All landmarks were exposed in the three zones, before utilizing anatomical mesh. Both patients stayed overnight and operation time was 84 and 90 minute respectively. Three months follow up showed no recurrence or significant pain. Conclusion To our knowledge, this is first study describe the use of TEP on TEP. It suggests that TEP should not be excluded in patients with previous posterior mesh repair, emphasizing the importance of proper consultation. The abstract calls for further cases and studies to assess the efficacy and safety of this approach.

SP1.1 - The effect of mesh fixation on post-operative pain and recurrence in laparoscopic inguinal hernia repair

Abstract Aims To evaluate post-operative pain and inguinal hernia recurrence following laparoscopic totally extraperitoneal (TEP) or transabdominal preperitoneal (TAPP) techniques. Secondly, in TAPP approach to compare outcomes with method of mesh fixation. Methods 545 patients underwent elective laparoscopic inguinal hernia repair in a single centre, between October 2015 and April 2023. Surgical approach and method of mesh fixation was obtained from operation note. Patients were contacted retrospectively via telephone call. Post-operative pain was assessed using a scale (1-10). Chronic pain defined as pain persisting beyond 3 months. Hernia recurrence defined as new groin lump at site of previous repair. Results 545 patients underwent surgery. 212 did not answer follow-up call, 43 declined to take part in study and 22 had died. 268 analysed; 167 underwent TEP and 101 TAPP inguinal hernia repair. Groups were similar in age and gender. Initial post-operative pain score in TEP group was 4.7 (range 1-10) as compared with 4.5 (range 1-10) in TAPP group.13.8% experienced chronic pain, score of 2.9 (range 2-5) in TEP group compared with 16.8%, score of 2.7 (range 2-5) in TAPP group. Hernia recurrences were similar between groups; 4.8% and 4% respectfully. Neither mesh-fixation or non-fixation techniques were found to affect post-operative chronic pain (p=0.8). Patients undergoing tacker fixation reported less hernia recurrence, 1.7% and 5.1% respectfully. No significant difference noted between absorbable and metallic tackers in terms of chronic post-operative pain and recurrence. Conclusion Mesh placement without fixation produced similar post-operative pain but a higher hernia recurrence than mesh-fixation techniques.

Comparison of Clinical Outcomes of Laparoscopic Totally Extraperitoneal (TEP) and Transabdominal Preperitoneal (TAPP) Techniques in Bilateral Inguinal Hernia Repair: A Retrospective Study.

This study compared the clinical outcomes of two commonly used laparoscopic techniques, transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) repair, in the treatment of bilateral inguinal hernias. This retrospective cohort study included 250 patients who underwent laparoscopic bilateral inguinal hernia repair using either the TEP or TAPP technique between May 2009 and May 2024. The patients were divided into two groups: 50 patients in the TEP group and 200 in the TAPP group. Data were collected from patient records, including demographics, type of hernia, surgical details, intraoperative and postoperative complications, conversion rates, and early hernia recurrence. Statistical analysis was performed to compare outcomes between the two groups. Among the 250 patients included in the study, the mean age was 51.62 ± 8.79 years, and 94% (n=235) were male. The mean operative time was significantly longer in the TEP group (93.2 ± 13.0 minutes) than in the TAPP group (57.95 ± 7.5 minutes) (p <.001). The mean hospital stay was also longer in the TEP group (1.36 ± 0.48 days) compared to the TAPP group (1.07 ± 0.25 days) (p <.001). The TEP group had a higher rate of conversion to open surgery 18%(n=9) and conversion to TAPP 10% (5) than the TAPP group, which had no conversions (p <.0001). Postoperative complications were more frequent in the TEP group, with urinary retention being significantly higher at 16%(n=8) than in the TAPP group at 2% (n=4) (p <.0004). Additionally, the TAPP group experienced two (1%) notable intraoperative complications that required reoperation: arterial injury and small bowel injury. The findings suggest that, while both TEP and TAPP effectively repair bilateral inguinal hernia, TAPP is associated with shorter operative times, shorter hospital stays, and fewer postoperative complications. However, the TAPP technique also presented notable intraoperative risks, including arterial and bowel injury. The choice between TEP and TAPP should be based on the surgeon's experience, patient characteristics, and the specific clinical context.

Is previous prostatectomy a risk factor for postoperative complications following minimally invasive inguinal hernia repair? A systematic review and meta-analysis.

The literature indicates that patients with prior pelvic surgery, particularly radical prostatectomy, pose challenges in minimally invasive inguinal hernia repair (IHR). However, there is no conclusive evidence regarding the impact of pelvic surgery on postoperative complications. To address this gap, we conducted a systematic review and meta-analysis to evaluate the influence of previous prostatectomy in men undergoing MIS IHR. We searched Cochrane Central, Scopus, SciELO, Lilacs, and PubMed/MEDLINE for studies comparing men undergoing MIS IHR after prostatectomy with men without previous pelvic surgery. Key outcomes evaluated included recurrence, overall postoperative complications, seroma, hematoma, surgical site infection (SSI), conversion rates, and operative time. Out of 402 screened studies, 9 met the inclusion criteria. Among the included studies, three analyzed totally extraperitoneal (TEP) technique, while four analyzed transabdominal preperitoneal (TAPP) and two presented both techniques together. The analysis comprised 189,183 patients, of which 4551 (2.4%) had a history of prostatectomy. The analysis revealed that post-prostatectomy patients presented higher postoperative complications (3.7% vs. 1.9%; RR 1.9; 95% CI [1.23; 2.94]; P = 0.004) and seroma (1.6% vs. 0.9%; RR 1.58; 95% CI [1.23; 2.04]; P < 0.001) following MIS IHR. Additionally, patients with a previous prostatectomy presented an increased operative time (MD 21.25min; 95% CI [19.1; 23.4]; P < 0.001). No significant differences were observed in recurrence (0.98% vs. 0.92%; RR 1.1; 95% CI [0.8; 1.53]; P = 0.54), SSI (0.07% VS. 0.07%; RR 0.99; 95% CI [0.34; 2.9]; P = 0.98), hematoma (3.6% vs. 1.2%; RR 3.18; 95% CI [0.84; 12.1]; P = 0.09), and conversion rates (1.1% vs. 0.9%; RR 1.26; 95% CI [0.91; 1.72]; P = 0.16). However, subgroup analysis of TEP technique in patients with previous prostatectomy showed higher conversion rates (2.4% vs. 0%; RR 20; 95% CI [2.9; 138.2]; P < 0.01). Analysis using funnel plots showed the absence of publication bias in the study outcomes. This comprehensive analysis indicates that patients with a history of prostatectomy undergoing MIS IHR may present higher postoperative complications and an increased operative time. Further comparative studies are needed to evaluate the cumulative impact of MIS IHR in patients with previous prostatectomy.

Combining Innovative Techniques: Total Extraperitoneal Approach in Orthopedic Surgery (O-TEP) and Percutaneous Both Column Screw (BCS) Fixation Technique in a Geriatric Acetabular Fracture Case.

The concepts of both column fixation corridor (BCFC) and both column screws (BCS) along with the orthopedic total extraperitoneal approach (O-TEP) are highly innovative approaches in orthopedic surgery. However, the orthopedic literature lacks sufficient studies on these topics, indicating a significant gap. This case report aims to highlight how combining these innovative techniques can facilitate the use of BCFC and BCS in the treatment of acetabular fractures with O-TEP, thereby enhancing the feasibility of endoscopic techniques. Furthermore, we aim to discuss the potential advantages of BCFC and BCS concepts when used in O-TEP.For this purpose, we present a case of a 74-year-old geriatric patient with a transverse acetabular fracture involving the posterior column. The quadrilateral surface was exposed using the O-TEP approach, and the fracture was reduced using a fully endoscopic approach. The fixation was achieved using BCS and a Magic screw through percutaneous screw placement.The patient's clinical condition was followed for at least 13 months. The clinical outcomes demonstrated the effectiveness of combining these innovative techniques in the treatment of acetabular fractures, with satisfactory healing and functional recovery observed.This case report illustrates that combining BCFC and BCS with the O-TEP approach can facilitate the treatment of acetabular fractures with minimally invasive techniques and enhance the feasibility of endoscopic procedures. These findings suggest potential advantages of using BCFC and BCS concepts in O-TEP, warranting further investigation and study.

A comparative study on effects of defect closure versus non-closure in laparoscopic totally extraperitoneal repair of direct inguinal hernia.

Totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) repair are the principal techniques in laparoscopic hernia repair. Seroma formation and pain are frequent complications of moderate-large size laparoscopic direct inguinal hernia mesh repair. This study was conducted to evaluate the feasibility of defect closure in moderate-large direct inguinal hernias and its effect on various outcomes. This is a prospective cohort study from September 2020 to August 2021, where a total of 88 patients with uncomplicated direct inguinal hernia (M3 or more) were enrolled in the study and divided into two equal groups of TEP defect closure and non-closure, and various outcome measures were noted. The majority of patients were male (94.31%), with a mean age range of 18-85 years, and had right-sided inguinal hernia (46.5%). Seroma formation at 10th POD in the defect closure and non-closure were 24% and 33% (p value: 0.225), which reduced to 11% and 18%, respectively, at 1 month (p value: 1.000). All seromas resolved within 6 months. Pain in VAS at 10th POD in the defect closure and non-closure were 1.55±0.571 and 1.38±0.527, respectively (p value: 0.121), which gradually decreased to 1.20±0.524 and 1.16±0.420 at a 6-month interval (p value: 0.689). The mean operative time in the bilateral and unilateral defect closure groups was 72.3±4.1 and 56.5±4.3 min, respectively, whereas that in the bilateral and unilateral defect non-closure groups was 62.3±3.7 and 45.7±3.6 min, respectively. The defect closure was found to have higher pain and less seroma formation at various intervals of time following TEP for moderate-large direct inguinal hernia. Although these findings were statistically insignificant, they may be clinically significant, and further studies with a larger sample size are suggested.

N-Butyl-2-Cyanoacrylate Adhesive Versus Absorbable Tacks in Laparoscopic Groin Hernia Repair: A Multicenter Randomized Clinical Trial.

We aimed to determine whether n-butyl-2-cyanoacrylate (NB2C) adhesive is a safe and effective mechanism for nonpenetrating mesh and peritoneal fixation during laparoscopic groin hernia repair. Chronic pain after laparoscopic groin hernia repair has been associated with penetrating fixation, but there had been no US Food and Drug Administration-approved devices for nonpenetrating fixation in this context. Patients undergoing laparoscopic transabdominal preperitoneal (TAP) or totally extraperitoneal (TEP) groin hernia repair with mesh at 1 of 5 academic medical centers were randomized to mesh (TAP/TEP) and peritoneal (TAP) fixation with NB2C adhesive or absorbable tacks. The primary outcome was improvement in pain (visual analog scale [VAS]) at 6 months. The noninferiority margin was 0.9 (α = 0.025; β = 80%). Recurrence, successful use of the device, quality of life, and rates of adverse events (AEs) were secondary outcomes. From 2019 to 2021, 284 patients were randomized to either NB2C adhesive or absorbable tacks (n = 142/142). Patient and hernia characteristics were comparable, and 65% were repaired using a TAP approach. The difference in VAS improvement at 6 months with NB2C adhesive was not inferior to absorbable tacks in intention-to-treat and per-protocol analyses, respectively (0.25 [95% CI, -0.33 to 0.82]; P = 0.013; 0.22 [95% CI, -0.36 to 0.80], noninferiority P = 0.011). There were no differences in secondary outcomes including recurrence, successful use of each device to fixate the mesh and peritoneum, quality of life, and additional VAS pain scores. Rates of adverse and serious AEs were also comparable. NB2C adhesive is safe and effective for mesh fixation and peritoneal closure during laparoscopic groin hernia repair.

COMPARISION OF LICHTESTEIN OPEN TENSION-FREE VERSUS LAPROSCOPIC TOTALLY EXTRAPERTIONEAL TECHNIQUE FOR INGUINAL HERNIA REPAIR

Objectives: The study aimed to assess and compare Litchtenstein’s open tension-free and laparoscopic totally extraperitoneal (TEP) mesh repair. Methods: This hospital-based comparative type of observational study was conducted on 50 cases for each of two groups at upgraded Department of General Surgery, SMS Hospital, Jaipur, between January 2014 and January 2016. All the cases of elective inguinal hernia coming to SMS outpatient department in a single surgical unit operated by a single surgeon in the given period which meet the inclusion and exclusion criteria. Thus, collected data were entered in Microsoft Excel sheet and analysis was done by Epi info software of CDC. Results: Total 100 patients were included in this study; 50 each in the two groups, the laparoscopic TEP group and open Lichtenstein group. Mean age in the laparoscopic group was 39.54 years and the open Lichtenstein group was 42.78 years. The mean pain score out of 10 at 24 h was 2.96 (±0.638) and 3.60 (±0.969) in TEP and Lichtenstein groups, respectively. The mean return to work for open group was 17.00 and TEP group was 11.34 days. There is no any recurrence and readmission in both groups. Conclusion: Laparoscopic TEP repair may be done in all uncomplicated inguinal hernia by an experienced surgeon for those desiring less pain, better cosmotic results, less post-operative complications, less hospital stay, and early return to work.

Laparoscopic Totally Extraperitoneal (TEP) Left Indirect Inguinal Hernia Repair with Mesh

Laparoscopic Totally Extraperitoneal (TEP) Left Indirect Inguinal Hernia Repair with Mesh

Subcutaneous fat thickness predicts postoperative seroma following laparoscopic total extra-peritoneal hernioplasty.

Seroma formation is the most common cause of morbidity associated with laparoscopic inguinal hernia repair. This study aimed to examine the relationship between the thickness of subcutaneous fat (TSF) and the risk of postoperative seroma. We reviewed data from a prospective cohort of 229 male patients who underwent laparoscopic total extra-peritoneal (TEP) hernioplasty for indirect inguinal hernia between August 2018 and July 2021. The TSF was assessed using preoperative ultrasound images. The risk factors for postoperative seroma were determined using univariate and multivariate logistic regression models. Postoperative seromas occurred in 26 patients (11.4%). The factors associated with postoperative seroma included longer hernia duration, larger hernia defects, extension into the scrotum, and greater TSF (P < 0.05). In multivariate analysis, a greater TSF was independently associated with a greater risk of postoperative seroma (per 1mm: odd ratio [OR] 1.105, 95% confidence interval [CI] 1.048-1.165, P < 0.001; TSF ≥ 26.0mm: OR 7.033, 95% CI 2.485-19.901, P < 0.001). Similar results were obtained in the subgroup analysis. The area under the curve of TSF for predicting seroma formation was 0.703 (95% CI 0.601-0.806). Ultrasound-derived TSF may be a promising prognostic factor for postoperative seroma in patients undergoing laparoscopic TEP repair. Further validation is required and then this parameter can be used to improve decision-making process.

Telescopic dissection versus balloon dissection during laparoscopic totally extraperitoneal inguinal hernia repair: A prospective randomised control trial.

Totally extraperitoneal (TEP) repair involves creating a preperitoneal space. The preperitoneal space can be created by balloon or telescopic dissection (TD). Nevertheless, these techniques may have some complications. However, there are very few studies that compare these two techniques. This study aims to assess the impact and comprehensively compare the TD and balloon dissection (BD) methods in patients undergoing laparoscopic TEP inguinal hernia repair. This was a single-centre, double-blinded, prospective, randomised, controlled trial comparing BD and TD for the creation of the preperitoneal space. The primary end point was to compare the post-operative pain score, intraoperative complications and surgical site occurrence between the two groups. The secondary end point was to assess the impact of the dissection technique on operative time for the creation of extraperitoneal space during laparoscopic TEP inguinal hernia repair. A total of 46 patients were included in the study (23 in each group). Baseline parameters were comparable between the groups. The total operative time between the groups (120 min vs. 160 min; P < 0.005) was statistically significant. The incidence of the peritoneal breach was statistically less in the BD group (43% vs. 13%; P < 0.005). Other short-term and long-term complications were less in the BD group but not statistically significant. BD in TEP inguinal hernia repair reduces the operative time and peritoneal breach. When compared to TD in terms of operative time, routine use of BD can be proposed. It will be beneficial in the early part of the learning curve.