Total Extraperitoneal Inguinal Hernia Repair Research Articles

Totally extraperitoneal inguinal hernia repair with or without fixation leads to similar results. Outcome of randomized prospective trial.

IntroductionThe use of implants in inguinal hernia repair has reduced its recurrence rate. However, postoperative groin pain still remains an unresolved problem. There are suggestions that in totally extraperitoneal inguinal hernia repair (TEP-IHR) two of the likely factors responsible for pain are use of fixation and the type of fixation used.AimTo evaluate the impact of mesh fixation on the incidence of postoperative pain, restriction of physical activities, hernia recurrence risk, return to normal activities and demand for analgesics in patients after unilateral TEP-IHR.Material and methodsUnilateral TEP-IHR was performed in 139 male patients randomized to three groups: self-gripping mesh (SG), lightweight mesh (L) and lightweight mesh with fixation (LF). Full study-inclusion criteria were met by 110 patients; 43, 18 and 49 in groups SG, L and LF respectively. Follow-up occurred on the 1st, 2nd, and 7th day and 3, 6, 12 months postoperatively. The numeric rating scale (NRS) was used to assess pain and the EuraHS-QoL (European Registry for Abdominal Wall Hernias Quality of Life Score) questionnaire to compare quality of life (QoL) prior to surgery and one year later.ResultsNo statistically significant differences were observed between study groups with regard to the incidence rate and intensity of acute post-operative pain, chronic pain, analgesic demand, return to normal activity, hernia recurrence rate and post-operative QoL.ConclusionsLack of fixation in TEP-IHR does not increase the risk of hernia recurrence, and its presence does not significantly worsen the treatment results; especially it does not increase the incidence of chronic pain.

Triangle Trocar Configuration in Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair: A Prospective Randomized Controlled Study

BackgroundIn totally extraperitoneal (TEP) operation, when trocars are arranged with midline configuration, operative instruments can easily interfere with each other because of the small operative angle. The triangle trocar configuration, which creates a large operative angle, may minimize interference. Therefore, we evaluated the use of triangle trocar configuration in TEP inguinal hernia repair. MethodsA prospective randomized controlled study was conducted in 113 patients of laparoscopic TEP inguinal hernia repair in the Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, between July 2016 and June 2017. Patients were randomly assigned to TEP laparoscopic inguinal hernioplasty with triangle trocar configuration (study group, n = 59) or midline trocar configuration (control group, n = 54). Perioperative outcomes (operative time, operative complications, postoperative pain, hospital stay, and costs), early postoperative complications (seroma/hematoma and uroschesis), and mid-term outcomes (late postoperative complications and recurrence) were observed and compared. ResultsAfter a mean follow-up of 10.21 ± 2.32 mo, there was no significant difference in operative time, operative complications, postoperative pain, postoperative hospital stay, costs, postoperative complications, and recurrence rate between the two groups. The indirect hernia sac dissection time was shorter in the study group than in the control group. ConclusionsTriangle trocar configuration in TEP laparoscopic hernia repair is safe and reliable and is an option for hernia surgeons. The technique creates a large operative angle and avoids interference between endo-instruments, which facilitates TEP and decreases the indirect hernia sac dissection time.

Comparison of minimally invasive preperitoneal (MIP) single-layer mesh repair and total extraperitoneal (TEP) repair for inguinal hernia in terms of postoperative chronic pain: a prospective randomized trial.

The aim of this study was to compare minimally invasive preperitoneal (MIP) single layer mesh repair with total extraperitoneal (TEP) inguinal hernia repair in terms of complications, recurrence, and chronic pain. A total of 240 patients who underwent elective, primary, unilateral inguinal hernia operation between April 2011 and September 2012 were divided into two randomized groups. The first group underwent MIP repair and the second group underwent TEP repair. Visual Analogue Scale (VAS) and Sheffield Scale (SS) were used to evaluate chronic pain. In all, 225 (95%) of the patients completed follow-up and were included in analyses. A significant difference was not detected between groups in terms of demographics, operative time, or intraoperative, early, or late complications. Length of time before return to work was significantly shorter in the TEP group (p <0.001). Recurrence was seen in 1 (0.88%) patient in the MIP group and 1 (0.89%) patient in the TEP group (p= 0.993). Evaluation of chronic pain revealed no significant difference between groups in VAS and SS values at postoperative 6th, 12th, and 24th months. In conclusion, it was observed that MIP repair for inguinal hernia has all of the advantages of preperitoneal repair and eliminates disadvantages of TEP repair. MIP technique is as safe as TEP repair and has similar qualities in terms of chronic pain, even though it is an open intervention.

Coagulation and deep vein flow changes following laparoscopic total extraperitoneal inguinal hernia repair: a single-center, prospective cohort study.

Venous thromboembolism (VTE) is a serious complication encountered in surgical practice. The purpose of this study was to identify changes in coagulation status and deep vein flow parameters, within 24h postoperatively, for patients undergoing laparoscopic total extraperitoneal inguinal hernia repair (TEP). For 144 patients undergoing TEP, coagulation markers including prothrombin time (PT), partial thromboplastin time, thrombin time, D-dimer, fibrinogen, fibrin degradation products (FDP), and international normalized ratio (INR) were monitored preoperatively and in the first morning postoperatively. Echo-Doppler recordings preoperatively and again within 24h postoperatively were completed for 23 patients to monitor lower extremity deep vein flow parameters including speed of flow (cm/s), diameter (cm), and cross-sectional area (cm2). Clinically significant VTE and other complications were recorded. No significant VTE were diagnosed. Significant increases were seen in the first morning postoperatively for PT, D-dimer, FDP, and INR (P < 0.05). Stratified by age, except for those < 50years, the ratio of value-outside-the-normal-range (VONR) for D-dimer and FDP increased significantly postoperatively for all age groups. Stratified by operation duration, a significant difference in the ratio of VONR in D-dimer was identified postoperatively between those with an operation duration < 60min and ≥ 60min. There were significant decreases in the iliac and common femoral vein flow velocity of the ipsilateral extremity postoperatively (P < 0.05). Activated hypercoagulability and hampered lower extremity deep vein flow were observed immediately after TEP. DVT formation was more pronounced in older patients and for those with operation duration ≥ 60min. Proper VTE risk stratification for laparoscopic inguinal hernia repair (LIHR) and prophylaxis early after LIHR should be important clinical considerations.

Laparoscopic total extraperitoneal inguinal hernia repair is safe and feasible in patients with continuation of antithrombotics.

Aims:We aimed to evaluate the safety and feasibility of laparoscopic total extraperitoneal (TEP) inguinal hernia repair in patients with the continuation of their antithrombotic agents.Settings and Design:This was prospective cohort study.Materials and Methods:A total of 115 patients who underwent TEP inguinal hernia repair between January 2015 and September 2016 were included in the analysis. Seventeen patients continued their antithrombotics (antithrombotic group); the other 98 had not been on antithrombotics (control group).Statistical Analysis Used:The analysis was performed by using Mann–Whitney U-test, Chi-square or Fisher's exact test.Results:The antithrombotic group had a greater mean age (65.9 ± 8.0 vs. 57.7 ± 13.6, P = 0.002) and higher prevalence of hypertension (64.7% vs. 33.7%, P = 0.015), cardiovascular diseases (64.7% vs. 7.1%, P < 0.001), atrial fibrillation (23.5% vs. 0, P < 0.001), ischaemic heart disease (35.3% vs. 0, P < 0.001) and the American Society of Anaesthesiologists ≥2 (94.1% vs. 81.6%, P = 0.005). The operation time for the antithrombotic group was longer than that of the control group (92.06 ± 32.81 min vs. 72.33 ± 20.99 min, P = 0.015). None experienced conversion to open surgery in either group. There was no difference in the post-operative complications (29.4% vs. 28.6%) and sero-haematoma formation (23.5% vs. 11.1%). The analgesic requirement, hospital stays (23.72 ± 7.74 vs. 22.35 ± 10.33 h) and the time for return to normal daily activity (3.56 ± 1.74 vs. 3.63 ± 1.90) were not statistically different between the two groups. None in either group experienced major cardiovascular events within 30 days.Conclusions:Laparoscopic TEP inguinal hernia repair can be safely performed in patients with the continuation of their antithrombotic agents in experienced hands.

Local anesthesia for open mesh repair of recurrences after previous total extraperitoneal inguinal hernia repair

INTRODUCTION: Optimum treatment for recurrences after laparoscopic repair of inguinal hernia (IH) is debatable. Guidelines recommend open repair under general anesthesia (GA), whereas emerging studies show relaparoscopy as a feasible option. Both require GA and incur extra cost. Does open surgery under local anesthesia (LA) is an option for recurrent hernia following laparoscopic surgery? METHODS: This is a retrospective review of medical reports of four patients who underwent open mesh repair under LA for recurrences after previous laparoscopic IH repair between May 2015 and August 2018. RESULTS: All the patients were male with a mean age of 50 years and 3 months (range 36–64 years). All the patients have primarily underwent total extraperitoneal (TEP) repair. Inadequate deperitonealization at the deep ring (n = 2), mesh migration (n = 1), and missed indirect sac were the causes for recurrences. All the patients underwent tension-free Lichtenstein repair under LA. The mean operative time was 25 min (range, 18–32 min). Tissue planes were well preserved and separation of cord structures from hernia sac and preservation of ilioinguinal nerve were possible in all cases. No conversions to GA. None of the patients had long-term morbidity or recurrences during the mean follow-up period of 1 year and 7 months (range, 1 month–2 years). All the cases were performed as day-case procedures. CONCLUSION: Open mesh repair under LA is a safe and effective option for recurrences after previous TEP repair of IH.

Laparoscopic total extraperitoneal inguinal hernia repair: Retrospective study on prosthetic materials, postoperative management, and quality of life.

Laparoscopic inguinal hernia repair is one of the most frequently performed operations. However, the search for the most appropriate prosthetic materials continues to occupy the surgical community. The purpose of this study was to evaluate the postoperative short- and mid-term effects (like duration of stay, number and type of complications, and inguinal pain) of laparoscopic inguinal hernia repair using the total extraperitoneal (TEP) approach. The evaluation encompassed different types of mesh and fixation devices, as well as medications prescribed during hospitalization.This retrospective study was conducted at the General, Laparoendoscopic, Bariatric, and Robotic Surgical Clinic of the Athens Medical Center. Clinical data from 524 patients were evaluated. The answers from an appropriately designed questionnaire completed from each individual were used to obtain information about their postoperative course. The statistical analysis was implemented in SPSS v 23.Analysis revealed that pain sensation on discharge decreased with increasing age (P < .05). No clear relationship was found between surgical clips and pain (P = .292), as well as mesh absorbability and chronic pain (P = .539). The major postoperative complications were annoyance and discomfort (15.9%). The recurrence rate was 1.7%.Postoperative complications following the TEP approach were mostly found to be minor; chronic pain, as an aspect of impaired quality of life, was not experienced in the majority (89.08%). The properties of prosthetic materials used and the type of medications prescribed were not found to exert a significant role in satisfactory postoperative outcomes.

EXTRAPERITONIAL HERNIA REPAIR

Objectives: To explore the learning curve associated with laparoscopic totallyextraperitoneal repair of inguinal hernia, procedure being carried out by single surgeon attertiary care hospital. Study Design: Prospective cohort. Place and Duration: It was conductedat Shifa International Hospital Islamabad from October 2014 to March 2016. Patients andMethods: Consecutive patients undergoing Laparoscopic TEP repair for unilateral or bilateralinguinal hernia from October 2014 to March 2016 were included in the study and divided in twogroups: group 1 of first 50 and group 2 consisting of the next 50 patients. Results: A total of100 patients divided in two groups (50 in each) were included in the study. Group I includedfirst 1 to 50 cases with mean age of 46.6 years (SD +14.81) including 46 (92%) male and 4 (8%)female with similar distribution in group II which consisted of 51 to 100 cases with mean age45.3 years (SD +14.43) including 44 (88%) male and 6 (12%) female. The mean operative timein group I was 78 min (SD +32.30) while in group II the mean operative time was 41.2 minutes(SD+15.99). Conclusion: Although our results are from single centre and single surgeon study,we believe that at least 20 to 30 laparoscopic TEP hernia operations are required to help youngsurgeon familiarize with the anatomy of the region. The learning curve for TEP according to ourstudy is 50 cases.

An 11-year analysis of reoperated groins after endoscopic totally extraperitoneal (TEP) inguinal hernia repair in a high volume hernia center.

Developments in inguinal hernia surgery have substantially lowered recurrence rates, yet recurrences remain an important outcome parameter of inguinal hernia repair. The aim of this study was to analyze the characteristics of all reoperated groins after endoscopic totally extraperitoneal (TEP) inguinal hernia repair in a high-volume hernia clinic in the Netherlands. All groins with recurrence-like symptoms reoperated after previous TEP inguinal hernia repair between January 2006 and December 2016 were analyzed. Patient characteristics, imaging findings, primary hernia type, time to recurrence and recurrence type were assessed. A total of 137 groins were reoperated in 130 patients. The median age at the TEP procedure was 55years [interquartile range (IQR) 45-64years]. Fifty-seven groins were initially part of a bilateral procedure (42%). Median time until recurrence was 9months (IQR 4-26months). Reoperation findings were a hernia recurrence in 76%, an isolated lipoma in 18%, and no recurrence or lipoma in 6%. The majority of hernias recurred at their initial site (70%), of which the greatest part involved direct hernias. Isolated lipomas were more frequently seen after indirect hernia repair. Inguinal hernia recurrences were still observed in this high-volume hernia clinic. Recurrences were most frequently seen at their initial hernia site, the majority involving direct hernias. Isolated lipomas presenting as a pseudorecurrence were most frequently seen after correction of indirect hernias. In accordance with the current guidelines, reducing recurrence rates can be achieved by mesh fixation in bilateral, large and direct defects and by thoroughly reducing lipomas.

Correction to: Laparoscopic-assisted transversus abdominis plane block as an effective analgesic in total extraperitoneal inguinal hernia repair: a double-blind, randomized controlled trial

In the original publication, one of the co-author 'M. Riaz' details were missed to include in the author group. The complete author group should read as A. Mughal, A. Khan, J. Rehman, H. Naseem, M. Riaz, R. Waldron, M. Duggan, W. Khan, K. Barry, I. Z. Khan.

Laparoscopic-assisted transversus abdominis plane block as an effective analgesic in total extraperitoneal inguinal hernia repair: a double-blind, randomized controlled trial

PurposeLaparoscopic inguinal hernia repair has facilitated early mobilization. Management of post-operative pain is paramount in these day case procedures. The aim of this study was to compare laparoscopic-assisted transversus abdominis plane (TAP) block with periportal local anaesthetic infiltration in managing post-operative pain.MethodsA double-blind, randomized controlled trial was conducted with patients undergoing elective laparoscopic inguinal hernia repair (January 2016–October 2017). The intervention group received laparoscopic-assisted TAP block with 30 ml 0.25% Bupivacaine. The control group received 15ml of 0.5% Bupivacaine at the periportal sites. Primary outcome measure was assessment of post-operative pain scores using numerical rating on visual analogue scale (VAS) at rest and on coughing at 3 h. Efficacy of TAP block was assessed as reduction in mean pain scores in the order of 2 points using the VAS.Results60 (57 males and 3 females) were enrolled; 30 patients were randomized to each group. Patient demographics, anaesthetic and surgical times were similar in both groups. Mean pain scores were significantly reduced in the intervention group at 3 (3.1 vs 1.1 p < 0.001) and 6 h (4.1 vs 1.7 p < 0.001) at rest and on coughing at 3 (4.8 vs 2.1 p < 0.001) and 6 h (5.4 vs 3.0 p < 0.001). Patient satisfaction was higher (8.0 vs 6.8 p < 0.001) and rescue analgesic requirements (169.4vs 71.3 p < 0.001) lower in the intervention group.ConclusionsThis analysis has demonstrated the therapeutic benefit of laparoscopic-assisted TAP block in initial post-operative pain management for patients undergoing elective laparoscopic inguinal hernia repair.

Comparison of slit mesh versus nonslit mesh in laparoscopic extraperitoneal hernia repair.

IntroductionEndoscopic hernia repair integrates the advantages of tension-free preperitoneal mesh support of the groin with the advantages of minimally invasive surgery procedures.AimTo compare outcomes between slit mesh (SM) and nonslit mesh (NSM) placement in laparoscopic totally extraperitoneal (TEP) inguinal hernia repair.Material and methodsThis is a retrospective study of 353 patients who underwent TEP inguinal hernia repair between January 2010 and December 2011. One hundred forty-nine and 154 hernias were operated on in the SM and NSM groups, respectively. Postoperative complications, recurrence, early postoperative pain, and chronic pain levels were evaluated.ResultsIn a total of 303 patients, hernia repair was performed as 395 direct and indirect hernias. Nonslit mesh was converted from TEP to transabdominal preperitoneal patch plasty (TAPP) in 4 patients in the group and 6 patients in the slit mesh group. The average operation time of the SM group was significantly higher than that of the NSM group (p < 0.001). In the evaluation of early postoperative pain, VAS levels of the NSM group were statistically significantly lower than those of the SR group in all evaluations (p = 0.001). The pain rate of the SM group after 3 months of chronic pain was significantly higher than that of the NSM group (p = 0.004). There was no difference in recurrence rate, 6th month chronic pain, wound infection or wound hematoma.ConclusionsThe use of SM and NSM in TEP operations is not different in terms of recurrence and complications. However, the use of NSM gives better results in terms of early postoperative pain and chronic pain.

To compare advantage of non-fixation versus fixation of mesh in Laparoscopic totally Extra Peritoneal (TEP) repair of inguinal hernias

Background: Mesh fixation during laparoscopic totally extra peritoneal repair is thought to be necessary to prevent recurrence of infections and post-operative complications. However, mesh fixation might increase the postoperative complications and chronic pain. This study was to describe the experience of a single surgeon at R.G. Kar Medical College and Hospital performing this operation. This study evaluates the outcomes of laparoscopic hernioplasty performed with and without mesh fixation at our institution.Aims and Objective: To compare advantage of non-fixation versus fixation of mesh in laparoscopic Totally Extra peritoneal (TEP) repair of inguinal hernias. This study was conducted for analysis of outcome with respect to pain, operative time, intra and postoperative complication, days of hospital stay, recurrence regarding the procedure between fixation and non-fixation of mesh in totally extra peritoneal repair of inguinal hernia.Materials and Methods: The study was conducted in the Department of Surgery, R.G.Kar Medical College and Hospital from January 2011 to April 2012. All patients admitted in General surgical unit presenting with uncomplicated unilateral inguinal hernias were included. A total of 60 patients were included in the study, of which 30 patients underwent TEP repair without fixation of mesh and for remaining 30 patients the mesh was fixed using metallic tacks.Results: Difference in average pain score at 24 hrs, 72 hrs, 1 month and 6 months was significant statistically (p =0.003, p = 0.003, p&lt; 0.001 and p=0.001 respectively) when compared in both groups. There was no recurrence in the study period in either of the groups. The duration of operative time and days of hospital stay was higher in fixation group and was statistically significant.Conclusion: Mesh fixation appears to be disadvantageous in TEP repair of inguinal hernias compared to non- fixation of mesh as it is associated with higher operative time, higher postoperative complication and an increased likelihood of developing chronic groin pain. The omission of mesh fixation did not increase the risk of early hernia recurrence.Asian Journal of Medical Sciences Vol.9(4) 2018 35-40

Postoperative urinary retention after laparoscopic total extraperitoneal inguinal hernia repair

BackgroundPostoperative urinary retention (POUR) after laparoscopic inguinal hernia repair has an incidence of 2%-30%. POUR can lead to increased length of stay, decreased patient satisfaction, and increased health-care costs. The objective of this study was to determine the patient risk factors at our institution contributing to POUR after laparoscopic total extraperitoneal (TEP) inguinal hernia repair. MethodsA retrospective chart review of patients who underwent a laparoscopic TEP inguinal hernia repair at our institution from 2009 to 2016. POUR is defined as the inability to urinate requiring urinary straight or indwelling catheterization in the postoperative period. Univariate analyses were performed on perioperative variables and their correlation with POUR. ResultsIn total, 578 laparoscopic TEP inguinal hernia repair patients were included in the study: 277 (48%) indirect, 144 (25%) direct, 6 (1%) femoral, and 151 (26%) combination of direct, indirect, and/or femoral hernias. Of these, 292 (51%) were bilateral, and 286 (49%) were unilateral. Overall, 64 (11.1%) of the 578 patients developed POUR. POUR was significantly associated with benign prostatic hyperplasia, age 60 y or older, urinary tract infection within 30 d, and decreased body mass index. ConclusionsPatients aged greater than 60 y, with benign prostatic hyperplasia, and a decreased body mass index (≤25.8 kg/m2) were more likely to develop POUR after laparoscopic TEP inguinal hernia repair. In addition, these patients were more likely to develop a urinary tract infection within 30 d. Future quality initiatives can be explored to minimize the incidence of POUR in high-risk patient populations.

Effectiveness of endoscopic totally extraperitoneal (TEP) hernia correction for clinically occult inguinal hernia (EFFECT): study protocol for a randomized controlled trial

BackgroundGroin pain is a frequent complaint in surgical practice with an inguinal hernia being at the top of the differential diagnosis. The majority of inguinal hernias can be diagnosed clinically. However, patients with groin pain without signs of an inguinal hernia on anamnesis or physical examination provide a diagnostic challenge. If ultrasonography shows a hernia that could not be detected clinically, this entity is called a clinically occult hernia. It is debatable if this radiological hernia is the cause of complaints in all patients with inguinal pain.The objective of this study is to assess whether watchful waiting is non-inferior to endoscopic totally extraperitoneal (TEP) inguinal repair in patients with a clinically occult inguinal hernia.MethodsThe EFFECT study is a multicenter non-blinded randomized controlled non-inferiority trial. Adult patients with unilateral groin pain and a clinically occult inguinal hernia are eligible to participate in this study. A total of 160 participants will be included and randomized to TEP inguinal hernia repair or a watchful waiting approach. The primary outcome of this study is pain reduction 3 months after treatment, measured by the Numeric Rating Scale (NRS). Secondary outcomes are quality of life, cost-effectiveness, patient satisfaction and crossover rate. Eight surgical centers will take part in the study. Participants will be followed-up for 1 year.DiscussionThis is the first large randomized controlled trial comparing treatments for patients with groin pain and a clinically occult inguinal hernia. To date, there are no interventional studies on the effect of surgery or a watchful waiting approach in terms of pain or quality of life in this subset of patients. A trial comparing the outcomes of the two approaches in patients with a clinically occult inguinal hernia is urgently needed to provide data facilitating the choice between the two treatment options. If watchful waiting is not inferior to surgical repair, costs of surgical repair may be saved.Trial registrationThe study protocol (NL61730.100.17) is approved by the Medical Ethics Committee (MEC-U) of the Diakonessenhuis, Utrecht, The Netherlands. The study was registered at the Netherlands Trial Registry (NTR6835) registered on November 13, 2017.

Laparoscopic totally extraperitoneal (TEP) inguinal hernia repair in patients with previous lower abdominal surgery.

We have performed laparoscopic totally extraperitoneal (TEP) repair for inguinal hernia repair for the last 20years. We use two balloon dilators (sphere and kidney type) to dissect the preperitoneal space for the TEP repair. It may be difficult to obtain exposure in patients who previously underwent lower abdominal surgery, because of adhesions to the abdominal wall. We reviewed our experience with inguinal hernia repairs to retrospectively analyze factors that limit the laparoscopic TEP approach. From 2006 to 2016, 313 patients (281 men and 32 women) underwent laparoscopic TEP inguinal hernia repair at Yuki Hospital. The medical records of these patients were reviewed, and data for patients who previously underwent lower abdominal surgery were analyzed. Eighty-four patients previously underwent lower abdominal surgery including appendectomy (N = 23), inguinal hernia repair [N = 45; including contralateral TEP repair (N = 26), ipsilateral anterior approach (N = 11)], and laparotomy with a lower abdominal midline incision (N = 22). TEP repair was successfully completed in 75 patients (75/84; 89%) and the procedure changed in nine patients to an anterior approach (N = 5), or transabdominal preperitoneal (TAPP) repair (N = 4). The reasons for changing the procedure included difficulty to develop the operative field (N = 5), violation of the integrity of the peritoneal envelope (N = 2), and intraoperative bleeding (N = 2). Seven patients had a contralateral inguinal hernia after TEP repair. The majority of patients with an inguinal hernia and previous lower abdominal surgery underwent successful laparoscopic TEP repair. There is no need to avoid the laparoscopic TEP approach, even in patients with a history of previous lower abdominal surgery. However, patients after TEP repair of a contralateral inguinal hernia may be at increased risk for peritoneal injury and the approach may need to be changed.

A comparative study between open lichtenstein mesh repair and laparoscopic totally extra peritoneal repair of inguinal hernia

Background: The study was conducted to compare and assess the duration of procedure, complications encountered, post-operative pain and recovery, duration of hospital stay, and time taken in resumption to work between two techniques of open Lichtenstein mesh repair (OLMR) and Totally extra peritoneal (TEP) repair in the low resource settings.Methods: A cross sectional comparative study was conducted among 50 male patients admitted for surgical repair of hernia. After considering the inclusion and exclusion criteria, the subjects were randomly assigned to the groups of OLMR and TEP and were assessed for pain in the post-operative period was rated using a Visual Analogue Scale. Total duration of the procedure, complications, duration of hospital stay, and time taken in resumption to work were elicited between two techniques. A p-value of &lt;0.05 was taken as statistically significant.Results: The mean duration of surgery among the study participants in TEP (49.60+3.62 mins) group was significantly higher compared to OLMR (45.96+4.63 mins) group (p=0.003). The median of post-operative pain scores in TEP group was significantly lower compared to OLMR group. The mean duration of post-operative recovery time (3.08+0.4 days), for resumption to work (5.08+0.28 days) among the study participants in TEP group was significantly lower compared to OLMR (5.00+0.00 days), (10.08+0.76 days) (p&lt;0.001) respectively. The complications were significantly higher among the OLMR group (100.0%) compared to the TEP group (p&lt;0.05).Conclusions: Though the procedure of TEP repair for inguinal hernia takes a little longer time and complications of general anaesthesia cannot be ruled out, it is a better procedure compared to open type.

Perioperative outcomes of laparoscopic total extraperitoneal inguinal hernia repair

Background: Laparoscopic total extraperitoneal (TEP) inguinal hernia repair has become increasingly common over the past decade due to reported reduced postoperative pain, shorter convalescence and lower incidence of long-term surgical related morbidity such as chronic pain and numbness. However, the technique has not yet become standard of care in many institutions. The hesitation to adopt this approach may be related to the relatively long learning curve and limited high quality outcome data available. The purpose of this study was to evaluate perioperative morbidity and short-term outcomes of laparoscopic TEP repair. Methods: We performed a retrospective review of a consecutive series of patients who underwent laparoscopic TEP inguinal hernia repair over a 10-year period. Data collected included patient demographics, operative parameters and postoperative complications. Results: A total of 403 patients underwent laparoscopic TEP repair for the management of unilateral or bilateral inguinal hernia. The median age was 51 and 97% were males. The median BMI was 26 and 96% were ASA grade 1 or 2. Ninety-seven percent of repairs were primary, 15% were bilateral and 65% were indirect. The mean operative duration was 50 minutes over the entire study period, however this decreased significantly with time to a mean of 37 minutes in the final year. Postoperative complications occurred in 10.6%, 86% were Clavien-Dindo grade 1 and there were no significant visceral or vascular injuries. The most common complications were seroma formation (4.2%), urinary retention (3.7%) and rectus sheath haematoma (1.4%). Almost all patients were discharged within 24 hours. Conclusions: Laparoscopic TEP repair is a safe and well tolerated surgical treatment of inguinal hernia, associated with a low incidence of perioperative complications.

Perioperative outcomes of laparoscopic total extraperitoneal inguinal hernia repair

Background: Laparoscopic total extraperitoneal (TEP) inguinal hernia repair has become increasingly common over the past decade due to reported reduced postoperative pain, shorter convalescence and lower incidence of long-term surgical related morbidity such as chronic pain and numbness. However, the technique has not yet become standard of care in many institutions. The hesitation to adopt this approach may be related to the relatively long learning curve and limited high quality outcome data available. The purpose of this study was to evaluate perioperative morbidity and short-term outcomes of laparoscopic TEP repair. Methods: We performed a retrospective review of a consecutive series of patients who underwent laparoscopic TEP inguinal hernia repair over a 10-year period. Data collected included patient demographics, operative parameters and postoperative complications. Results: A total of 403 patients underwent laparoscopic TEP repair for the management of unilateral or bilateral inguinal hernia. The median age was 51 and 97% were males. The median BMI was 26 and 96% were ASA grade 1 or 2. Ninety-seven percent of repairs were primary, 15% were bilateral and 65% were indirect. The mean operative duration was 50 minutes over the entire study period, however this decreased significantly with time to a mean of 37 minutes in the final year. Postoperative complications occurred in 10.6%, 86% were Clavien-Dindo grade 1 and there were no significant visceral or vascular injuries. The most common complications were seroma formation (4.2%), urinary retention (3.7%) and rectus sheath haematoma (1.4%). Almost all patients were discharged within 24 hours. Conclusions: Laparoscopic TEP repair is a safe and well tolerated surgical treatment of inguinal hernia, associated with a low incidence of perioperative complications.

Laparoscopic total extraperitoneal hernia repair under regional anesthesia: a systematic review of the literature.

General anesthesia has been used as a standard for laparoscopic inguinal hernia repair including both techniques (Trans-Abdominal Pre-Peritoneal repair and the Total Extra-Peritoneal repair), while regional anesthesia has been occasionally applied in high risk patients where general anesthesia is contraindicated. In case of the total extraperitoneal repair (TEP), several authors have attempted to perform TEP repair under regional anesthesia and reported on the safety and feasibility of this procedure. The present review was conducted according to the PRISMA guidelines. Outcome parameters where patients and hernia characteristics, characteristics of anesthesia and surgery procedure, perioperative complications, length of hospital stay, follow up duration. Eight studies on 1287 male and 24 female patients underwent laparoscopic TEP under spinal anesthesia were systematically analyzed. The most common anesthetic agent used, was bupivacaine 0,5%. The conversion rate to general anesthesia, due to anesthesia failure was 0.76% and the rate of conversion to open procedure was 0.2%. The most common intraoperative incidence was hypotension which was successfully managed with the appropriate medical intervention. Seroma was the most common postoperative complication regarding the procedure. The estimation of overall mean length of stay was 1.56 days. Spinal anesthesia for total extraperitoneal inguinal hernia repair seems safe and feasible. However, more well-designed randomized clinical studies are required to determine the safety as well as the advantages and disadvantages of regional anesthesia in TEP hernia repair in different population groups before this method can be adopted into routine daily clinical practice.