Total Extraperitoneal Repair Research Articles

Two-port (single incision plus one port) versus single-port laparoscopic totally extraperitoneal repair for inguinal hernia: a retrospective comparative study.

The aim of this study is to compare the feasibility and efficacy of two-port (single incision plus one port) laparoscopic totally extraperitoneal repair (TEP) with single-port TEP for the treatment of inguinal hernia. We performed a retrospective comparative study from a prospectively maintained database. A cohort of 229 patients with inguinal hernia who underwent TEP were included. Of these patients, 124 underwent two-port TEP and 105 underwent single-port TEP. Differences in surgical outcomes were compared. The mean operative time was shorter in the two-port TEP group compared to the single-port TEP group (55.3 ± 13.1 vs. 65.1 ± 16.6min, P < 0.001). There was no significant difference between the two groups in terms of other surgical outcomes including postoperative pain, postoperative hospital stay, time to resume daily activities, cosmetic satisfaction and complications. Two-port TEP is associated with a shorter operative time compared to single-port TEP, while the other outcomes evaluated in this study appear to be comparable.

Laparoscopic Inguinal Hernia Repair in the Obese Patient Population: A Single-Center Five-Year Experience.

Purpose The objective of the present study is to evaluate the distribution of the transabdominal preperitoneal (TAPP) and the totally extraperitoneal repair (TEP)proceduresamong the obese and non-obese patient populations, to show how obesity impacts daily practice by reviewing the experience of a single center, and finally, to assess theoutcomes of the operations. Methods All patients who underwent elective, minimally invasive inguinal hernia repair in our hospital from January 2017 to January 2022 were included in the present study. The data that were analyzed were patient demographics, eachindividual patient's American Society of Anesthesiology (ASA) score, the minimally invasive technique (TAPP or TEP) utilized, the body mass index (BMI), and other comorbidities such as underlying diabetes,hypertension, and smoking status. Results A total of 109 patients were included in the present analysis, of which 81 (74.3%) underwent elective TEP repairswhile 28 (25.7%) underwent elective TAPP repairs. Overall, 39 (35.7%) patients were included in the obesity subgroup with an average BMI of 35.4 ± 4.9, with a range from 30.1 to 52.7, and 70 (64.3%) were included in the non-obese subgroup, with an average BMI of 23.2 ± 3.3 and a range from 16.2 to 29.7. Conclusions The laparoscopic approach to the inguinal hernia repair in obese patients has similar outcomes as an open approach regarding the 30-day events, in the hands of experienced surgeons with the advantages of the laparoscopic approach vs. the open one.

The Effect of Mesh Fixation Methods on Pain Sensation After Laparoscopic Inguinal Hernia Repair

Aim: Groin hernia repair is one of the most common surgical procedure in general surgery. The use of prosthetic meshs has reduced the recurrence rate after inguinal hernia repair to less than 5%. Chronic pain is thought to be multi-factorial. Among these, surgical-related factors are the types of mesh used and fixation methods. It was aimed to evaluate the effect of the use of absorbable and non-absorbable screws for mesh fixation on post-operative pain during TEP repair.&#x0D; Material and Methods: The data of patients who were operated on by a single surgeon and who underwent TEP repair for unilateral or bilateral inguinal hernia were reviewed retrospectively. Post-operative first-week pain sensations were compared between patient groups in which absorbable and non-absorbable screws were used for patch fixation.&#x0D; Results: A total of 35 patients who were operated by a single surgeon and who underwent laparoscopic total extraperitoneal (TEP) repair for unilateral or bilateral inguinal hernia were included in the study. It was found that patients in the absorbable screw group felt statistically significantly less pain [VAS: 3 (2-7) vs. 4 (2-8); p=0.03].&#x0D; Conclusion: Chronic pain after patchy hernia repair is also seen as a late complication that can last up to 6 months. This study, which proves that the use of absorbable stabilizers leads to less pain in the early period, reveals that this method may also be a suitable method for preventing the development of possible chronic pain.

Laparoscopic TAPP vs TEP? What’s Better for Hernial Repair-a Narrative Review

Inguinal hernias are very common and most cases require surgical repair. Several different methods of open and laparoscopic hernia surgery are available. Laparoscopic incisions are minimally invasive and include two common operating types, the trans-abdominal preperitoneal (TAPP) and the total extraperitoneal repair (TEP). TAPP and TEP mainly differ in the use of a different access route and the inguinal surgical method is similar. Herein, the two laparoscopic types are reviewed and described.

Bilateral inguinal hernia repair by laparoscopic totally extraperitoneal (TEP) vs. laparoscopic transabdominal preperitoneal (TAPP)

BackgroundThe guidelines recommend laparoscopic repair for bilateral inguinal hernia. However, few studies compare the totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) techniques in bilateral inguinal hernias. This study aimed to compare the outcomes of TEP and TAPP in bilateral inguinal hernia.MethodsWe conducted a retrospective cohort study of patients operated on for bilateral inguinal hernia by TEP and TAPP repair from 2016 to 2020. Intraoperative complications, operative time, acute postoperative pain, hospital stay, postoperative complications, chronic inguinal pain, and recurrence were compared.ResultsA total of 155 patients were included in the study. TEP was performed in 71 patients (46%) and TAPP in 84 patients (54%). The mean operative time was longer in the TAPP group than in the TEP group (107 min vs. 82 min, p < 0.001). The conversion rate to open surgery was higher in the TEP group than in the TAPP group (8.5% vs. 0%, p = 0.008). The mean hospital stay was longer in the TAPP group than in the TEP group (p < 0.001). We did not observe significant differences in the proportion of postoperative complications (p = 0.672), postoperative pain at 24 h (p = 0.851), chronic groin pain (p = 0.593), and recurrence (p = 0.471). We did not observe an association between the choice of surgical technique (TEP vs. TAPP) with conversion rate, operative time, hospital stay, postoperative complications, chronic inguinal pain, or hernia recurrence when performing a multivariable analysis adjusted for the male sex, age, BMI, ASA, recurrent hernia repair, surgeon, and hernia size > 3cm.ConclusionsBilateral inguinal hernia repair by TEP and TAP presented similar outcomes in our study.

Laparoscopic Totally Extraperitoneal Repair Using Self-gripping Polyester Mesh (ProGrip™) in Inguinal Hernia: A Retrospective Study in a Tertiary Care Hospital

Abstract Introduction: Surgical management of inguinal hernia (IH) is advanced with laparoscopy surgery, and total laparoscopic totally extraperitoneal (TEP) repair is gaining popularity. The use of self-gripping mesh (ProGrip™) further provided substantial advancements with improved postoperative outcomes and early recovery. Objectives: The objective of our study was to determine the short-term outcomes, complications, postoperative hernia recurrence, and chronic inguinal pain in laparoscopic IH. Furthermore, we assessed the factors associated with longer operative time. Subjects and Methods: We retrospectively analyzed the data of adult IH patients who had undergone TEP repair with ProGrip™ mesh. Data on demographics, hernia characteristics, operating time, surgical details, and postoperative outcomes such as infection, hernia recurrences, chronic pain, and other complications were collected and analyzed. P &lt;0.05 was considered statistically significant. Results: During January 2020 to January 2022, we collected the data of 208 patients and analyzed them. The mean age of the patients was 59.7 ± 13.1 years and 96.2% were males. Hernia was bilateral in 26% of cases and 78.8% were indirect hernias. The mean duration of surgery was 60.4 ± 8.6 min. Hernia size ≥2.5 cm was associated with significantly longer operative time. After a median follow-up of approximately 1 year, there were no postoperative complications, recurrence of hernia, or chronic inguinal pain. Conclusion: In experienced hands, laparoscopic TEP repair of IH using ProGrip™ mesh is effective and safe without significant complications or recurrences.

Outcome Of Totally Extra-Peritoneal (TEP) Mesh Repair Among Patients With Unilateral Primary Inguinal Hernia: A Single Center Experience

Introduction: Inguinal hernias were conventionally treated with open methods like hernioplasty and herniorrhaphy. However, with the development in minimal access surgery, the trends have changed and surgeons are also performing the TEP and TAPP laparoscopic hernia repair routinely. Hence, a retrospective study was performed to assess the safety, feasibility, and associated complications of the TEP laparoscopic hernia repair. Methods: A single institution, single unit retrospective study of all TEP hernia repair was performed at the department of surgery from May 2020 to April 2021. Data of all patients undergoing TEP were obtained from a proforma attached to the case file during patients’ admission and was analyzed. Results: A total number of 30 patients underwent the TEP laparoscopic hernia repair during the study period. Age group ranged from 25 years to 80 years and a male preponderance was noted with all patients being male. Per operative findings of indirect hernia was noted in 27, and direct hernia in 3 patients. The mean operating time was 76.23 ± 13.53 minutes. Complications encountered in the post-operative period were seroma in one patient, and wound erythema in two patients. The mean hospital stay was 1.6 ± 0.72 days. Conclusion: Totally Extra-peritoneal (TEP) laparoscopic repair can be performed and has all the established benefits of minimal access surgery among patients with primary unilateral inguinal hernia.

Do we need mesh fixation at the laparoscopic hernia repair?

ObjectiveWith the development of laparoscopic treatment, widespread use of laparoscopy has become inevitable for the treatment of inguinal hernias, which is one of the most common ailments in surgical practice. Fixing or not fixing the mesh during laparoscopic repair remains a debate. In our study, we aimed to compare patients with and without mesh fixation in terms of postoperative pain, recurrence, complications, hospitalization and return to social life. MethodThe surgical technique to be performed was randomly determined, 81 patients whose data were kept prospectively and evaluated retrospectively were included in the study. Total extraperitoneal repair (TEP) was performed in all patients. While the mesh was not fixed in 50 patients, it was fixed with 2 tackers in 31 patients. ResultsWhen the two groups of patients were compared, the group without mesh fixation was found to be superior in terms of postoperative pain, length of hospital stay and return to social life. There was no difference between the 2 groups in terms of complications and recurrence. ConclusionsIn the light of these findings, it is seen that TEP hernia repair can be performed safely without mesh fixation, although prospective randomized studies are needed.

Comparison of Early Postoperative Outcomes Between Totally Extraperitoneal and Lichtenstein Repair of Inguinal Hernia: A Prospective Randomized Study.

Background: Surgical repair of inguinal hernia is among the most commonly performed surgical interventions in general surgery clinics, with minimal postoperative complications, less pain, and maximum cosmetic results. The aim of this study is to compare the outcomes of patients who underwent Lichtenstein repair (LR), which is currently the most commonly used open surgical procedure to repair inguinal hernias, and laparoscopic totally extraperitoneal (TEP) repair with regard to postoperative cosmesis, patient satisfaction, pain, and inflammatory response. Patients and Methods: The study consisted of male patients 18-65 years of age, who were operated for inguinal hernia with two different methods between February 2022 and January 2023 in the general surgery clinic of Elazig Fethi Sekin City Hospital. C-reactive protein (CRP), white blood cell, and interleukin 6 (IL-6) levels were observed to evaluate the inflammatory response in all patients. Visual Analog Scale and Verbal Rating Score systems were used to monitor the response to pain in the postoperative period. In addition, both groups were evaluated for patient satisfaction in cosmetic terms using the Vancouver Scar Scale and the Modified Stony Brook Scar Evaluation Scale. Results: Postoperative pain sensation in the TEP group was found to be significantly lower compared to the LR group. In terms of inflammatory response, IL-6 and CRP levels were found to be significantly higher in the LR group on postoperative day 1 and 2. Satisfaction with the cosmetic appearance of the surgical scar was significantly higher in the TEP group. Conclusion: TEP, which is a laparoscopic hernia repair method, is a safe surgical technique that can be preferred, especially in patients with less postoperative pain and higher cosmetic expectations. In terms of inflammatory response, significant difference is also in favor of TEP repair.

Immune Thrombocytopenic Purpura

A case of Immune Thrombocytopenic Purpura (ITP) presented as an unusual case of post- operative hemorrhage. Our patient had presented for an elective laparoscopic total extraperitoneal repair for an inguinal hernia. He had undergone the procedure with no procedural or immediate post- operative complications. On post- op day 1, our patient had developed tachycardia with hypotension with clinical examination revealing signs of pallor with petechiae and ecchymosis. A complete blood count revealed thrombocytopenia with normocytic anemia while coagulation parameters were normal. Serum biochemistries did not reveal any renal failure or elevated lactate dehydrogenase. A computer- tomography with angiography revealed features supportive of a hemoperitoneum. Our patient was first stabilized with transfusion and vasopressor support. Evaluation with bone marrow analysis revealed features suggestive of ITP while secondary workup remained negative. Our patient was managed with dexamethasone pulse followed by maintenance steroids, following which there was an incremental response of the platelet count.

Athletes treated for inguinal-related groin pain by endoscopic totally extraperitoneal (TEP) repair: long-term benefits of a prospective cohort

PurposeInguinal-related groin pain (IRGP) in athletes is a multifactorial condition, posing a therapeutic challenge. If conservative treatment fails, totally extraperitoneal (TEP) repair is effective in pain relief. Because there are only few long-term follow-up results available, this study was designed to evaluate effectiveness of TEP repair in IRGP-patients years after the initial procedure.MethodsPatients enrolled in the original, prospective cohort study (TEP-ID-study) were subjected to two telephone questionnaires. The TEP-ID-study demonstrated favorable outcomes after TEP repair for IRGP-patients after a median follow-up of 19 months. The questionnaires in the current study assessed different aspects, including, but not limited to pain, recurrence, new groin-related symptoms and physical functioning measured by the Copenhagen Hip and Groin Outcome Score (HAGOS). The primary outcome was pain during exercise on the numeric rating scale (NRS) at very long-term follow-up.ResultsOut of 32 male participants in the TEP-ID-study, 28 patients (88%) were available with a median follow-up of 83 months (range: 69–95). Seventy-five percent of athletes were pain free during exercise (p < 0.001). At 83 months follow-up, a median NRS of 0 was observed during exercise (IQR 0–2), which was significantly lower compared to earlier scores (p <0.01). Ten patients (36%) mentioned subjective recurrence of complaints, however, physical functioning improved on all HAGOS subscales (p <0.05).ConclusionThis study demonstrates the safety and effectivity of TEP repair in a prospective cohort of IRGP-athletes, for whom conservative treatment had failed, with a follow-up period of over 80 months.

Laparoscopic Groin Hernia Repair Using the Totally Extraperitoneal Approach: A Retrospective Study and Our Experience.

Background Recently, laparoscopic totally extraperitoneal (TEP) inguinal hernia repair has been considered one of the most effective and widely performed techniques for repairing inguinal hernias by avoiding entry into the peritoneal cavity. Its indications have evolved and expanded to almost encompass the entire range of groin hernias. This retrospective study aims to determine the outcomes and postoperative complications in patients undergoing TEP inguinal hernia repairperformed by a single surgeon for groin hernias at a single center. Methodology We retrospectively evaluated the prospectively collected data of 900 patients who underwent elective TEP repair over 18 years at a single center performed by a single surgeon from April 2004 to February 2023. Patients were evaluated for age, sex, type of hernia, time taken for surgery, open from laparoscopy, intra and postoperative complications, hospital stay, and days taken to resume regular activity. Results The mean age of the 900 patients was 59 years (range = 21-83 years). The mean age of males and females was 59 and 56 years, respectively. The mean operative time was 40 and 55 minutes for a unilateral and bilateral hernia, respectively. In total, 369 (41%) patients had a right-sided groin hernia, 382 (42%) patients had a left-sided groin hernia, and 149 (16.5%) patients had bilateral groin hernias. A total of 121 (13%) patients had occult hernias, and 17 patients underwent concurrent TEP and transurethral resection of the prostate. Of the 900 patients, 20 (2.2%) had a recurrent hernia after a previous open inguinal hernia repair. Seven (0.8%) patients had a recurrence of hernias post-TEP and subsequently underwent open inguinal hernia repair. Seven (0.7%) patients needed conversion from TEP to the transabdominal pre-peritoneal approach. Only minor complications were noted intra and postoperatively. The average time of hospitalization was 24 hours. The time to resume normal activities was five (±1) days. Conclusions Our experience suggests that TEP repair with mesh fixation is a safe and effective procedure with a marginal recurrence rate. Apart from the obvious cosmetic benefits of minimal tissue invasion, a significant advantage of TEP is the visualization of the contralateral groin along with the surgical repair of a hernia, if required, in the same sitting and without the insertion of any extra trocars.

Laparoscopic inguinal hernia repair: A comparison of transabdominal preperitoneal and total extraperitoneal techniques—Results of initial experiences

Abstract Aims: This study aimed to analyze the results of transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP) repairs performed by two authors and to compare two laparoscopic methods. Materials and Methods: Patients who underwent inguinal hernia surgery in a secondary-care hospital between 2019 and 2022 were evaluated retrospectively. Demographics, hernia side and type, primary or recurrent hernia situation, size of hernia orifice, operation type, postoperative complications, duration of operation, length of hospital stay, recurrence, and follow-up time were examined. Perioperative outcomes were compared between the two groups. Results: One hundred and eleven patients were analyzed. The mean age was 49.4 ± 13 years, with a male/female ratio of 106/5. About 82% of hernias were unilateral, and 18% were bilateral. Sixty-four TAPP and 47 TEP repairs were performed. Follow-up time (months, mean ± standard deviation) (range) was 14.2 ± 10 (1–37). About 42.3% of the hernias were direct, 49.5% were indirect, and 8.1% were pantaloon hernias. The recurrence rate was 1.8%. The operation time was significantly lower in the TEP than in TAPP (64.4 ± 23.5, 96.7 ± 31.9, respectively, P &lt; 0.001). TAPP was preferred in patients with larger hernia orifices (P = 0.01). The two groups had no significant difference regarding postoperative complications and recurrence rate. Conclusion: Our study did not detect any significant difference between TAPP and TEP repair regarding recurrence rate and postoperative complication. Laparoscopic inguinal hernia repair, which has advantages such as short hospital stay and less pain, can be safely performed in a secondary-care hospital.

Comparison of Extended Total Extraperitoneal (E-TEP) Repair and Trans-Abdominal Pre-Peritoneal (TAPP) Mesh Repair in Inguinal Hernia Repair.

To find the superiority of extended total extraperitoneal (E-TEP) repair and trans-abdominal pre-peritoneal (TAPP) mesh repair in inguinal hernia repair. A total of 30 patients with a unilateral or bilateral inguinal hernia (IH), and recurrent IH, following open repair were studied. Out of 30 patients, laparoscopic TAPP or E-TEP mesh repair was performed in an equal number of inguinal hernia patients. The patient's demographic parameters, duration of surgery, postoperative hospital stay, and complications were compared. In the E-TEP group, 33.33% of patients had left inguinal hernia (LIH), 60% of patients were diagnosed with right inguinal hernia (RIH) and 6.67% of patients had right inguinal and right direct hernia (RDH). In the TAPP group, 33.33% of patients had LIHand 53.33% of patients were suffering from RIH. Moreover, 6.67% of patients were diagnosed with a left inguinal direct hernia, and a similar proportion of patients had a right inguinal direct hernia.The mean duration of surgery was found to be significantly higher in the TAPP group(P<0.0000). The mean postoperative hospital stay was 2.07±0.59and 2.80±1.32 days in E-TEP and TAPP groups, respectively (P=0.044). In the present study, E-TEP mesh repair is a superior technique in the management of inguinal hernia as compared with TAPP repair.

P-052 RISK FACTORS FOR PERITONEAL TEARS DURING LAPAROSCOPIC EXTRAPERITONEAL HERNIA REPAIR

Abstract Background Peritoneal tears (PTs) are not uncommon during the course of laparoscopic total extraperitoneal (TEP) repair of groin hernias. There are several mechanisms involved in the occurence of PTs during the course of the operation. There are many studies about the causes of peritoneal tears. Detection of independent risk factors in peritoneal tear formation may identify patients who will benefit from elective inguinal hernia repair in laparoscopic extraperitoneal hernia surgery. Methods Between April 2018 and december 2022, 518 consecutive patients undergoing 575 TEP repair surgery were recruited by the retrospective study. They were divided into two groups as with and without peritoneal tear. Patient characteristics, operative data, and postoperative outcomes were compared between patients with and without peritoneal tear. Risk factors for peritoneal tear were evaluated by univariate and multivariate analyses. Results The overall incidence of peritoenal tear was 19.7% (n=97). The median age was 45 years (18 to 83) and body mass index was 25.7 kg/m2 (15.67 to 35.20). Significant clinical factors associated with peritoneal tear included such as hernia type, previous hernia surgery, large hernial defects, presence of scrotal hernia, and the defect size of inguinal hernia. Multivariate analysis identified independent risk factors for peritoneal tear as indirect hernia type and previous hernia surgery. Conclusion Peritoneal tears is a major complication seen during TEP repair surgery and its incidence varies depending on many factors. Previous hernia surgery and indirect inguinal hernia the risk for peritoneal tears from during TEP repair.

V-017 LAPAROSCOPIC TRANSVERSUS ABDOMINIS RELEASE (L-TAR) VIA TOTALLY EXTRAPERITONEAL REPAIR (TEP)

Abstract Aim Posterior component separation via transversus abdominis release (TAR) allows the treatment of complex incisional hernias, although it is associated with high morbidity rates. In recent years, the laparoscopic TAR was introduced, showing the benefits of the minimally invasive surgery such as less postoperative pain, less surgical site infection, and a shorter hospital stay. When compared to the transabdominal preperitoneal (TAPP) approach, the Totally Extraperitoneal Repair (TEP) technique avoids entry into the abdominal cavity, making it a suitable strategy for patients with previous abdominal surgeries. Material &amp; Methods We present the case of a 68-year-old male with three previous umbilical repairs, one of them with mesh. He consulted for a recurrent umbilical hernia associated with a large weakness on the abdominal wall in the left flank. He complained that it increased in size and significantly altered his quality of life. Computed tomography scan revealed weakness and atrophy of the abdominal wall muscles in the left anterolateral area, which measured 22×10×15 centimeters. Surgical repair was decided and a TEP-TAR technique with mesh reinforcement was performed to restore the abdominal wall anatomy. Results The patient had an uneventful postoperative course and was discharged 36 hours after surgery. No recurrence was observed at 6 months. Conclusions Complex abdominal wall defects are challenging. The use of minimally invasive advanced techniques is feasible and safe, making it a suitable tool for the management of this type of cases.

OC-007 ATHLETES TREATED FOR INGUINAL-RELATED GROIN PAIN BY ENDOSCOPIC TOTALLY EXTRAPERITONEAL (TEP) REPAIR: LONG-TERM BENEFITS

Abstract Aim Inguinal-related groin pain (IRGP) in athletes is a debilitating condition with a multifactorial origin. Hence, it creates difficulties in diagnosis and treatment, demanding a multidisciplinary approach. If conservative treatment fails, totally extra-peritoneal repair (TEP) has been shown effective in pain relief within 3 months, but results of long-term follow-up are sparse. For that reason, it is important to know whether these positive outcomes are maintained with longer term follow-up. This study aimed to evaluate whether these patients still benefit many years after the procedure. Material &amp; Methods Patients that participated in the initial prospective, observational cohort study (TEP-ID-study) were subjected to two telephone questionnaires. The first questionnaire aimed to detect recurrence of initial complaints and the occurrence of new groin-related complaints. Secondly, physical functioning was assessed by using the Copenhagen Hip and Groin Outcome Score (HAGOS). Results Out of 32 male participants in the original study, 28 patients (88%) were available with a median follow-up of 83 months (range: 69–95). Seventy-five percent of athletes were pain-free during sports (p &amp;lt; 0.001). At very long-term follow-up, a median NRS of 0 was observed (IQR 0-2). This was a significant decrease compared to scores pre- and 3-months post-operatively (p ≤ 0.001). Although ten patients described recurrence of symptoms, physical functioning improved on all HAGOS subscales (p ≤ 0.005). Conclusions This study demonstrates the safety and effectivity of TEP-repair in a prospective cohort of athletes with IRGP, for whom conservative treatment had failed, with a follow-up period of over 80 months.

P-069 TOTAL EXTRAPERITONEAL (TEP) APPROACH FOR THE TREATMENT OF SPIGELIAN HERNIAS: SINGLE-CENTRE EXPERIENCE

Abstract Aim Spigelian hernias are rare. Surgical treatment is often recommended. Different minimally invasive techniques are available by means of intraperitoneal or extraperitoneal mesh placement, either by IPOM, transabdominal preperitoneal (TAPP) or total extraperitoneal (TEP) approach. TEP approach is seldom reported in the literature. We present a short series of TEP repair of Spigelian hernias. Materials and Methods Between February and October 2022, TEP repair was performed in two patients with unilateral Spigelian hernia, one case of bilateral hernia, and one combined unilateral Spigelian and inguinal hernia, ensuing the following technique. Preperitoneal access was achieved placing a contralateral 11mm trocar, a few centimetres above the umbilicus, posterior to the rectus muscle toward Retzius space. A 5mm trocar was placed suprapubic and another 11mm trocar at the flank. Working space is developed by blunt dissection. Spigelian hernia sac is dissected and reduced. At this point other inguinal or femoral hernias are explored, performing simultaneous repair if necessary. Sufficient preperitoneal space is ensured to allow correct overlap of a polypropylene self-gripping mesh, prior to closing the defect with barbed-polydioxanone suture. Results Median age was 72 years. Three cases were right hernias and two left, all diagnosed by imaging test due to symptoms. Latest discharge was 24 hours after surgery. No complications or recurrences were encountered at a median follow-up of 4 months. Conclusions Comparative studies between minimally invasive approaches of Spigelian hernias are scarce. In the presented experience, TEP approach proved to be an efficient and reproducible technique with favourable results.

OC-041 TOTALLY EXTRA-PERITONEAL REPAIR VERSUS TRANS-ABDOMINAL PRE-PERITONEAL REPAIR FOR THE LAPAROSCOPIC SURGICAL MANAGEMENT OF SPORTSMAN'S HERNIA: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Aim Open and laparoscopic modalities are employed for treatment of sportsman's hernia, with totally extra-peritoneal (TEP) and trans-abdominal pre-peritoneal (TAPP) laparoscopic approaches both currently being utilised. At present, neither subtype has demonstrated superiority for sportsman's hernia repair. The aim of this review was to evaluate current evidence to ascertain whether there was a difference in laparoscopic techniques following sportsman's hernia repair. Material &amp; Methods A systematic literature search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards. Databases searched included PubMed, Scopus and Web of Science to identify all randomised controlled trials (RCTs) and observational studies. Risk of bias was assessed using the Cochrane risk of bias tool and Newcastle-Ottawa scale for RCTs and observational studies, respectively. The assessed outcomes included median time to return to sporting activity, complications and the degree of postoperative pain reduction within three months. Random effects model was used to calculate pooled proportion data where feasible. Subgroup analyses were also performed. Results 28 studies were identified including 2 RCTs and 26 observational studies. No significant differences were observed between techniques in the primary or secondary outcomes. Significant heterogeneity was observed in all outcomes. This was signficant for return to sporting activity; thus meta-analysis was not feasible in this domain. Median time to return to sporting activity was 28 days for both techniques. Conclusions There is no difference in the primary and secondary outcomes in either technique. An RCT comparing TEP and TAPP repair is needed to provide definitive data.

COMPARISON OF OUTCOME FOLLOWING TOTALLY EXTRAPERITONEAL REPAIR AND LICHTENSTEIN TENSION FREE HERNIOPLASTY FOR PRIMARY UNILATERAL INGUINAL HERNIA IN MALES

In spite of a steep learning curve, laparoscopic Totally Extraperitoneal repair (TEP) promises less wound complications and shorter hospital stays over Lichtenstein's repair for primary unilateral inguinal hernia. We randomly allocated 50 male patients with primary unilateral inguinal hernia into two groups (21 in TEPgroup and 29 in open group) during a one year period and followed them up for a minimum of 3 months. Mean duration of surgery was 88.00 ± 28.12 minutes in laparoscopic repair versus 77.97 ± 22.22 minutes for open repair (p = 0.30). TEP group had signicantly lesser wound complications overall (p = 0.004), signicantly shorter mean post-operative stay (p&lt; 0.001) and earlier return to occupational work (p&lt; 0.00001). The incidence of groin pain at 3 months was again less in the TEP group (p = 0.70) with similar recurrences in both groups. So, TEP did not lead to increased recurrence but surprisingly offered better post-operative outcomes than Lichtenstein's repair.