Totally Extraperitoneal Group Research Articles

Comparison of Perioperative Complication Rates of Total Extraperitoneal and Transabdominal Preperitoneal Repairs in Primary Inguinal Hernia.

Hernia may be defined as a protrusion of viscus through layers anatomically designed to contain that viscus. Most abdominal hernias occur at well-described sites of potential weakness. Repair of inguinal hernia is one of the most common operations in general surgery. Objectives: To compare the perioperative complication rates of total extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) repairs of primary inguinal hernias. It is a randomised comparative study, conducted at the department of general surgery. A total of 50 patients were included and divided into two groups with 25 in each. Group A represents the laparoscopic TEP repair and group B represents the laparoscopic TAPP repair. Patients above 18 years with primary unilateral inguinal hernia were included. Patients having complicated inguinal hernia and history of previous abdominal surgery were excluded. We observed that hernia occurrence is more common in the 31-50 years of age group and right-sided hernia is more common. Scrotal oedema and conversion to open surgery chances are similar in both TEP and TAPP groups. The duration of surgery in TEP is significantly higher as compared to TAPP. Patients who underwent TEP experienced less pain as compared to TAPP as per visual analogue scale. Postoperative hospital stay and time taken to resume the routine activity were significantly less in case of TEP. TEP is preferred over TAPP for laparoscopic hernia repair because it preserves the peritoneal integrity and has lesser postoperative pain. The early recovery and return to the routine work were seen with the patient treated with the TEP and also showed better visual analogue score than the TAPP repair group.

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.

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.

A Prospective Comparative Study of Laparoscopic Totally Extraperitoneal (TEP) and Laparoscopic Transabdominal Preperitoneal (TAPP) Inguinal Hernial Repair.

Introduction Inguinal hernia is a common surgical problem throughout the world. Currently, the management options available are open mesh hernioplasty and laparoscopic mesh repair. Laparoscopic mesh repair can be performed by either transabdominal preperitoneal (TAPP) repair or totally extraperitoneal (TEP) repair. Many studies comparing the two procedures have been unable to establish the superiority of one procedure over the other and have yielded conflicting results. Thus, we performed this study to compare TAPP and TEP. Aim The aim of this study is to compare the clinical outcomesand safety of laparoscopic TEP and laparoscopic TAPP for inguinal hernia repair. Materials and methods Patients were randomly divided into two groups on the basis of surgical procedures. The first group of patients underwent laparoscopic TAPP mesh repair, and the second group of patients underwent laparoscopic TEP mesh repair. Their intraoperative and postoperative findings were noted. Patients were followed up at regular intervals for up to six months. Results The mean age and mean weight distribution between the two groups were not significant. The duration of surgeryneeded (in minutes) for TAPP was found to be significantly less compared to TEP. In the TEP group, conversion to open occurred for three subjects (6.7%) while there was no conversion in the TAPP group. Postoperative pain at 24 hrs was found to be higher in TAPP subjects compared to that in TEP subjects, but the difference was statistically insignificant. Tolerance to a liquid diet started few hours after surgery was found to be the same in both groups. Association of the duration of hospital stays with the type of surgery was not significant. Six subjects (13.2%) showed hematoma in the TEP group while five subjects (11%) in the TAPP group showed hematoma after one week of surgery. Eight subjects (17.6%) showed seroma in the TEP group while three subjects (15.4%) in the TAPP group showed seroma after one week of surgery. Two subjects (4.4%) showed superficial wound infection in both the TEP group and TAPP group after one week of surgery. Four subjects each (8.9%) showed scrotal edema in the TEP group as well as the TAPP group after one week of surgery. No subject showed port site hernia withoutclosureofthesheathat one-week, one-month,and six-monthfollow-upvisits. Two subjects (4.4%) each showed groin pain in the TEP group as well as the TAPP group after one week of surgery. There were no instances of bowel obstruction or mesh infection. Conclusion TEP is a more skill-demanding procedure as compared to TAPP and thus takes more time to perform. However, it is superior on account of not breaching the peritoneum. TAPP is favorable for larger hernias. The choice of procedure should be individualized according to the patient's characteristics and surgeon's preference.

An Observational Comparative Study of the Impact of Accidental Pneumoperitoneum in Understanding the Learning Curve for Totally Extraperitoneal and Extended Totally Extraperitoneal Inguinal Hernia Repair.

Abdominal wall hernia repair is among the fundamental procedures in general surgical practice. Subsequent to the advent of minimally invasive repair, there have been efforts to find the most reliable technique, with easily reproducible results that can be practiced by surgeons worldwide. From an analytical point of view, this study aimed to highlight the advantages and disadvantages of two techniques. A total of 60 participants were divided into two groups of 30 patients: the totally extraperitoneal (TEP) and the extended TEP (eTEP) hernia repair groups. Covariates and outcomes were analyzed using the chi-square and Mann-Whitney U tests. The study was carried out at a tertiary postgraduate teaching hospital in the western zone of Maharashtra, Pune, India, by a single surgeon. The operative procedures were as per standard surgical practice for both groups.The study was conducted to understand types of difficulties observed in the early implantation stages and the learning curve of these procedures. Ten percent of the procedures in the TEP group and 6.7% of procedures in the eTEP group required Veress needle use to manage accidental pneumoperitoneum (P=0.64). The mean operative time in the eTEP group was significantly shorter than that of the TEP group (P=0.031). Compared with the TEP approach, eTEP repair is associated with shorter operative times, owing to a shorter learning curve, a wider-angle view, a wider range of motion for instrument manipulation, and an ergonomically superior operative experience.

Pain and quality of life after laparoscopic unilateral inguinal hernia repair

Introduction Surgical repair of inguinal hernias is one of the most frequently performed operations. Transabdominal preperitoneal (TAPP) and Total extraperitoneal (TEP) methods are the two commonly employed laparoscopic methods for herniorrhaphy. Objective To evaluate the pain and quality of life (QoL) following laparoscopic inguinal hernia surgery utilizing the TAPP and TEP methods. Patients and methods One hundred individuals with unilateral inguinal hernias who had received a clinical diagnosis participated in this prospective trial. The research population was randomly split into two groups by computer-generated software: group A, which consisted of 50 inguinal hernia patients who experienced laparoscopic TAPP surgery, and group B, which consisted of 50 inguinal hernia patients who were treated with laparoscopic TEP surgery. Results After one week and one month postoperatively, the TAPP group had a higher median pain VAS score than the TEP group, which was significant statistically (p values 0.001 and 0.001, respectively). The two groups’ VAS scores did not differ significantly after three- and six-months follow-up. In terms of preoperative and six-month postoperative QoL related domains, the TAPP versus TEP patients showed insignificant difference. Cases involving TAPP and TEP showed an increase of statistical significance in QoL domains from preoperative to six months following surgery. Conclusion According to our investigation, TEP is superior to TAPP. When performed by skilled hands, it appears to be the best method for repairing inguinal hernias.

Lichtenstein versus TIPP versus TAPP versus TEP for primary inguinal hernia, a matched propensity score study on the French Club Hernie Registry.

Groin hernia repair is one of the most frequent operation performed worldwide. Chronic postoperative inguinal pain (CPIP) is the most common and challenging complication after surgical repair with subsequent high socio-economic impact. The aim of this study was to compare the one-year CPIP rates between Lichtenstein, trans-inguinal pre-peritoneal (TIPP), trans-abdominal pre-peritoneal (TAPP) and totally extra-peritoneal (TEP) repair techniques on the French Hernia Registry. Between 2011 and 2021, 15,161 primary groin hernia repairs with 1-year follow-up were available on the register. Using propensity score (PS) matching, matched pairs were formed. Each group was compared in pairs independently; Lichtenstein versus TIPP, TEP and TAPP, TIPP versus TEP and TAPP and finally TEP versus TAPP. After PS matching analysis, Lichtenstein group showed disadvantage over TIPP, TAPP and TEP groups with significantly more CPIP at one year (15.2% vs 9.6%, p < 0.0001; 15.9% vs. 10.0%, p < 0.0001 and 16.1% vs. 12.4%, p = 0.002, respectively). The 1-year CPIP rates were similar comparing TIPP versus TAPP and TEP groups (9.3% vs 10.5%, p = 0.19 and 9.8% vs 11.8%, p = 0.05, respectively). There was significantly less CPIP rate after TAPP versus TEP repair (1.00% vs 11.9%, p = 0.02). This register-based study confirms the higher CPIP risk after Lichtenstein repair compared to the pre-peritoneal repair techniques. TIPP leads to comparable CPIP rates than TAPP and TEP repairs.

Quality of life of patients after inguinal hernia repair

Introduction. Endoscopic procedures for inguinal hernia repair have become widespread. There are many methods of such treatment: transinguinal preperitoneal mesh-plasty (TIPP), TAPP, TEP, MINI (combination of TEP and TAPP). However, the most common among them are TAPP and TEP. Despite the fact that these procedures are now common in many hospitals, the choice of tactics and repair procedures for different types of inguinal hernias is still uncertain. First, it concerns the quality of life of patients.&#x0D; Aim. The aim of this study was to compare TAPP, TEP and Lichtenstein based on quality of life analysis using the EuraHS-QoL scale.&#x0D; Materials and methods. We performed surgical treatment of inguinal hernia in 211 patients. Lichtenstein's procedure was performed in 65 patients (Lichtenstein group), transabdominal preperitoneal (TAPP) inguinal hernia repair in 81 patients (TAPP group) and totally extraperitoneal (TEP) inguinal hernia repair in 65 patients (TEP group). We assessed quality of life using a special scale for hernias (EuraHS-QoL). The missing values were treated according to the instructions of the validation study.&#x0D; Results and discussion. As we expected, inguinal hernia repair improved EuraHS-QoL scores in all groups. In the Lichtenstein group, the total mean decreased from 51.2 to 11.8 (4.3 times) (r=-0.13), in the TAPP group – from 51.1 to 9.9 (5.2 times), in the TEP group – from 51.2 to 12.6 (4.1 times). Cosmetic discomfort was highest at the follow-up visit in patients in the Lichtenstein group (4.2). In the TAPP group, this indicator was probably (p&lt;0.05) the smallest (3.0). Low-traumatic methods of operations in modern surgery are priorities today. The Lichtenstein procedure, despite its simplicity, is a traumatic operation compared to TAPP and TEP.&#x0D; Conclusions. Different options for inguinal hernia repair, which are based on the tension-free principle of inguinal canal correction, can be useful. However, when we analyzed the quality of life according to the EuraHS-QoL scale, we decided that transabdominal preperitoneal (TAPP) inguinal hernia repair is the most optimal in terms of various indicators.

Clinical Data Analysis for Treatment of Adult Inguinal Hernia by TAPP or TEP.

BackgroundTransabdominal preperitoneal (TAPP) repair and totally extraperitoneal (TEP) repair are the primary surgical methods for the treatment of adult inguinal hernia, but it remains necessary to consider which one to choose in clinical practice. Our study seeks to compare the efficacy of laparoscopic TAPP and laparoscopic TEP in the treatment of adult inguinal hernia and to explore which surgical method is a better choice.MethodsA retrospective analysis of 686 adult patients with inguinal hernia admitted to our hospital from the period January 2016 to December 2020 was conducted. According to different surgical methods, they were divided into two groups: a TAPP group (n = 361) and a TEP group (n = 325). These two groups of patients were statistically analyzed, and the operation time, postoperative pain, postoperative hospital stay length, postoperative complications, and recurrence rate were compared between them.ResultsThere were no significant differences in postoperative hospital stay, complications, and the recurrence rate between the two groups (p > 0.05). The duration of operation in the TEP group was significantly shorter than that in the TAPP group, and the difference was statistically significant (p < 0.001); in terms of postoperative pain, the TEP group fared better than the TAPP group, and the difference was statistically significant (p < 0.001).ConclusionTAPP and TEP are safe and effective surgical methods in the treatment of adult inguinal hernia. However, compared with TAPP, TEP can significantly shorten the operative time, reduce intraoperative trauma, and limit postoperative pain in the treatment of adult inguinal hernia. Furthermore, it does not increase the rate of complications or recurrence, so it is worth popularizing.

Pain After Transabdominal Preperitoneal (TAPP) or Totally Extraperitoneal (TEP) Technique for Unilateral Inguinal Hernia: A Randomized Controlled Trial.

IntroductionLaparoscopic inguinal hernia repair is the most commonly performed surgery in many hospitals. This study aimed to compare the outcome of the transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) techniques in unilateral, uncomplicated inguinal Hernia.Material and methodsThis prospective randomized study was conducted in a tertiary care hospital in North India from November 2018 to March 2020. Sixty-eight male patients of unilateral, uncomplicated inguinal hernia were enrolled for laparoscopic hernia repair. The first group of 34 patients underwent TAPP repair and the second group of 34 patients underwent TEP repair under general anesthesia (GA). Both groups were compared for intraoperative or postoperative complications, analgesic requirements, postoperative pain, length of hospital stay, resumption of routine activity, and patient satisfaction scores. Fisher's exact test or Chi-square test were used for nominal data and the median or interquartile range was used for ordinal data.ResultsThe mean operative time for TAPP was more than that for the TEP group (101 vs 76, p<0.001). The TAPP group exhibited significantly less postoperative pain at six hours, 24 hours and seven days than TEP (p<0.001) and an insignificant difference at three months of the follow-up period (p=0.188). Additional analgesics requirement was less in the TAPP group, although the difference was not significant (p=0.099). Seroma formation was found in four patients (11.8%) in the TEP group and two patients (5.9%) in the TAPP group (p= 0.672). Length of postoperative hospital stay (p=0.907), resumption of routine activity (p=0.732), and patient satisfaction scores (p=0.492) during follow-up were similar in both groups and were also insignificant.ConclusionThe TAPP technique is slightly better than TEP for inguinal hernia in terms of lesser postoperative pain with similar chances of complications and other outcomes.

Totally extraperitoneal versus transabdominal preperitoneal approach: A comparative study between the two laparoscopic procedures

Background: Groin hernia surgery is one of the most common procedures performed by surgeons worldwide. With the advent of minimal access surgery, the procedure for repair is now done either by transabdominal preperitoneal approach Transabdominal preperitoneal (TAPP) or totally extraperitoneal (TEP) approach. The advantage of one procedure over the other is still controversial.Objectives: This prospective study was conducted to find out the intraoperative and postoperative outcomes of TEP and TAPP for inguinal hernia repair in terms of operative time, intraoperative complications, conversion to open, visual analog scale (VAS) score, postoperative complications, length of hospital stay, and recurrence of hernia and chronic pain.Materials and Methods: A total of 88 patients of inguinal hernia enrolled prospectively between November 2017 and November 2019 and patients aged 18 years and above admitted in Jawaharlal Nehru Medical College and Hospital were included in this study. Forty-four patients were included in TEP group, while 44 patients were allocated to TAPP group.Results: The statistical analysis was done using Chi-square test and unpaired t-test, respectively. The mean operative time in TEP was 91.14 ± 11.14 min and in TAPP repair was 103.16 ± 6.79 min, which was found to be significantly significant. The mean pain score on VAS score on postoperative day 1 was 5.70 ± 0.95 in laparoscopic TEP group and 5.86 ± 0.97 in laparoscopic TAPP group. The mean pain score on VAS score on postoperative day 2 was 3 ± 1.27 in laparoscopic TEP group and 2.95 ± 1.29 in laparoscopic TAPP group. Similarly, the mean pain score on VAS scale on postoperative day 7 was 0.863 ± 1.26 in laparoscopic TEP group and 0.659 ± 1.21 in laparoscopic TAPP group. No significant difference was observed in VAS between TEP and TAPP groups during follow-up. Both TEP and TAPP mesh techniques were comparable in terms of the intraoperative complications and postoperative complications (seroma [during hospital stay, after 1 week of discharge, after 1 month of follow-up]; hematoma [during hospital stay, after 1 week of discharge]; wound infection) and in conversion to open and length of hospital stay. The difference in mean cost of surgery was found to be statistically significant.Conclusion: Although the mean operative time and cost of surgery were significantly more in TAPP than in TEP group, no significant difference could be found between the intraoperative and postoperative complication rates, conversion to open, and length of hospital stay. Recurrence was observed in one case of TEP groups during follow-up. Our study supports the view that both laparoscopic TEP and TAPP mesh repairs of inguinal hernia are safe and efficacious.

A randomized clinical trial comparing early patient-reported pain after open anterior mesh repair versus totally extraperitoneal repair of inguinal hernia.

This was a prospective, multicentre, non-blinded, randomized clinical trial involving two parallel groups of patients. Adult patients with symptomatic unilateral primary inguinal hernia were included in this study. Patients were enrolled and treated in five Finnish hospitals. Eligible patients were randomized by use of a computer-based program to receiving either open anterior repair (modified Lichtenstein) with glue mesh fixation or totally extraperitoneal (TEP) repair. The primary aims were to compare 30-day patient-reported pain scores and return to work after surgery between the two groups. A total of 202 patients were randomized: 98 patients to TEP repair and 104 patients to open repair. All randomized patients received their allocated treatment. A total of 86 patients (88 per cent) in the TEP group and 94 patients (90 per cent) in the Lichtenstein group completed the 30-day follow-up. Patients experienced less early pain (P < 0.001) and used less analgesics after TEP repair, compared to those who had modified Lichtenstein repair. Two patients in the TEP group and five in the Lichtenstein group developed superficial wound infection (P = 0⋅446). Only one reoperation was performed in the Lichtenstein group due to haematoma. TEP inguinal hernia repair is associated with less early postoperative pain compared to the open glue mesh fixation technique. NCT03566433 (http://www.clinicaltrials.gov).

Outcome of Laparoscopic Total Extra Peritoneal Versus Lichtenstein Repair For Treatment of Inguinal Hernia: A Randomized Control Trial

&#x0D; &#x0D; &#x0D; &#x0D; OBJECTIVES: &#x0D; To compare the outcome of laparoscopic total extra peritoneal (TEP) repair versus Lichtenstein repair (LR) of inguinal hernia in terms of post-operative pain, hematoma, seroma, wound infection and early recurrence.&#x0D; METHODOLOGY:&#x0D; This randomized control trial was conducted at Surgical Unit III, General Hospital Lahore, Pakistan during the period June 2017 to May 2018. Male patients aged up to 50 years diagnosed with unilateral, reducible primary inguinal hernia were randomized into two groups, Group A (TEP) and Group B (LR), with 38 patients each. Data was collected prospectively on structured proforma. Patients were regularly followed up for one year for early postoperative complications. Statistical analysis was done using SPSS version 26.&#x0D; RESULTS:&#x0D; Out of 76 patients, mean age for TEP was 36.72±4.50 years and LR was 34.42±6.8 years. No significant difference was found in both the groups in terms of short-term postoperative complications. LR group had comparatively high rate of postoperative complications; hematoma formation (n=3/38; 7.9%), wound infection (n=3/38; 7.9%) and seroma formation (n=1/38; 2.6%). Postoperative pain with Visual Analogue Score in TEP group on the 1st day, 3rd day, 7th day and 1 month follow up was less as compared to LR group.&#x0D; CONCLUSION:&#x0D; The present study concludes that TEP is better than LR in inguinal hernia in terms of less postoperative pain after 1 month. However, no statistical difference was found in seroma and hematoma formation and wound infection.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

Laparoscopic Inguinal Hernia Repair—TAPP versus TEP: Results of 301 Consecutive Patients

Introduction: Transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) hernia repair are the two most commonly used techniques in laparoscopic inguinal hernia repair, and the results of comparative studies are conflicting. The objective of this study is to compare the two methods in unilateral inguinal hernia repair. Materials and Methods: The data of consecutive patients who underwent TEP and TAPP due to unilateral inguinal hernia between December 7, 2017, and March 15, 2020, were analyzed retrospectively. The primary outcome was to compare the clinical outcomes of the two techniques in terms of complications, conversion, pain, and operative time. The secondary outcome was recurrence rates. Results: A total of 301 (TEP n=234, TAPP n=67) patients were included in the study. The mean age was 43 years, and the follow-up period was two years. The groups were similar in terms of demographic characteristics and hernia type. The mean operative time was longer in the TAPP group than in the TEP group (67 min and 58 min, p=0.007). The recurrence rate was 4.3% in the TEP group and 5.9% in the TAPP group (p&gt;0.05). The conversion rate was 6% in both groups. In total, 19 (6.3%) patients had intraoperative complications (TEP n=16, TAPP n=3), and 23 (7.6%) patients had postoperative complications (TEP n=16, TAPP n=7). Both intraoperative and postoperative complication rates were similar between the groups (p=0.31 and p=0.051, respectively). The early postoperative pain was less in the TEP group (p=0.004). Conclusion: Less early postoperative pain and shorter operative time were detected in patients who underwent TEP.

Comparison of intraocular pressure during laparoscopic totally extraperitoneal (TEP) versus transabdominal preperitoneal (TAPP) inguinal hernia repair.

Laparoscopic totally extraperitoneal (TEP) repair and transabdominal preperitoneal (TAPP) repair are standard laparoscopic procedures for inguinal hernia repair. Some evidence has shown that pneumoperitoneum can cause an increase in intraocular pressure (IOP) during surgery. This study aimed to compare intraoperative IOP following extraperitoneal CO2 insufflation with the TEP approach and intraperitoneal CO2 insufflation with the TAPP approach. This study is a prospective cohort study. Patients who had inguinal hernias suitable for laparoscopic inguinal hernia repair were assigned to undergo the TEP or TAPP approach. We measured preoperative, intraoperative, and postoperative IOP. The IOP of the TEP and TAPP groups was evaluated using a t test. The relations between peak inspiratory pressure (PIP), mean arterial pressure (MAP), and end-tidal CO2 (EtCO2) were estimated using ANOVA. Univariate and multivariate analyses were performed to determine the factors associated with IOP. There were 50 patients in this study (TEP group n = 25, TAPP group n = 25). The change in intraoperative IOP from the preoperative measurement to the measurement after CO2 insufflation was not statistically significant in either the TEP or TAPP group (p value = 0.357). There was no significant difference in intraoperative IOP change between the TEP and TAPP groups. Intraoperative MAP and PIP were related to IOP, but intraoperative EtCO2 was not. There was no significant intraoperative IOP change during laparoscopic inguinal hernia repair. Both the TEP and TAPP techniques can be performed safely without increasing intraoperative IOP.

A three-arm randomized study to compare sexual functions and fertility indices following open mesh hernioplasty (OMH), laparoscopic totally extra peritoneal (TEP) and transabdominal preperitoneal (TAPP) repair of groin hernia.

With evolving technology, the focus of groin hernia repair has shifted to sexual function and fertility outcomes. This three-arm randomized study was conducted in tertiary care hospital from 1st July 2017 to 30th March 2019. Consecutive patients of groin hernia were randomized into 3 groups, TAPP (Group 1), TEP (Group 2), and OMH (Group 3). Demographic profile and hernia characteristics were assessed preoperatively. Sexual functions (using BMSFI) and fertility (using surrogate fertility indices, viz., semen analysis and anti-sperm antibodies (ASA)) were assessed preoperatively at 3months after the surgery. A total of 121 patients were included in the study with 41 patients in TAPP (Group 1) and 40 each in TEP (Group 2) and OMH (Group3) group. All the 3 groups were comparable in terms of demographic profile, hernia characteristics, intra-operative and early post-operative outcomes. Significant improvement was found in most of the domains of BMSFI score in the study population (p value < 0.001) with no intergroup difference. There was significant increase of anti-sperm antibody level in OMH group as compared to TAPP and TEP (p = 0.001), however, the levels were within normal limit. In conclusion, this study has shown that inguinal hernia repair whether open or laparoscopic (TEP or TAPP) leads on to improvement in sexual functions and fertility indices and can have a significant impact on pre-op counseling of the patient in terms of choice of repair, depending on the available expertise in a given center.

A prospective randomized comparison of sexual function and semen analysis following laparoscopic totally extraperitoneal (TEP) and transabdominal pre-peritoneal (TAPP) inguinal hernia repair.

With standardization of laparoscopic technique of groin hernia repair, the focus of surgical outcome has shifted to lesser studied parameters like sexual function and fertility. This prospective randomized study was conducted in a single surgical unit at a tertiary care hospital. A sample size of 144 was calculated with 72 in each group (Group 1 TEP and Group 2 TAPP). Primary outcomes measured included comparison of sexual function using BMFSI, qualitative semen analysis and ASA levels between patients undergoing TEP or TAPP repair. Semen analysis and ASA was measured pre-operatively and 3months post-operatively. A total of 145 patients were randomized into two groups, TAPP (73) and TEP (72) patients. Both the groups were comparable in terms of demographic profile and hernia characteristics with majority of the patients in both the groups having unilateral inguinal hernia (89.0% in TAPP group and 79.2% in TEP group). Both the groups showed statistically significant improvement in overall sexual function score (BMFSI) at 3months; however, there was no inter group difference. Both the groups were also comparable in terms of ASA and qualitative semen analysis. Both TEP and TAPP repair are comparable in terms of sexual function and effect on semen analysis. Laparoscopic repair improves the overall sexual functions in patients with groin hernia.

Laparoscopic totally extraperitoneal and transabdominal preperitoneal approaches are equally effective for spigelian hernia repair.

Spigelian hernias (SH) are rare intraparietal abdominal wall hernias occurring just medial to the semilunar line. Several small series have reported on laparoscopic SH repair and both totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) approaches have been described. However, there are limited outcome data including both of these techniques. We present the largest series to date of laparoscopic SH repair comparing both popular approaches. Consecutive patients (n = 77) undergoing laparoscopic SH repair from 2009 to 2019 were identified from a prospectively managed quality database. All procedures were performed at a single institution. Patients were divided based on laparoscopic approach used, TEP group (n = 37) and TAPP group (n = 40). Comparison of patient demographics, surgical characteristics, and post-operative complications between TAPP and TEP groups was made using the Wilcoxon rank-sum and Fisher's exact tests. Individuals undergoing TAPP had higher mean BMI (29.3 ± 5.4 vs. 26.3 ± 5.6kg/m2; p = 0.019) and were more likely to have had prior abdominal surgery (65% vs 24.3%, (p < 0.001). Mean procedure length was 77 ± 45min for TAPP repairs and 48 ± 21 for TEP repairs (p = 0.001). TAPP repairs had a significantly longer median LOS than TEP (25 vs. 7h; p < 0.001). Days of narcotic use were significantly shorter after TEP repair than for TAPP (0 vs. 3; p = 0.007) and return to ADL was significantly shorter after TEP repair than for TAPP (5 vs. 7days; p = 0.016. There were no significant differences in readmission, reoperations, SSI, or recurrence between the two groups. Our large series revealed that both preperitoneal laparoscopic approaches, TEP, and TAPP, for SH repair are equally safe, effective, and can be performed on an outpatient basis. Therefore, we suggest that the approach used for repair should be based on surgeon experience, preference, and individual patient factors.

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.

Lichtenstein repair using lightweight mesh versus laparoscopic total extraperitoneal repair using polypropylene mesh in patients with inguinal hernia: A randomized study

Background: With the introduction of mesh for repair of inguinal hernia, the focus of surgeons has shifted to postoperative pain and quality of life (QOL). As compared to open procedures, laparoscopic procedures have been found to be associated with less pain and faster recovery. The present study was designed to assess whether this holds true when open Lichtenstein repair is done using lightweight mesh (LWM) because, in previous studies where laparoscopic inguinal hernia repair is compared to open Lichtenstein repair, heavyweight mesh (HWM) was used for both techniques. HWM was used for total extraperitoneal (TEP) in the current study because of higher recurrence associated with LWM.Materials and Methods: This prospective randomized study was done on 60 patients divided into two groups: the Lichtenstein group and the TEP group. Patients were followed at 1 week, 1 month, and 6 months for any postoperative complication. QOL was assessed using hernia-specific Carolinas Comfort Scale.Results: No statistically significant difference was observed between the two groups with regard to various postoperative complications. Only one recurrence was detected at 1 month in TEP group. The mean groin pain was significantly less in TEP group at 24 h, 1 week, and 1 month (P < 0.05). The sensation of mesh was significantly less in Lichtenstein group at 24 h and 1 week (P ≤ 0.001) but comparable to TEP at 1 month and 6 months. The difference in movement limitation was not significant at any time between the two groups.Conclusion: Except for less pain in the early postoperative period TEP does not offer any advantage and Lichtenstein repair using LWM can still be considered as the best option for inguinal hernia repair, especially in countries where resources are limited.