Total Extraperitoneal Hernia Repair Research Articles

TEP or TAPP: who, when, and how?

Groin hernia repair is the most common procedure performed by general surgeons. The open mesh technique generally represents the main technique for an inguinal repair, but a different approach is often required. Laparoscopy was found to be the answer to minimizing the impact of the preperitoneal open techniques described by Nyhus and Stoppa. The introduction of the totally extraperitoneal hernia repair (TEP) and transabdominal preperitoneal repair (TAPP) in the early 1990s started a new chapter in groin hernia surgery. The minimally invasive techniques vs. open mesh, and then one against the other, soon became a hot topic among abdominal wall surgeons. With time, the number of procedures and indications increased and are still increasing. This review aims to provide an overview of the two main laparoscopic techniques for groin hernia repair, answering the following questions: Who should perform them? What is the learning curve required to minimize complications and optimize operative time? When is a minimally invasive approach indicated, and which one (both in elective and in emergency setting)? How are they performed? The standard techniques have been described in detail, and personal observations from an abdominal wall surgery referral center were added. The main reviews from the early 2000s up to date, which compared the techniques, were analyzed, and the results reported, confirming the comparable safety and efficacy of both these techniques.

Quality of life following laparoscopic totally extraperitoneal repair of a unilateral reducible inguinal hernia.

Laparoscopic totally extraperitoneal (TEP) inguinal hernia repair has become increasingly favored over open Lichtenstein tension-free mesh repair owing to its associated benefits, including reduced postoperative pain, early return to normal activities, and a comparable recurrence rate. In recent years, emphasis has been placed on patient-reported outcomes, particularly health-related quality of life (QOL), as a critical metric for evaluating surgical success. This study aimed to evaluate the overall QOL following laparoscopic TEP repair of unilateral inguinal hernia. This prospective study enrolled patients aged 18 years or older who underwent elective laparoscopic TEP hernia repair for unilateral inguinal hernia from April 2020 to March 2022. Data collected include demographic details, hernia characteristics, postoperative complications, and postoperative QOL assessment. The Short Form 36 Health Survey Version 2 (SF-36v2), a validated general QoL questionnaire, was administered preoperatively and at 1 month, 6 months, and 1 year postoperatively. Statistical analysis utilized paired t-tests for comparisons, with significance set at a p-value <.05. A cohort of 49 patients, with a mean (standard deviation) age of 56.7 (14.0) years, predominantly comprising 47 men, was available for evaluation. Complications were observed in three (6.1%) of cases, with seroma/hematoma occurring in two patients and a wound infection necessitating antibiotic treatment in one patient. Notably, there were no instances of recurrence during the study period. Postoperative assessments revealed significant improvements in both physical and mental health at 1 month, with continued improvement noted up to 12 months. Laparoscopic TEP inguinal hernia repair has been shown to improve both physical and mental health in patients with unilateral reducible inguinal hernia, with the majority of the improvement typically occurring within the initial month following surgery. It is crucial to communicate these improvement trends to patients undergoing hernia repair to help manage their expectations effectively.

Risk of conversion after intended total extraperitoneal hernia repair for inguinal hernia depends on type of previous abdominal surgery.

Risk of total extraperitoneal hernia repair (TEP) in patients with previous lower abdominal surgery (PLAS) is still debated. The present study was designed to assess the rate of conversion in TEP for inguinal hernia stratified by type of PLAS. Variables on patients undergoing TEP inguinal hernia repair at our center were prospectively collected between July 2012 and May 2018. Patients with PLAS were compared to patients without PLAS. Furthermore, the most frequent subtypes of PLAS were defined and TEP conversion rate was stratified according to type of PLAS. A total of 1589 patients with TEP inguinal hernia repair were identified including 152 (9.6%) patients with PLAS. Operative time was increased in patients with PLAS (70 vs. 60min, p < 0.001). Conversion from TEP to transabdominal preperitoneal patch plasty(TAPP) or Lichtenstein open inguinal hernia repair was eight-times more frequent after PLAS (8% vs. 1%, p < 0.001). Considering type of PLAS, open appendectomy was most frequently encountered, followed by multiple PLAS and surgery to the bladder and prostate (53%, 11% and 10%). After stratification for type of PLAS, conversions were most frequently found after previous surgery to the bladder or prostate and after multiple PLAS (conversion rate of 20% and 24%, p < 0.001). In contrast, conversion rate after open appendectomy was not increased. PLAS to the bladder and prostate is associated with TEP conversion. Selected patients might profit from a different operative approach for inguinal hernia repair.

Large Symptomatic Inguinoscrotal Seroma Occurred Early after Laparoscopic Total Extraperitoneal Hernia Repair (TEP): a Case Report and Literature Review

Large Symptomatic Inguinoscrotal Seroma Occurred Early after Laparoscopic Total Extraperitoneal Hernia Repair (TEP): a Case Report and Literature Review

A Long-Term Study on Recurrence, Chronic Pain, and Quality of Life in Obese Patients with Groin Hernia undergoing Laparoscopic Total Extraperitoneal Hernia Repair: Comparison between Mesh Fixation and Nonfixation Techniques.

"Laparoscopic Total Extraperitoneal (TEP)" repair of hernia is a common surgical procedure for treating groin hernias. This study focused on the long-standing assessment of "quality of life (QoL)," chronic pain, and recurrence to compare the effectiveness of TEP hernia surgery with "mesh fixation (MF)" against "nonfixation (NF)" in patients who are obese with a BMI of 35 kgs/m2 or higher. In this study's randomized controlled experiment, 73 obese individuals with groin hernias underwent total extraperitoneal hernia repair with either MF (n = 35) or NF (n = 38). A check-up was conducted 1, 3, and 5 years after the operation. Recurrence, chronic pain, and QoL were assessed using a physical examination and validated questionnaires. There were no changes between the subjects of either group in baseline characteristics, hernia recurrence rate, chronic pain rate, or QoL. There were neither significant variations in surgical complications nor hospital stay duration. The results suggest that treating TEP hernias among people with a BMI of 35 kgs/m2 or above with mesh NF may be successful. The recurrence rates among the subject groups were not substantially different; however, NF was linked with reduced rates of chronic pain which would be beneficial for patient satisfaction and recovery. To decide the optimal technique for MF in TEP hernia repair, these findings need to be verified by additional studies.

Roboticassisted incisional hernia surgery-Retromuscular techniques

The trend to minimally invasive surgery has also made its way into the surgical treatment of incisional hernias. Unlike other areas of visceral surgery, recent years have seen aresurgence of open sublay repair in incisional hernia procedures, primarily due to the recognition of the retromuscular layer as the optimal mesh placement site. Additionally, with the growing availability of robotic systems in visceral surgery, these procedures are increasingly being offered in the form of minimally invasive procedures. These methods can be categorized based on the access routes: robotic-assisted transperitoneal procedures (e.g., r‑Rives, r‑TARUP, r‑TAR) and total extraperitoneal hernia repair (e.g., r‑eTEP, r‑eTAR). Notably, the introduction of transversus abdominis muscle release enables the robotic-assisted treatment of larger and more complex hernia cases with complete fascial closure. With respect to the comparison with open surgery required in retromuscular hernia treatment, the currently available literature on incisional hernia repair seems to show initial advantages of robotic-assisted surgery in the perioperative course. New technologies create new possibilities. In the context of surgical training the use of surgical robot systems with double consoles opens up completely new perspectives. Furthermore, the robot enables the implementation of models of artificial intelligence and augmented reality and could therefore open up novel dimensions in surgery.

Comparative Review of Outcomes of Totally Extraperitoneal (TEP) and Transabdominal Preperitoneal (TAPP) Primary Inguinal Hernia Repair.

There is an ongoing debate about the efficacy and postoperative outcomes of transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) inguinal hernia repair. Our aim is to assess the surgical outcomes of each technique, focusing predominantly on postoperative components to determine if establishing a policy to advocate for a single technique is warranted. A literary review of randomized control trials and cohort studies to delineate recurrent concerns or points of contention was undertaken. A retrospective, comparative analysis was performed of TEP and TAPP primary inguinal hernia repairs performed by surgeons with more than five-yearexperience with their preferred technique over a three-year period (January 2020 to December 2022) at three separate institutions. A total of 279 applicable cases were reviewed of which 38% (n=106) were performed as TEP and 62% (n=173) performed as TAPP. The demographic of the cohort was heavily skewed towards the male population as expected; however, there were no differences between each subgroup. TEP hernia repair showed a significantly improved postoperative pain score at one and 24 hours, respectively(1.67 ± 0.45, p < 0.05 and 1.97 ± 0.31, p < 0.05). No discernible difference was noted in the categories of length of hospital stay, recurrence rate, and overall patient satisfaction. The study showed overall improved results using the TEP inguinal hernia repair technique; however, no statistically significant results were demonstrated in the long term to advocate for changes to pre-existing surgeon preferences.

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.

Transabdominal Preperitoneal Versus Lichtenstein Procedure for Inguinal Hernia Repair in Adults: A Comparative Evaluation of the Early Postoperative Pain and Outcomes.

Inguinal hernia repairs are one of the most common procedures in general surgery. In addition to classical open surgery, laparoscopic techniques, such as transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP) hernia repair, have gained acceptance and are increasingly used for inguinal hernia repairs, and these three techniques arethe only standards for inguinal hernia repairs. This study aimed to compare the results of inguinal hernia repairs in adult patients using the TAPP patch technique and Lichtenstein techniques regarding the level of pain perceived one day after surgery and the number of days of hospitalization. A two-year study was performed on 129 patients who underwent TAPP vs. 109 patients who underwent Liechtenstein hernia repair. Our results revealed statistical significance for both variables (Tpain(233) = -7.12, p<0.001, d=2.92; Tdays of hospitalization(233) = -31.34, p<0.001, d=4.01). TAPP is a safe method for inguinal hernia repairs, allowing quick recovery and less postoperative pain than the classical Liechtenstein technique.

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.

Comparison of balloon dissection and telescopic dissection of the preperitoneal space in laparoscopic totally extraperitoneal hernia repair: a systematic review and meta-analysis.

Safety in creating a preperitoneal space is crucial in laparoscopic totally extraperitoneal (TEP) hernia repairs. In this systematic review and meta-analysis, we compared the outcomes of balloon dissection and telescopic dissection in patients with inguinal or femoral hernias who underwent TEP hernia repair. We searched PubMed, Embase, Web of Science, and Cochrane databases for randomized controlled trials (RCTs) and prospective and retrospective studies published from inception to July 2022. Meta-analysis was performed using a random-effects model. The treatment outcome was measured using operation time, incidence of intraoperative hemorrhage, peritoneal laceration, conversion to other approaches, surgical site infection (SSI), hematoma, seroma formation, hernia recurrence, and postoperative pain. Five RCTs, one prospective study, and two retrospective studies (in total, 936 patients) were included. No significant between-group differences were noted in operation time, SSI, hematoma, seroma, recurrence rate, and postoperative pain on days 1 and 7. The conversion rate was significantly lower in the balloon group than in the telescopic group (odds ratio, 0.34; 95% confidence interval, 0.15-0.81). Both balloon dissection and telescopic dissection are viable techniques for creating preperitoneal space in laparoscopic TEP hernia repair and have similar operation time, complication rate, and postoperative pain. Nevertheless, the conversion rate was lower in patients undergoing balloon dissection than in those undergoing telescopic dissection.

Prospective comparative study of mesh fixation in laparoscopic TEP hernia repair using tacker versus cyanoacrylate versus fibrin glue tep mesh fixation with cyanoacrylate

Background: Laparoscopic inguinal hernia repairs done by totally extra peritoneal (TEP) or trans abdominal preperitoneal techniques require mesh fixation which is commonly done by either tackers or fibrin glue. In this study, we discuss about using cyanoacrylate glue for mesh fixation as a more cost effective but equally suitable alternate. Aims and Objectives: The aim of the study was to evaluation of suitability of using highly economical cyanoacrylate ($ 0.13) with tackers ($ 318.52) and fibrin glue ($ 11.94) for mesh fixation during TEP hernia repair. Materials and Methods: A comparative study was done in the Department of Surgery over a period of 3 years (2018–2021). This study included 210 patients who underwent laparoscopic TEP hernia repair. Cases were randomized into three groups of 70 subjects each: Group A - mesh was fixed with tacker, Group B - mesh was fixed using cyanoacrylate, and Group C - mesh was fixed with fibrin glue. Subjects were followed up for 3 months. Type of presentation, diagnosis, and type of mesh fixation were compared to post-operative complications that included pain, seroma, hematoma, and urinary retention findings were recorded and data were statistically analyzed using “SPSS” software. Results: Decreased incidence of post-operative pain (P=0.01) and hematoma was observed in Group B as compared to Groups A and C. Average hospital stay was significantly less in fibrin glue group (P=0.02) and cyanoacrylate group (P=0.02) as compared to tacker group. There was same incidence of postoperative urinary retention (P=0.520) and seroma (P=0.354) formation between all groups. Patients of Group B started daily activities earlier at 15 days follow-up (P=0.032) as compared to Groups A and C. Conclusion: Cyanoacrylate and fibrin glue fixation of mesh in laparoscopic TEP have better outcomes when compared to tackers. Furthermore, as cyanoacrylate is 300 times cheaper than tacker and 10 times cheaper than fibrin glue, this imparts a huge cost advantage to this technique in developing countries. Therefore, use of cyanoacrylate for mesh fixation in laparoscopic TEP can be safely advocated over tackers and fibrin glue.

Laparoscopic total extra-peritoneal (TEP) inguinal hernia repair under local anesthesia by topical lidocaine injection.

Laparoscopic total extra-peritoneal (TEP) inguinal hernia repair is usually performed under general anesthesia (GA) for muscle relaxation. However, TEP hernia repair may be reluctant in high-risk patients of GA. The aim of this study was to compare the outcomes of the TEP under GA and local anesthesia (LA). We retrospectively analyzed patients with inguinal hernia who underwent TEP under GA or LA in a single center from December 2016 to May 2018. The outcomes, such as demographics, duration of surgery, length of hospital stay, visual analog scale (VAS), and postoperative complications, were compared in each group. Seventy-six patients with inguinal hernia underwent TEP under GA (n = 52) or LA (n = 24). Total operation time (mean ±standard deviation; GA, 111.6 ± 23.0min; LA, 76.3 ± 18.0min; p < 0.001) and length of hospital stay (GA, 38.3 ± 11.6min; LA, 30.3 ± 15.6min; p < 0.014) were shorter in LA group compared to GA group. There were no significant differences in postoperative VAS (1h, p = 0.247; 4h, p = 0.086; 12h, p = 0.469; 24h, p = 0.411), postoperative adverse effects (vomiting, p = 0.570; urinary retention, p = 0.214; headache, p = 0.494), and postoperative complications (seroma, p = 0.348; scrotal edema, p = 0.178; recurrence, p = 0.822) between LA group and GA group. Compared with GA, there were no differences in postoperative pain and complications in patients who underwent TEP hernia repair under LA. Furthermore, in LA group, total operation time and length of hospital stay were shortened.

Early Results of Comparison of Hydrophilic Anatomical Mesh and Polypropylene Mesh for Laparoscopic Total Extraperitoneal (TEP) Inguinal Hernia Repair.

To compare the results, feasibility, and effectiveness of laparoscopic total extraperitoneal (TEP) hernia repair made using anatomical hydrophilic mesh and polypropylene mesh. Descriptive study. Department of General Surgery, Recepc Tayyip Erdoğan University Training and Research Hospital, Rize, Turkey and Department of General Surgery, Ondokuz Mayıs University Medical Faculty, Samsun, Turkey from January 2017 to October 2020. Comparative analysis on patient who had TEP for inguinal hernia. Group 1 included repairs using hydrophilic anatomical mesh, Group 2 included repairs using polypropylene mesh. Both were compared for operation times, complications, and return to work. There were 34 patients in Group 1 and 31 patients in Group 2. The average operation time was shorter in Group 1 (p = 0.001). Postoperative complications, were significantly less common in Group 1 (p = 0.045). Patients were able to return to their work-life earlier in Group 1 after surgery (p = 0.001). Both anatomic mesh and polypropylene mesh can be used in TEP hernia repair. These two materials stand out with their different properties. Whereas anatomical mesh shortens the operation time, decreases the rate of postoperative complications, and enables the early return to work, polypropylene mesh is cost-effective and easily accessible. Inguinal hernia, Postoperative complication, Laparoscopic total extraperitoneal (TEP).

Outcomes and Learning Curve in Total Extra Peritoneal Hernia repair.

ABSTRACT Background: A hernia surgery can be performed via the classical open technique, or laparoscopically. However, the later techniques viz. total extraperitoneal repair and transabdominal pre-peritoneal techniques are allied to a steep learning curve. Aim and Objectives: In this study, we aim to define the learning curve associated with a TEP inguinal hernia repair. Materials and Methods: We conducted a prospective study, of 125 patients with inguinal hernia posted for laparoscopic inguinal hernia repair by a total extra peritoneal technique, to assess the learning curve. Two surgeons: surgeon 1 (assessee, junior surgeon) and surgeon 2 (assessor, senior surgeon) were chosen. The learning curve was assessed for surgeon 1, who was a general laparoscopic surgeon, not performing laparoscopic hernia repair, while surgeon 2 was regularly performing laparoscopic hernia repairs. The study period was between January 2018 and January 2022. A direct comparison was made, based on operative time, peritoneal laceration, vascular injury, conversion rates, hospital stay and complications. Results: Out of 125 patients, 50 patients were operated by the surgeon 1 and 75 were operated by surgeon 2. Mean operating time by surgeon 2 was 52 ± 4.5 minutes, and 66 ± 4.18 minutes for surgeon 1 with a p value of 0.0005. This was the only statistically significant variable, while surgical complications like peritoneal laceration, vascular injury or conversions to TAPP were statistically insignificant. Conclusion: Surgeon 1 (Assessee) required to perform 10 TEP surgeries to overcome the learning curve. Therefore, surgeons with a prior experience in laparoscopic surgery needs a shorter learning curve as compared to a beginner in laparoscopic surgery, when it comes to laparoendoscopic groin hernia repair.

Outcomes and Learning Curve in Total Extraperitoneal Hernia Repair: A Cross-sectional Study

Introduction: A hernia surgery can be performed via the classical open technique, or laparoscopically. However, the later techniques i.e, total extraperitoneal repair and transabdominal preperitoneal techniquesare allied to a steep learning curve. Aim: To define the learning curve associated with a Total Extraperitoneal (TEP) in inguinal hernia repair. Materials and Methods: A cross sectional study was conducted in Department of Surgery at Mahatma Gandhi Hospital, Jaipur, Rajasthan, India, from January 2018 and January 2022. Total 125 patients with inguinal hernia posted for laparoscopic inguinal hernia repair by a TEP technique, to assess the learning curve using the moving average method. Two surgeons i.e, surgeon 1 (assessee, junior surgeon) and surgeon 2 (assessor, senior surgeon) were chosen. The learning curve was assessed for surgeon 1, who was a general laparoscopic surgeon, not performing laparoscopic hernia repair, while surgeon 2 was regularly performing laparoscopic hernia repairs. A direct comparison was made, based on operative time, peritoneal laceration, vascular injury, conversionrates, hospital stay and complications. Results: Out of 125 patients, 50 patients were operated by the surgeon1 and 75 were operated by surgeon 2. Mean operating time by surgeon 2 was 52±4.5 minutes, and 66±4.18 minutes for surgeon 1 with a p-value of 0.0005. This was the only statistically significant variable, while hospital stay and surgical complications like peritoneal laceration, vascular injury or conversions to TAPP were statistically insignificant (p-value &lt;0.05). Surgeon 1 (assessee) required to perform 10 TEP surgeries to overcome the learning curve. Oral intake was started at mean of postoperative day 1.08±0.32 for surgeon 1 and 1.04±0.20 for surgeon 2. Full diet was initiated on postoperative day 1.5±0.5 for senior surgeon, while 2.08±0.8 days for the junior surgeon. Conclusion: Surgeons with a prior experience in laparoscopic surgery needs a shorter learning curve ascompared to a beginner in laparoscopic surgery, when it comes to laparoendoscopic groin hernia repair.

Evaluation and Comparison on the Results of Totally Extraperitoneal Laparoscopic Surgery under General and Spinal Anesthesia for Inguinal Hernia.

Totally extraperitoneal (TEP) hernia repair surgery is one of the recently considered hernioplasty methods. Here, in the current study, we aimed to compare the results of TEP hernia repair surgery in the two groups of general anesthesia and spinal anesthesia. This is a randomized clinical trial that was performed in 2018-2019 in Isfahan on 106 patients undergoing TEP inguinal hernia repair. Patients were randomly divided into two groups. The first group underwent TEP inguinal hernia repair surgery under general anesthesia and the second group of patients underwent TEP inguinal hernia repair surgery under spinal anesthesia. Data regarding surgery duration, intensive care unit admission, pain of patients, mean of analgesic injections after the surgery, and complications such as urine retention, seroma, and hematoma, and wound infection were collected. Data were compared between two groups. We found significantly higher duration of surgery in the spinal anesthesia group (P = 0.02). Patients in the spinal anesthesia group had shorter duration of nutrition regime beginning (P = 0.002) and lower frequencies of urine retention (P = 0.001). Further analysis showed that the mean pain severity was significantly lower in spinal anesthesia group compared to general anesthesia during postoperation measurements (P = 0.001) and patients in spinal anesthesia group received less postoperation analgesics compared to the other group (P = 0.001). TEP surgery under spinal anesthesia was associated with better clinical results such as lower postoperative pain and analgesics injections compared to general anesthesia.

Comparison of the impact of open and laparoscopic inguinal hernia operations on male sexual function and pain during sexual activity

In the current study, we aimed to compare sexual function and pain during the sexual activity of men who underwent surgery with the open or laparoscopic total extraperitoneal hernia repair techniques. Patients were randomised into two groups according to the technique used during the operation: the Lichtenstein hernia repair open technique (n=63) and the laparoscopic total extraperitoneal repair technique (n=57). In both groups, postoperative sexual function score was significantly improved compared with the preoperative period (p<.001 for both), but the change was higher in the laparoscopy group (6.8±3.7) compared with the open group (4.3±4.4) (p<.001). In both groups, postoperative pain during sexual activity score was significantly decreased compared with the preoperative period (p=.001 for the open group and p<.001 for the laparoscopy group), with the amount of decrease being higher in the laparoscopy group (1.8±0.9) compared with the other (1.1±1.4) (p=.002). This study showed that both hernia repair techniques had a positive impact on sexual function and pain during sexual activity. The improvement in sexual parameters and pain during sexual intercourse was better in the laparoscopy group.

Learning curve of single-incision laparoscopic totally extraperitoneal repair (SILTEP) for inguinal hernia.

Laparoscopic totally extraperitoneal hernia repair (TEP) is a widely used treatment for inguinal hernia. Single-incision laparoscopic TEP (SILTEP) has attracted the attention of several surgeons, given its superior cosmetic results and patient satisfaction, as well as comparable outcomes to multiport surgery. Nonetheless, no relevant studies have evaluated the learning curve (LC) of SILTEP in terms of both operation time (OT) and surgical failure. Therefore, we aimed to investigate the LC of SILTEP for inguinal hernia. Medical records of 180 patients who underwent SILTEP performed by a single surgeon from a single institution between October 2012 and November 2017 were retrospectively reviewed. The LC was analyzed using the moving average method and cumulative sum control chart (CUSUM) for OT and surgical failure. Surgical failure was defined as the need for additional ports, open conversion, severe postoperative complications (Clavien-Dindo ≥ IIIa), and recurrence. Eight patients who underwent combined surgery or bilateral hernia repair were excluded from the OT analysis. From CUSUM graphs, the study period was divided into three phases: OT-phases 1 (1st-32nd), 2 (33rd-83rd), and 3 (84th-172nd) for OT and failure-phases 1 (1st-29th), 2 (30th-58th), and 3 (59th-180th) for surgical failure. Mean OTs were statistically different in the three OT phases (64.6 vs. 50.8 vs. 35.2min; p < 0.001). Open conversion (31.0% vs. 0% vs. 2.5%) and additional port insertion (6.9% vs. 24.1% vs. 2.5%) stabilized consecutively at failure-phases 2 and 3 (p < 0.001). Surgical failure rates decreased to 5.7% by failure-phase 3 (37.9% vs. 24.1% vs. 5.7%; p < 0.001). For an experienced laparoscopic surgeon, we estimated that approximately 60 cases are needed to overcome the LC for SILTEP in terms of both reducing OT and achieving a surgical failure rate < 10%. Further proficiency could be achieved after approximately 85 SILTEP procedures with a stable OT of approximately 35min.

Comparative Study Of Clinical Outcome Of Laparoscopic Total Extraperitoneal Repair Vs Lichtenstein Repair In 50 Cases Of Inguinal Hernia

INTRODUCTIONAbdominal hernia includes groin hernia (70%), umbilical hernia (15%), epigastric hernia (7%) and incisional hernia (9%). After Bassini’s published paper on the techniques of tissue repair, numerous modifications like use of prosthetic material by Usher and open preperitoneal mesh repair introduced by Stoppa but these were associated with significant postoperative pain and morbidity. The concept of Tension free open mesh repair was first introduced by Lichtenstein. Totally extra peritoneal hernia repair (TEP) is a relatively new technique of repairing inguinal hernias laparoscopically where the dissection and repair are carried out without violating the peritoneal cavity laparoscopically. This study compares the results of laparoscopic hernioplasty by Total Extra-Peritoneal (TEP) technique and Lichtenstein tension free repair hernioplasty technique by open method and determine if the relative advantages achieved could be put in practice in large scale and also identify criteria which may help to choose the patient to a particular type of repair to obtain encouraging results for that particular patient.METHODS AND MATERIALS:The present study was carried out with 50 patients admitted in the department of general surgery at our hospital from period May 2018 to December 2019.Inclusion criteria: Patient aged 18 years and above giving written valid consent. Patients diagnosed as having unilateral incomplete inguinal hernia. Patients medically fit to undergo the procedure. Exclusion criteria:Single or multiple previous lower abdominal surgeries;Complicated inguinal hernia, i.e., irreducible, obstructed, or strangulated;Uncorrected coagulopathies;Patients unfit for general anaesthesiaRESULTIn our prospective Comparative study of laparoscopic and open inguinal hernioplasty, we studied 50 patients with unilateral direct inguinal hernia. Average operative time in open repair was 48 minutes and 70 minutes in laparoscopic repair. In TEP, complications such as difficulty in dissection was seen in 3 patients (12%), accidental opening of peritoneum in 2 patients (8%), and inadequate/inability to insufflate was seen in 1 patient (4%). On postoperative day 7, 8 patients (32%) have mild pain and 3 patients (12%) have moderate pain after open hernia repair. And rest 14(56%) patients experienced no pain. After laparoscopic hernia repair 16 patients (64%) have no pain and 7 patients (28%) have mild pain and 2 patients (8%) had moderate pain. Duration of hospital stay in open (3.5 days) is more compared to laparoscopic repair (2.5 days). Return to normal routine activities in open repair (15.3 days) is delayed than laparoscopic repair (12.92 days). CONCLUSION Here, we have done prospective comparative study of clinical outcome of laparoscopic TEP Vs Lichtenstein open inguinal repair in 50 cases of inguinal hernia. We have reached to following conclusion in our study. Incidence of wound infection and scrotal edema are more in open repair then TEP. TEP is less painful in the early postoperative period leading to earlier ambulation than open repair. TEP results in significantly earlier return to work and better cosmetic results. TEP results in decreased hospital stay and faster recovery than open repair. Average operative repair in TEP is more (70 mins) compared to open repair (48mins) Issue of steep learning curve for laparoscopic surgery should be addressed with better supervision and standardization of training in laparoscopy