Laparoscopic Transabdominal Preperitoneal Repair Research Articles

Postoperative pain in transabdominal preperitoneal laparoscopic hernia repair with staple fixation versus self-fixation mesh

BackgroundThe mesh fixation method is one of the multiple factors associated with chronic postoperative pain in inguinal hernia surgery. The aim of this study is to evaluate postoperative pain associated with the two available fixation strategies (staple fixation versus self-fixating mesh) used in our field. MethodsWe designed an observational study with retrospective cohorts to analyze postoperative pain in patients who underwent a laparoscopic transabdominal preperitoneal inguinal hernia repair with a self-fixating mesh or staple fixation, which are the two available techniques in our field. A total of 296 patients who met the inclusion criteria were included between January 2014 and October 2021. ResultsThe evaluated patients’ median age was 66.0 (interquartile range (IQR): 20.75) years and were predominantly male (70.13 %). The proportion of participants with chronic pain was 3.20 % in the staple fixation group and 0 % in the self-fixating mesh group, with no statistically significant differences. On the other hand, recurrency in the staple fixation group was 2.28 % versus 3.90 % in the self-fixating mesh group, without statistically significant differences. ConclusionsSelf-fixating meshes have a trend towards smaller proportion of chronic pain and similar proportions of recurrence; therefore, they seem to be the best fixation method between the two mechanisms that are available in our field to prevent postoperative chronic pain.

A case of indirect inguinal bladder hernia treated with laparoscopic transabdominal preperitoneal repair with high peritoneal incisional approach

BackgroundInguinal herniation of the urinary bladder is uncommon and those descending into the scrotum are even rarer. Although open anterior repair has been used for inguinal bladder hernia, the efficacy of laparoscopic herniorrhaphy has been reported in recent years.Case presentationA 63-year-old man presented with an irreducible right groin and scrotal bulge associated with voiding difficulty. Abdominal ultrasonography showed a dislocation of the urinary bladder descending into the right scrotum. Abdominal CT imaging revealed that a part of the bladder and small intestine was herniating into the scrotum through the internal inguinal ring and running laterally to the inferior epigastric artery. Under the diagnosis of indirect inguinal bladder hernia, the patient underwent trans-abdominal preperitoneal hernia repair (TAPP). The bladder herniated into the scrotum through the internal inguinal ring was replaced to the original position. Then the myopectineal orifice was exposed and covered with polypropylene mesh, where a horizontal peritoneal incision 4 cm above the hernia orifice, i.e., the high peritoneal incision approach (HPIA), allowed an easy peeling of the peritoneum and hernia sac. The patient’s postoperative course was uneventful and the voiding difficulty resolved. The patient continued to do well without recurrence at 20 months after surgery.ConclusionPreoperative evaluation with abdominal ultrasonography and CT scan allowed a precise diagnosis of a groin hernia with voiding difficulty. TAPP with HPIA was useful in the treatment of inguinal bladder hernia because this technique facilitated a quick confirmation of the hernia contents, secure dissection of the whole protruded bladder, and adequate replacement of the bladder to the original position without any injury.

Meta-analysis of the effectiveness and safety of robotic-assisted versus laparoscopic transabdominal preperitoneal repair for inguinal hernia.

Inguinal hernia is a common global disease. This study aims to investigate the effectiveness and safety of robot-assisted transabdominal preperitoneal repair (RTAPP) and laparoscopic transabdominal preperitoneal repair (LTAPP) for inguinal hernia. We conducted a thorough search in Cochrane Library, Embase, and PubMed for relevant clinical studies. After applying inclusion and exclusion criteria, the quality of selected studies was assessed using the Jadad scale for randomized controlled studies and the Newcastle-Ottawa scale for observational studies. Meta-analysis was performed using RevMan 5.3 software. A total of ten studies were included, comprising two randomized controlled studies and eight non-randomized controlled studies. Meta-analysis results revealed no statistically significant differences between the RTAPP group and the LTAPP group regarding hospital stay [MD = 0.21 days, 95% CI (-0.09, 0.51), P = 0.17], incidence of seroma [OR = 0.85, 95% CI(0.45, 1.59), P = 0.61], overall complication rate [OR = 1.22, 95% CI(0.68, 2.18), P = 0.51], readmission rate [OR = 1.31, 95% CI(0.23, 7.47), P = 0.76], and recurrence rate [OR = 0.82, 95% CI(0.22, 3.07), P = 0.77]. However, the RTAPP group had longer operation time compared to the LTAPP group [MD = 14.02 minutes, 95% CI (6.65, 21.39), P = 0.0002], and the cost of the RTAPP procedure was higher than that of the LTAPP procedure [MD = $4.17 thousand, 95% CI (2.59, 5.76), P<0.00001]. RTAPP for inguinal hernia is a safe and feasible approach, however, it is associated with increased operation time and treatment costs.

Comparing stapler and sutured mesh fixation techniques for laparoscopic TAPP repair: a study on chronic groin pain on 3-year follow-up.

Trans-abdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) repairs are the available surgeries for inguinal hernias, with both methods of laparoscopic repairs requiring mesh applications. This study analyzes the correlation between sutured versus stapler mesh fixation in a laparoscopic TAPP for unilateral groin hernia regarding chronic pain during 3-year follow-up. A total of 130 patients with laparoscopic hernia undergoing TAPP repair were randomized into 2 groups based on their fixation technique-one with sutures and the other with stapler. Postoperative complications and chronic groin pain were noted for each technique. Equal number of participants was present in the stapler and suture groups, with the majority having an ASA score of one. The mean age was 42.50 ± 13.86years, and the body mass index (BMI) was 27.47 ± 5.88. The stapler group presented a shorter mean operative time than the suture group. However, the stapler group had a significantly higher mean VAS score than the suture group. Most participants in the suture group (89.2%) had LOS for 1day, while a 2-day LOS was significantly higher in the stapler group (12.3%) than in the suture group (9.2%). No patient reported mesh erosion, conversion, recurrence, testicular atrophy, and mesh infection. Early postoperative pain was more in stapler group along with long hospital stay, but both were non-significant. Chronic postoperative pain results and recurrence incidences over 3-year follow-up were also similar. Re-admission rates were minimal, no significant complications occurred.

Totally laparoscopic surgery for a hydrocele of the canal of Nuck extending from the abdominal cavity to the subcutaneous space: a case report

BackgroundHydrocele of the canal of Nuck (HCN) is a rare disease, and its indications for laparoscopic surgery are not well-established.Case presentationA 53-year-old woman was referred to our hospital due to an uncomfortable thumb-sized inguinal mass. Preoperative computed tomography scan and magnetic resonance imaging revealed a hydrocele extending from the abdominal cavity around the left deep inguinal ring via the inguinal canal to the subcutaneous space. The patient was diagnosed with HCN protruding into the abdominal cavity and extending to the subcutaneous space. Laparoscopy can easily access the hydrocele protruding into the abdominal cavity. Furthermore, laparoscopic hernioplasty can be superior to the anterior approach for females. Hence, laparoscopic surgery was performed. After transecting the round ligament of the uterus, a tense 3-cm hydrocele was dissected with it. In order to approach the hydrocele distal to the deep inguinal ring, the transversalis fascia was incised medially to the inferior epigastric vessels. The subcutaneously connected hydrocele was excised from the incision. Then, the enlarged deep inguinal ring was reinforced using a mesh with the laparoscopic transabdominal preperitoneal approach. The patient was discharged 2 days postoperatively. Laparoscopic resection can be more effective for a hydrocele protruding into the abdominal cavity as it facilitates an easy access to the hydrocele. Moreover, laparoscopic resection of a hydrocele extending from the inguinal canal to the subcutaneous space via a transversalis fascia incision can be safer, with low risk of injury to the inferior epigastric vessels. The incised transversalis fascia and the enlarged deep inguinal ring due to the HCN were simultaneously repaired with the laparoscopic transabdominal preperitoneal repair. There are two reports on laparoscopic resection via a transversalis fascia incision for HCNs located between the inguinal canal and the subcutaneous space, which does not require intraperitoneal hydrocelectomy. However, this is the first report on laparoscopic resection of large HCNs protruding into the abdominal cavity and extending beyond the inguinal canal into the subcutaneous space via intraperitoneal hydrocelectomy and a transversalis fascia incision.ConclusionsLaparoscopic surgery with transversalis fascia incision can be useful for HCNs extending from the abdominal cavity to the subcutaneous space.

Single-incision laparoscopic transabdominal preperitoneal repair in the treatment of adult female patients with inguinal hernia.

Women have a 3% lifetime chance of developing an inguinal hernia, which is not as common in men. Due to its cosmetic benefits, single-incision laparoscopic transabdominal preperitoneal (SIL-TAPP) inguinal hernia repair is becoming increasingly popular in the management of inguinal hernia in women. However, there are no studies comparing the safety and applicability of SIL-TAPP repair with conventional laparoscopic transabdominal preperitoneal (CL-TAPP) inguinal hernia repair for the treatment of inguinal hernia in women. To compare the outcomes of SIL-TAPP and CL-TAPP repair in adult female patients with inguinal hernia and to estimate the safety and applicability of SIL-TAPP repair in adult female inguinal hernia patients. We retrospectively compared the clinical information and follow-up data of female inguinal hernia patients who underwent SIL-TAPP inguinal hernia repair and those who underwent CL-TAPP inguinal hernia repair at the Affiliated Hospital of Nantong University from February 2018 to December 2020 and assessed the long-term and short-term outcomes of both cohorts. This study included 123 patients, with 71 undergoing SIL-TAPP repair and 52 undergoing CL-TAPP repair. The two cohorts of patients and inguinal hernia characteristics were similar, with no statistically meaningful difference. The rate of intraoperative inferior epigastric vessel injury was lower in patients in the SIL-TAPP cohort (0, 0%) than in patients in the CL-TAPP cohort (4, 7.7%) and was significantly different (P < 0.05). In addition, the median [interquartile range (IQR)] total hospitalization costs were significantly lower in patients in the SIL-TAPP cohort [$3287 (3218-3325)] than in patients in the CL-TAPP cohort [$3511 (3491-3599)]. Postoperatively, the occurrence rate of trocar site hernia was lower in the SIL-TAPP cohort (0, 0%) than in the CL-TAPP cohort (4, 7.7%), and the median (IQR) cosmetic score was significantly higher in the SIL-TAPP cohort [10 (10-10)] than in the CL-TAPP cohort [9 (9-10)]. SIL-TAPP repair did not increase the incidence of intraoperative and postoperative complications in female inguinal hernia patients. Moreover, female inguinal hernia patients who underwent SIL-TAPP repair had a lower probability of trocar site hernia and inferior epigastric vessel injury than female inguinal hernia patients who underwent CL-TAPP repair. In addition, female inguinal hernia patients who underwent SIL-TAPP repair reported a more aesthetically pleasing postoperative abdominal incision. Therefore, SIL-TAPP repair is a better option for the treatment of inguinal hernias in women.

Comparison Between Mesh Fixation and Non-Fixation in Laparoscopic Transabdominal Preperitoneal Inguinal Hernia Repair

Objectives: To compare mesh fixation and non-fixation in laparoscopic transabdominal preperitoneal inguinal hernia repair in terms of recurrence rate with mesh folding and non-folding. Methodology: A comparative randomized controlled trial was conducted between October 2022 and March 2023 at General Surgery Department, Akbar Niazi Teaching Hospital, Islamabad. Consecutively 100 patients who underwent inguinal hernia surgery. The patient population was divided randomly into two groups. Group-A (Mesh fixation) was administered as a prolene mesh 6 x 11cm and fixed with cooper ligament and pubic symphysis, whereas Group-B (Non-fixation) was administered with the same mesh and placed in the fruchaud myopectineal orifice. The study endpoint in terms of recurrence rate, and mesh folding and non-folding between two groups was measured. The data was analyzed through SPSS v 23. Results: The patients overall mean average age was 36.43±10.81 years. Unilateral hernia in all patients, 60% had right sided, and 40% had left sided. The recurrence rate, and mesh folding was evaluated in both groups during 1 month, 3rd month, and after 6 months completion of follow-up period. No patient developed recurrence in mesh fixation group-A, whereas three patients developed recurrence with mesh folding in non-fixation group-B (p ? 0.05). The chronic pain was lowest and statistically significant difference in non-fixation group-B as compared to mesh fixation group-A (p ? 0.05). Conclusion: Mesh fixation in transabdominal preperitoneal inguinal hernias should be recommended for patients with inguinal hernias less than 4.0 cm in diameter.

Comparison between Lichtenstein hernioplasty and laparoscopic transabdominal preperitoneal repair according to quality of life

Comparison between Lichtenstein hernioplasty and laparoscopic transabdominal preperitoneal repair according to quality of life

Closure of the Peritoneum in Laparoscopic Transabdominal Preperitoneal Inguinal Hernia Repair (TAPP) With Cyanoacrylate Glue in a Microdroplet Device: A Single Surgeon Prospective Comparison vs. Barbed Suture.

To describe and compare a peritoneal closure technique using cyanoacrylate glue (Glubran 2®, GEM, Cardiolink SL) with a microdroplet device (Glutack®, GEM, Cardiolink SL) in laparoscopic transabdominal preperitoneal repair (TAPP) of inguinal hernia with the routinely used barbed suture peritoneal closure (V-Lock 3.0, Covidien France). From January to August 2022, 60 patients undergoing TAPP repair for uni- or bilateral inguinal hernia were randomized into one of two groups. One using as mesh fixation and peritoneal closure the Glutack® device with Glubran 2® cyanoacrylate glue (Glu-close group) and the other using mesh fixation with cyanoacrylate and peritoneal closure with V-lock 3.0 (Sut-close group), with a follow-up of 12 months. Demographic variables, operative time, peritoneal closure time, main surgical findings and main intra- and postoperative complications were analyzed prospectively. 63 patients were included with no losses to follow-up. The mean operative time was 34min (range 58.25) for the glu-close group and 40 (range 64.25) for the sut-close group, with no conversion (0%) for either group. The mean flap closure time was 1.18min (SD 24 0.19) for the glu-close group and 3.24min (SD 0.78) for the sut-close group, with statistically significant differences (p < 0.001). The intraoperative complication rate was 0 for the glu-close group and 0 for the sut-close group, with no significant difference. The median hospital stay was 0.8 days (range, 0-1) for both groups. The median duration of follow-up was 12 months and none had hernia recurrence. The postoperative VAS score at the first and second check-up at 1 month and 3 months was 2.83 (SD 1.341) and 0.60 (SD 0.621) in the sut-close group and 1.03 (0.984) and 0.24 (SD 0.435) in the glue-close group, with significant differences (p < 0.001 and p < 0.012). The data demonstrated by the study are that the glue can be used safely to close the peritoneum and that the method provides a small, statistically significant but not clinically relevant reduction in the time to close the peritoneal flap, as well as in postoperative pain after surgery in short and medium term.

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.

Comparison of Open Lichtenstein Repair and Laparoscopic Transabdominal Preperitoneal of Inguinal Hernia: A Pragmatic RCT in Bangladesh

Background: Laparoscopic inguinal hernia repair has emerged as an effective alternative to open Lichtenstein mesh repair for inguinal hernias. Objective: The purpose of the present study was to compare the surgical outcomes of laparoscopic trans-abdominal pre-peritoneal (TAPP) and open Lichtenstein mesh repair for the treatment of inguinal hernia. Methodology: This single centered, pragmatic randomized controlled trial was conducted in the Department of Surgery at 300 bed hospital, Narayanganj, Bangladesh from January 2018 to June 2020 for a period of two and half year. Patients who were presented with reducible, primary/recurrent, complete/incomplete inguinal hernias among male and female in more than or equal to 18 years of age were selected as study population. Lichtenstein mesh repair was performed which was compared with the laparoscopy group. Open Lichtenstein repair was done under spinal anesthesia with lightweight poly propylene mesh. Laparoscopy was performed by trans-abdominal pre-peritoneal (TAPP) technique under general anesthesia and heavy weight mesh was used. The hospital stay, operating time, post-operative complications like superficial wound infection, seroma formation, scrotal swelling as well as early recurrence and chronic groin pain were compared among these group. Results: A total number of 90 patients presented with inguinal hernia were recruited for this study of which TAPP was performed in 25 cases and 65 cases were undergone Lichtenstein repair. The mean age of laparoscopy and open group of patients were 49.28±9.9 years and 55.05±14.4 years respectively (p-0.03). The mean operation time was 85±10.31 minutes and 52.1±15.36 minutes in laparoscopy and open group respectively (p-0.000). The mean post-operative hospital stay was 2.9±0.78 days and 2.9±0.71 days in laparoscopy and open group respectively (p-0.94). In this study 21 (23.3%) patients developed 25 different early and late post-operative complications, out of which 15 (23.1%) in open group and 06 (23.3%) in laparoscopy group (p-0.52). One early recurrence was reported after 6 months follow up in laparoscopy group. Chronic groin pain was reported in 7 cases of which 5 (7.7%) cases in open group and only 2 (8.0%) cases in laparoscopy group (p-0.002). Conclusion: In conclusion the surgical outcomes of laparoscopic TAPP performed by a young surgeon in Bangladesh has given a clinically better result than open Lichtenstein repair considering hospital stay, seroma formation, wound infection, scrotal swelling and chronic groin pain. Journal of Current and Advance Medical Research, January 2023;10(1):35-40

Retraction Note: Retrospective study of preservation and transection of the round ligament of uterus during laparoscopic transabdominal preperitoneal inguinal hernia repair in adult women

Retraction Note: Retrospective study of preservation and transection of the round ligament of uterus during laparoscopic transabdominal preperitoneal inguinal hernia repair in adult women

1227 Laparoscopic Repair of a Grynfeltt-Lesshaft Hernia: Case Report

Abstract Background Lumbar hernias are an uncommon presentation, with only 300 cases published to date. The aetiology is variable, and they usually present as palpable masses or swellings in the lumbar region. We present a case of successful laparoscopic transabdominal preperitoneal (TAPP) repair of a lumbar hernia with mesh. Case report A 62-year-old male patient, with a history of sarcoidosis and hypertension, was referred to general surgeons with a symptomatic enlarging swelling in the left lumbar region. Preoperative computed tomography (CT) and Ultrasound revealed a superior lumbar hernia. Intraoperatively a 2cm defect was identified. A small lipoma was present within the defect and excised. The defect was repaired with a 10x15cm SymbotexTM mesh secured with ProtackTM. There were no complications operatively or post-operatively and he was discharged the following day. Discussion Anatomically, the lumbar region is bound by the 12th rib superiorly, the iliac crest inferiorly, erector spinae muscles medially and external oblique laterally. Two defined areas of weakness are the superior (Grynfeltt-Lesshaft’s) and inferior (Petit’s) triangles, the first being more common for hernias and experienced by our patient. Surgical repair is the only definitive management and is recommended due to the significant risk of complications. A therapeutically aimed classification system, such as Mereno-Ageas, can be utilised to decide between open and laparoscopic approaches. Conclusions Lumbar hernias are often misdiagnosed due to their rarity. An in-depth history, clinical examination and use of CT preoperatively will aid diagnosis and guide management. Ultimately management will depend on the individual patient and clinician preferences and experience.

Colocutaneous fistula with recurrent urinary tract infection: a delayed complication following laparoscopic transabdominal pre-peritoneal repair

There has been an increase in incidence of delayed complications following transabdominal pre-peritoneal repair (TAPP) for inguinal hernia in the last two decades. Mesh related visceral complications (MRVCs) are difficult to diagnose and treat. Colocutaneous and colovesical fistualas are rare yet devastating delayed complications caused by mesh migration. We present the case of a 40-year-old man who presented to us after numerous hospital visits with urinary symptoms and a recurring fistula on the left abdominal wall at a previously operated site. Computed tomography revealed an ill-defined collection in left loin region abutting the sigmoid colon and urinary bladder. Owing to acute angulation, the colonoscope could not be passed beyond 30 cm. The patient was managed with cystoscopy, laparotomy, mesh explantation, and sigmoid colon resection.

Laparoscopic TAPP Inguinal Hernia Repair: Mesh Fixation &amp; Peritoneal Closure by Sutural Technique

Background: The laparoscopic transabdominal preperitoneal (TAPP) inguinal repair is an evolving technique associated with well-known advantages of a minimally invasive approach. This prospective study was conducted to evaluate the feasibility, safety and effectiveness of laparoscopic TAPP using sutural mesh fixation &amp; peritoneal closure. Intracorporeal sutural technique needs steep learning curve. Methods: Between May 2018 to December 2019, a total of 41 inguinal hernias underwent TAPP repair in 37 adults under general anesthesia. All the patients scheduled for elective inguinal hernia repair were offered the choice of the laparoscopic TAPP repair under general anesthesia. A detailed explanation of the procedure was given to all patients and informed consent was obtained. We used 2/0 vicryl for mesh fixation &amp; peritoneal closure which took only 6.80 US Dollar in comparison to Protack from Covidien which is 167.80 US Dollar. Intraoperative &amp; postoperative variables were recorded in pre structured proforma. Results: The 41 hernia includes 34(82.92%) direct, 07(17.08%) indirect. Unilateral hernia were 33(89.19%), &amp; bilateral were 4(10.81%). Mean operating time for unilateral cases was 122 minutes &amp; for bilateral 210 minutes. Mean operating time in the cases using 3D-4K image system was 70 minutes. Mean duration of hospital stay was 2.9 days. There was no conversion in this study. Postoperative complications included scrotal seroma 2(5.40%), hematoma 1(2.70%), port site infection 2(5.40%) &amp; mesh infection 1(2.70%). Assessment of intensity of postoperative pain was evaluated according to VAS. 05 patients complained of mild pain: pain on the visual analog score (VAS) = 1-3 during one month follow-up. No patient reported with chronic pain &amp; recurrence during the followup period. Conclusion: TAPP inguinal hernia repair with sutural mesh fixation &amp; peritoneal closure is a feasible &amp; safe technique with minimum postoperative morbidity and maximum patient’s satisfaction. J Bangladesh Coll Phys Surg 2023; 41: 187-192

Is the self-adhesive mesh a solution for chronic postoperative inguinal pain after TAPP: A single centre preliminary experience?

Minimally invasive surgery for groin hernia has expanded significantly over the last two decades and has demonstrated better outcomes in terms of pain and quality of life. A major contributing factor related to chronic post-operative inguinal pain (CPIP) is mesh fixation. An alternative to the standard fixation methods is the self-adhesive surgical mesh. Prospective data analysis was performed of all patients undergoing laparoscopic transabdominal pre-peritoneal (TAPP) inguinal hernia repair in a single centre for the period 1 st January, 2022-15 th December, 2022. A standardised surgical technique was used with a lightweight self-adhesive mesh without additional fixation. The analysis has encompassed early and late post-operative complications as well as the assessment of pain with an emphasis on CPIP. The study enrolled 52 patients where a total number of 64 elective hernia repairs were performed: 92.2% ( n = 59) primary and 7.8% ( n = 5) recurrent. Fifty-one patients received post-operative follow-up: 100% at 1 month and 78.8% ( n = 41) at 3 months. The incidence of early postoperative complications was 7.7% ( n = 4): one patient developed a seroma, two patients - port site hematomas and one a transient subileus that were all managed conservatively. No patients suffered a recurrence. The average pain score according to the Visual Analogue Scale was 3.3 (0-8) at discharge, 0.6 (0-4) at 1 month and there was no incidence of CPIP after the 3 rd month. Laparoscopic TAPP repair for inguinal hernia with a self-adhesive mesh is an adequate surgical technique with the potential to reduce CPIP, but more research is needed to evaluate this method.

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.

V-047 VIDEO OF A LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL(TAPP) REPAIR FOR GIANT INGUINOSCROTAL HERNIA

Abstract Giant inguinoscrotal (GIS) hernias are rarely encountered in clinical settings and are oftenassociated with mental neglect for many years. This type of hernia is defined as “giant” if it descends belowthe mid-point of the inner thigh of a patient in an upright position. The laparoscopic repair approach of aGIS hernia is technically challenging. It has been claimed that laparoscopic surgery has several advantagesover the open surgical approach, with less pain and an earlier recovery. The aim of this video is to evaluatethe efficacy of TAPP (laparoscopic transabdominal preperitoneal) in order to treat a GIS hernia. A 65-year-old male without a relevant past medical history was admitted to theemergency service with abdominal pain, belching and nausea. He denied any other symptoms, and noprevious surgical operations were recorded. Physical examination showed a large mass in the left scrotumbelow the mid-point of the inner thigh of the patient in an upright position. A CT scan confirmed thediagnosis of a GIS. A laparoscopic TAPP procedure was decided upon as the best course of treatment. Results The patient underwent a successful repair procedure. The operation time was 150 min. Nointraoperative blood transfusion was necessary. The patient's diet was resumed on the first day postsurgery, and the postoperative hospital stay was three days. Laparoscopic TAPP repair is a safe and feasible method for surgically managing GIS hernias.

V-043 Laparoscopic TAPP repair for strangulated femoral hernia

Abstract Aim To present a case of a strangulated femoral hernia successfully submitted to laparoscopic transabdominal preperitoneal (TAPP) repair and segmental enterectomy. Material and Methods Video recording of the surgical procedure and patient clinical files. Results A 75-year-old woman with previous medical history of diabetes and dyslipidaemia, went to the Emergency Department with complaints of generalized abdominal pain and absence of bowel moves since the previous day. On physical exam, an incarcerated left femoral hernia was evident. She also presented a renal dysfunction and computed tomography scan revealed a femoral hernia containing a bowel segment with upstream intestinal occlusion. Laparoscopic correction was proposed. Laparoscopy revealed an ischemic loop of bowel incarcerated in the femoral hernia defect, which was manually reduced. Signs of irreversible ischemia were present, but no perforation was evident. TAPP correction was performed with a polypropylene flat mesh of 37.8g/m2 with wide pores. After, the umbilical incision was extended and an extracorporeal segmental enterectomy with totally mechanical anastomosis was made. The patient had a favourable postoperative course with no complications. Conclusions Urgent groin hernia surgery with mesh requiring segmental enterectomy, but without gross peritoneal contamination, is associated with decreased recurrence rates and similar postoperative complications. In experienced centres, laparoscopic surgery may be associated with better results, although randomized multicentre studies are needed.

V-026 LAPAROSCOPIC TAPP REPAIR: IS IT REALLY FEASIBLE IN A RE-RECURRENT HERNIA?

Abstract Aim Describe a step by step laparoscopic transabdominal preperitoneal (TAPP) repair of a re-recurrent incisional lumbar hernia. Material &amp; Methods This is the case of a 72-year-old man who had a previous traumatic right lumbar hernia initially approached by laparoscopic intra-peritoneal onlay mesh repair (IPOM) and its recurrence approached by open onlay mesh repair. CT-scan revealed a lumbar hernia on the right with a neck size of 40 mm. The hernia sac measured 65 mm and contained part of the right colon inside, without signs of incarceration nor dilated intestinal loops. According to the European Hernia Society classification for incisional abdominal wall hernias, the patient had a lateral hernia (L4 W2). Results Lateral incisional hernias are limited by the inguinal region inferiorly, the costal margin superiorly, the lateral margin of the rectal sheath medially and the lumbar region laterally. Due to their low incidence and the resulting lack of expertise in the treatment of this abdominal wall defect, surgical treatment poses a challenge- Conclusion The repair of a recurrent hernia is a daunting task, even more so of a re-recurrent one. By choosing to perform a TAPP repair, we were able to prove a laparoscopic re-do repair is feasible even faced with weakened tissues and distorted anatomy.