Transabdominal Preperitoneal Repair Research Articles

Primary upper lumbar hernia repaired by transabdominal preperitoneal approach technique using a self-expanding mesh with a memory-recoil ring, report of a case

BackgroundUpper lumber hernia is a rare entity which can cause obstruction and strangulation. Laparoscopic technique has been considered effective for such hernia repairs; however, there is no report of use of the self-expanding mesh.Case presentationA 77-year-old woman visited to our hospital complaining of a bulge of about 5 cm in the left lumbar dorsal region while standing. Abdominal CT and MRI scans showed a fascial defect in the left lumbar abdominal wall and confirmed the presence of a hernia, in which retroperitoneal fatty tissue and the descending colon protruded. Transabdominal preperitoneal repair (TAPP) was performed and the operative findings revealed the hernia orifice, 3 × 2.5 cm in diameter, between two intercostal nerves. To avoid nerve injury or entrapment, the number of mesh fixation was desirable minimum; therefore, a self-expanding mesh with a memory-recoil ring was used. The mesh, 9.5 × 13 cm in diameter, was placed and tacked to the abdominal wall at two points, 1 cm ventral and dorsal to the hernia orifice. The postoperative course was uneventful and no pain or recurrence was observed with follow-up of 6 months.ConclusionWe herein present a case of upper lumber hernia successfully repaired by TAPP with a self-expanding mesh.

Incidentally found Bilaterally Occult Femoral Hernia during Transabdominal Preperitoneal Inguinal Hernia Repair: A Case Report

Hernia is defined as an area of anatomical weakness or an abnormal protrusion of a viscous or a part of a viscous through an opening, covering it. Inguinal hernia is the most common hernia because of the presence of natural weakness like the deep ring and cord structures. The minimally invasive procedures for inguinal hernia repair include Intraperitoneal Onlay Mesh (IPOM) repair, Transabdominal Preperitoneal Repair (TAPP), and Total Extraperitoneal (TEP) repair. Laparoscopic inguinal hernia repair has the advantage of inspecting the entire myopectineal orifice, as it allows for the identification of bilateral or recurrent hernias. The principle behind laparoscopic repair includes strengthening of myopectineal orifice in all the above approaches. TAPP repair is mainly indicated for large indirect hernias or irreducible hernia. TEP repair is technically challenging to perform and has the advantage of avoiding interbowel adhesions as the peritoneum is not opened. IPOM repair is not routinely performed but has advantages in cases where there is an increased risk of spermatic cord injury seen in patients with a history of lower abdominal irradiation or a history of multiple recurrent hernia surgery. Occult contralateral inguinal hernia and the occult femoral hernia can be easily diagnosed and repaired with no extra incisions while performing TAPP repair. These hernias, if left untreated may present as recurrent hernias or as non resolution of symptoms posthernia surgery. A rare case of bilateral occult femoral hernia found during laparoscopic TAPP repair of an inguinal hernia was reported. The entire myopectineal orifice was repaired using the same mesh with no extra risk or cost.

Assessment of laparoscopic hernia repair in bubonocele

Back ground Inguinal hernias are one of the most common surgeries performed by a general surgeon. Repair of an inguinal hernia via surgery is the only treatment for inguinal hernias and can prevent incarceration and strangulation. Laparoscopic inguinal hernia repair has gained popularity with good results in terms of early return to work, reduced postoperative pain, decline in mesh infection and minimal recurrence. However, the routine use of laparoscopic inguinal hernia repair for the unilateral, uncomplicated hernia is a more controversial issue. Objective Assess the laparoscopic hernia repair in bubonocele in terms of risks, ease of technique, advantages and postoperative outcome including recovery time, postoperative complications, and short-term recurrence rate. Patients and methods This is a prospective cohort study was conducted from June 2022 till September 2022 and performed on a total of 20 patients who had inguinal hernia in bubonocele and were candidates for laparoscopic hernia repair. Results In the current study 20% of cases had bilateral inguinal hernia. As regards operative characteristics, our study results showed that the operative time ranged between 50 and 80 min in 75% of cases. There were no significant intraoperative complications, however, a mild bleeding was recorded only in one (5.0%) case and was easily managed intraoperatively, operating surgeons reported satisfaction and operation ease in 55% of cases. As regards postoperative characteristics, our study results revealed that almost all cases (100.0%) had stayed in the hospital 1 day only, majority of cases (85.0%) had resumed their daily activity and work within 2–4 days after the discharge date with no significant postoperative complications. mild seroma was reported in one (5.0%) case only, mild port site wound infection in one (5.0%) case only, pain was reported in one (5.0%) case only, and all these complications were managed conservatively and completely resolved during the follow up period. Ultimately, laparoscopic transabdominal preperitoneal repair showed good cosmetic outcome with good patient satisfaction in 80% of cases with no short-term recurrence. Conclusion We concluded that transabdominal preperitoneal repair of inguinal hernia was a safe, effective, feasible, and successful with the advantages of less hospital stay and less operative time. Moreover, it is associated with minimal intraoperative and postoperative complications.

One-year experience of robotic transabdominal preperitoneal approach in a single institute: 2 different surgeons with different levels of experience.

The robotic platform, an extension of minimally invasive procedures, is distributed nationwide and readily available. However, its application in inguinal hernia repair seems rare in Korea. This report aims to share our initial experience with robotic inguinal hernia repair. The patients who underwent robotic inguinal hernia repair by 2 different surgeons with different experiences at a single center were retrospectively analyzed. The surgical procedures were performed on all patients using the Da Vinci Xi robotic platform (Intuitive Surgical Inc). Patient demographics, operation variables, and postoperative outcomes were analyzed. A total of 35 patients underwent robotic inguinal hernia repairs consecutively. The mean age was 55.03 ± 18.20 years. The majority of patients were male. The overall mean operation time was 103.98 ± 47.92 minutes for unilateral hernia surgery and 139.28 ± 46.07 minutes for bilateral surgery. None of the patients experienced intraoperative complications. However, postoperative complications were noticed in 8 patients: 3 with seroma formation, 1 with hematoma, 1 with superficial surgical site infection, and 3 with persistent pain at the operation site. This report demonstrates an early experience of hernia surgery using the robotic platform. The robotic approach for transabdominal preperitoneal hernia repair was completed without any significant intraoperative or postoperative complications. It may be a viable option as a minimally invasive technique. Cost-effectiveness, optimal procedural steps, and indications for the robotic approach remain to be further investigated.

Immediate Dialysis After Simultaneous Laparoscopic Peritoneal Dialysis Catheter Placement and Laparoscopic Inguinal Hernia Repair.

Peritoneal dialysis (PD) is an accepted renal replacement therapy for end-stage renal disease (ESRD). Managing inguinal hernia in patients with PD is not standardized. Thus, this study reported the outcomes of simultaneous laparoscopic peritoneal dialysis catheter (PDC) placement and transabdominal preperitoneal (TAPP) repair of inguinal hernia. Thirteen patients with chronic renal disease and inguinal hernia attending a tertiary hospital between May 1, 2016 and June 30, 2021 were evaluated for laparoscopic PDC placement. Concurrent laparoscopic inguinal herniorrhaphy and laparoscopic PDC placement were performed. Dialysate fluid was measured intraoperatively to the level below the incised peritoneum by 1 inch. The inflow and outflow was smooth without leakage. The amount was increased gradually in the two weeks after regular PD was obtained. Laparoscopic PDC was inserted for 13 patients. Ten patients had unilateral hernia and two had bilateral inguinal hernia. Associated paraumbilical hernia was discovered in two patients. The median follow-up was 30 months. The measured safe amount of dialysate fluid intraoperatively was 400 - 600 mL. There was no death, intraoperative complication, or dialysate leakage. Three PDCs were removed owing to noncompliance. No hernia recurrence was observed. Simultaneous laparoscopic PDC placement and laparoscopic repair of inguinal hernia with immediate dialysis is a safe and feasible surgical technique. Utilizing minimally invasive surgery affords PDC placement and inguinal hernia repair simultaneously.

Comparison of open and laparoscopic inguinal hernia surgery based on chronic pain, paraesthesia and recurrence

Aim: To assess the preoperative and operative findings and postoperative early and late complications in patients who were operated on electively and to compare the factors affecting these results through open and laparoscopic hernia techniques. Materials and Methods: In this retrospective study, the patients were initially divided into two groups as open inguinal hernia repair (OIHR) and laparoscopic inguinal hernia repair (LIHR); then the LIHR group was divided into two subgroups as transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP) groin hernia repair with respect to the operation techniques. Preoperative, operative, and early and sixth-month late-period complications of the patients were statistically analyzed. Results: In a total of 241 patients included in the study, 170 patients were included in the OIHR group, and 71 patients were included in the LIHR group (TAPP=20, TEP=51). No statistically significant difference was noted between the OIHR and LIHR groups and between the TAPP and TEP subgroups in terms of chronic pain, paraesthesia, and recurrence. Conclusions: We believe that there is no difference in long-term results between open and laparoscopic elective inguinal hernia surgery.

Endoscopic totally extraperitoneal repair for groin hernia: Experience from a tertiary care centre.

Totally extra-peritoneal (TEP) and transabdominal preperitoneal (TAPP) repair are two established minimal access techniques of groin hernia surgery. TEP offers the advantage of avoiding violation of the peritoneal cavity. This study aims to describe the decade-long experience of TEP in groin hernia repair in a tertiary care teaching institute and the feasibility of the same in difficult scenarios. Retrospective analysis of the database of patients undergoing TEP repair for inguinal hernia in a single surgical unit at a tertiary teaching hospital between January 2008 and December 2019 was performed. Detailed pre-operative clinical details, operative duration, intraoperative and post-operative complications, including pain, length of post-operative hospital stay and hernia recurrence data were analysed. Over 12 years' duration, 511 patients underwent endoscopic TEP mesh repair and the total number of hernias repaired was 614. Majority (97.45%) of patients were male. The mean age of the patient population was 51.3 years. Primary hernia was seen in 490 patients. The mean operating time for unilateral inguinal hernia repair was 56.8 ± 16 min and for bilateral repair 80.9 ± 25.2 min. TEP in previous lower abdominal/suprapubic surgical scars was attempted in 17 (3.3%) patients, with only one requiring conversion. The intraoperative peritoneal breach was the most common documented complication (34.8%). Seroma was seen in 9.4% of patients. Seventeen patients required conversion (14 TAPP and 3 open). Recurrence was seen in 4 (0.7) patients. TEP repair is an effective method of groin hernia repair and can be attempted in the majority of patients groin hernia, including patients with previous lower abdominal incisions.

Comparative Study on Laparoscopic Hernia Repair: Totally Extra Peritoneal Repair (TEP) and Transabdominal Preperitoneal (TAPP) at a Tertiary Care Centre

Background Minimal invasive surgery (MIS) procedures in the early 90's as laparoscopic transabdominal preperitoneal repair (TAPP) and totally extra peritoneal repair (TEP), have gained popularity worldwide over open hernia mesh repair with low recurrences, complications and early return to work and activities. This retrospective study aims to compare the two laparoscopic procedures regarding various parameters like duration of surgery, postoperative complications and duration of hospital stay in various ages and different sexes as described in the methodology. Methods This is a retrospective study for over 2 years which included patients with unilateral inguinal hernia both direct and indirect using either (TAAP) or (TEP) technique. Results Among sixty patients with an inguinal hernia, 30 patients had undergone (TAPP) and 30 had undergone (TEP). The duration of surgery for (TAPP) was observed 111.03±13.71 minutes which was significantly higher than that of (TEP) (92.80±8.24 minutes) at P<0.001. The pain score at 6 hours for (TEP) was 6.97±1.01 in comparison to 8±0.00 for (TAPP) (P<0.001). The pain score at 24 hours for (TAPP) was 5.18±1.00 in contrast to 4.27±0.70 for (TEP) (P<0.001). Conclusion Both (TAPP) and (TEP) are feasible surgical options to treat an inguinal hernia. (TAPP) had significantly longer operating time and more early post-operative pain as compared to (TEP). However, there was no significant difference in hospital stay, post-operative complications in both the group.

Orchiectomy due to delayed severe scrotal hematocele after laparoscopic transabdominal preperitoneal repair for a giant inguinoscrotal hernia: a case report

BackgroundA giant inguinoscrotal hernia is a rare inguinal hernia that extends below the midpoint of the inner thigh while standing. Although reports of laparoscopic surgery for giant inguinoscrotal hernias have increased, the risk of delayed hematocele has not yet been clarified.Case presentationA 68-year-old man was evaluated for a left giant inguinoscrotal hernia, and laparoscopic transabdominal preperitoneal repair (TAPP) was performed. In the procedure, the distal hernia sac was not resected. The postoperative course was uneventful for 3 months postsurgery, after which he complained of giant scrotal swelling, which gradually grew to 13 cm. It did not improve with several punctures and caused dysuria because of increased pressure on the urethra. Thus, reoperation was performed 9 months after surgery. The hematocele consisted of a thickened hernia sac, which was tightly adhered to the spermatic cord and testicle. The hernia sac including the hematocele was removed from the scrotum through an anterior approach, preserving the spermatic cord and testicle. On the third postoperative day, an orchiectomy was performed due to poor testicular perfusion caused by spermatic cord injury. There was no hematocele or hernia at the 3-year follow-up. The remnant sac after laparoscopic TAPP for a giant inguinoscrotal hernia possibly caused refractory hematocele. Additionally, the removal of the hernia sac, including hematocele, from the spermatic cord and testicle has a risk of inducing injury, leading to orchiectomy.ConclusionSurgeons should be aware of the possibility of delayed refractory hematoceles after laparoscopic TAPP for giant inguinoscrotal hernias when the hernia sac is not resected.

LIGHT WEIGHT VERSUS MEDIUM WEIGHT MESH IN LAPAROSCOPIC INGUINAL HERNIA MESH REPAIR

Hernia is repaired by laparoscopic or open approach. Laparoscopic inguinal hernia repairs performed are trans-abdominal preperitoneal repair (TAPP) and totally extra-peritoneal repair (TEP). This study aimed to update the previous reviews and to compare Light Weight versus Medium Weight Mesh in LIHR. Previous studies have shown benets of LWM compared to MWM in terms of decreased pain, discomfort, and early return to normal activity. Method: 50 patients operated for Laparoscopic Inguinal Hernia Mesh Repair were evaluated from Inpatient department of Sahyadri Speciality Hospital, Deccan, Pune between January 2020 to May 2021. 30 patients were operated using Anatomical 3D Light weight Mesh and 20 were operated using Paritene Flat Sheet Medium Weight Mesh; allocation done by simple randomization. It is a prospective, observational study. Aim was to evaluate the post-operative outcome and return to normal activities in LWM versus MWM in LIHR. Result: Mean duration of hospital stay, mean duration of days taken to resume daily activities, intensity of pain by VAS and NRS, foreign body sensation, incidence of seroma formation and inuence on male sexual life and fertility did not differ between patients of both groups. No signicant difference in post-operative pain and foreign body sensation between use of LWM and MWM.

Significance of routine preoperative prone computed tomography for predicting intractable cases of inguinal hernias treated by transabdominal preperitoneal repair

Physical examination is the standard diagnostic approach for adult inguinal hernias. We aimed to evaluate the clinical utility of routine preoperative computed tomography scans in the prone position for predicting intractable cases of inguinal hernias before performing transabdominal preperitoneal repairs. We retrospectively analyzed 56 lesions in 48 patients with inguinal hernias who underwent prone computed tomography scans prior to transabdominal preperitoneal repairs. To assess the ability of prone computed tomography to enable the accurate preoperative diagnosis of inguinal hernias, we compared preoperative hernia types as classified through hernia computed tomography and intraoperative diagnosis. We also analyzed the relationship between operation time and hernia type in unilateral cases (n = 40). The overall hernia computed tomography detection and classification accuracy rates were 81.0% and 83.9%, respectively, using the Japan Hernia Society classification system (2009 version) and 84.3% and 91.2%, respectively, using the European Hernia Society classification system. There were no differences in the hernia type frequencies between the shorter (n = 20) and longer (n = 20) operation time groups. Two patients had sliding inguinal hernias with prolapsing bladders, both of which were detectable using preoperative prone computed tomography. Although transabdominal preperitoneal repairs were completed in both cases, the operation times were exceptionally long (185 and 291 minute). Preoperative prone computed tomography is useful for predicting intractable cases of inguinal hernias. Prone computed tomography can play a significant role in not only typing and differentiating hernias from other diseases, but also in helping surgeons appropriately treat unexpected intractable cases with laparoscopic surgery.

Comparison of open preperitoneal and transabdominal preperitoneal hernia repair for primary unilateral femoral hernia: a retrospective cohort study of 132 case.

Femoral hernia (FH) is traditionally treated by open surgery (OS). Laparoscopic treatment has also shown good results in treating FH. However, there have been few comparative studies of these two techniques. Therefore, our aim was to compare the outcomes of open and laparoscopic surgical FH treatment. Adult patients with primary unilateral FH undergoing OS or transabdominal preperitoneal (TAPP) hernia repair at our hospital from January 2013 to June 2018 were included in this study. Patients with history of abdominal surgery, contraindications to general anesthesia and those not wishing to receive general anesthesia received OS. Demographics, operation details and complications were compared retrospectively between the two groups. A total of 132 patients were recruited to the study, 62 and 70 of whom underwent OS and TAPP, respectively. Compared to OS group, the TAPP group had a significantly shorter hospital stay (3.0 vs. 2.0days, respectively, P < 0.05) and a lower postoperative pain score (3.0 vs. 1.0, P < 0.05), and took less time to return to normal activities (13.0 vs. 6.0days, respectively, P < 0.05). The overall complication rates were equivalent between the groups (10 vs. 9.7%, OR = 1.037, 95% CI 0.329-3.270). Both laparoscopic and open surgery appear to be safe and effective in a cohort of patients with femoral hernia and laparoscopic surgery might offer some advantages in reducing length of hospital stay, lower postoperative pain score and quicker return to activities.

Does the mesh type influence the outcomes and costs of robotic inguinal hernia repair?

The aim of this study was to compare the clinical outcomes and hospital costs associated with two different meshes in robotic transabdominal preperitoneal inguinal hernia repair (IHR). Patients who underwent IHR were assigned to either the polyester self-gripping (PSG) or the polypropylene (PP) group depending on the mesh used. A propensity score matching analysis was performed to obtain balanced populations. Postoperative variables included complications such as surgical site events and recurrences. Hospital costs included all possible expenses generated by the surgery during the hospitalization period. From a database of IHR performed between February 2012 and July 2022, 131 PSG patients were matched to 131 PP repairs. Median operative time was shorter in the PSG group [55 (40-78) vs. 80 (60-116) minutes, p < 0.001]. No intraoperative complications were recorded. Patients who received the PSG mesh experience reduced immediate postoperative pain compared to the PP group. Average follow-up time was 35.2months in the PSG group vs. 12.5months in the PP group (p < 0.001). Median Comprehensive Complication Index was comparable in both groups (p = 0.489), with no surgical site infections logged. No cases of chronic pain were noted. Only two recurrences were recorded in the cohort, both of them in the PSG repairs. Hospital costs were USD $232 higher in the PP group but did not statistically differ (p = 0.523). There were no differences between the polyester self-gripping and the polypropylene mesh in terms of postoperative complications, clinical outcomes and hospital costs. Surgeons may opt for either meshes depending on their preferences and familiarity with each of the products.

Opioid prescribing practices and patient-requested refill patterns following laparoscopic inguinal hernia repair.

Excessive post-operative opioid prescribing has led to efforts to match prescriptions with patient need after surgery. We investigated opioid prescribing practices, rate of patient-requested opioid refills, and associated factors after laparoscopic inguinal hernia repair (LIHR). LIHRs at a single institution from 3/2019 to 3/2021 were queried from the Abdominal Core Health Quality Collaborative for demographics, perioperative details, and patient-reported opioid usage. Opioid prescriptions at discharge and opioid refills were extracted from the medical record. Univariate and multivariable regression were used to identify factors associated with opioid refills within 30-days of surgery. Four hundred and ninety LIHR patients were analyzed. The median number of opioid tablets prescribed was 12 [interquartile range (IQR) 10-15], and 4% requested a refill. On univariate analysis, patients who requested refills were younger [55years (IQR 37-61) vs. 62years (IQR 36.8-61), p = 0.012], more likely to have undergone transabdominal preperitoneal repair (75% vs. 26.4%, p < 0.001), have a scrotal component (30% vs. 11%, p = 0.022), and have permanent tacks used (80% vs. 49.4%, p = 0.014). There was a 12% increase in the odds of opioid refill for every 1 tablet of oxycodone prescribed at discharge (95% CI for OR 1.04-1.21, p = 0.003) after controlling for age and surgery type. Patient-reported opioid use was available for 289 (59%) patients. Post-operatively, 67% of patients used ≤ 4 opioid tablets, and 87% used no more than 10 opioid tablets. Most patients use fewer opioid tablets than prescribed. Requests for opioid refills are rare following LIHR (4%) and associated with higher opioid prescribing.

Tapp in the treatment of irreducible and inguinoscrotal hernia

Laparoscopic surgery is known to be technically difficult to perform for irreducible and inguinoscrotal hernias. The aim of the work is to conduct a comparative analysis of early postoperative complications in the surgical treatment of irreducible and inguinoscrotal hernias using the modified laparoscopic and classic TAPP techniques. Comparative analysis of the local early postoperative complications in 49 male patients who were surgically treated for irreducible and/or inguinoscrotal hernias was carried out. The patients were divided into 2 groups according to the technique of hernioplasty: the first group (n = 19) - surgical treatment was performed by the classical hernioplasty, described in the literature, TAPP technique; the second group (n = 20) - surgical treatment included a modified laparoscopic TAPP technique. Only 1 (5.3%) patient in group 1 (p = 0.079) who had experienced bleeding during surgery. Post-operative subcutaneous emphysema was common in 5.3% in group 1 and 5.0% in group 2 (p = 0.490), inguinal hematoma in 5.3% and 5.0% (p = 0.490), scrotal hematoma in 10.5% and 0% (p = 0.445), inguinal paresthesia 5.3% and 5.0% (p = 0.490), inguinal seroma 5.3% and 5.0% (p = 0.490), scrotal seroma 26.3% and 0% (p = 0.047), orchiepididymitis 5.3% and 0% (p = 0.079) respectively.&#x0D; The modified technique of transabdominal preperitoneal repair of irreducible and inguinoscrotal hernia provides low-trauma fractures of surgery, which reduced the incidence of local intra- and postoperative complications.

Robotic Plication of Rectus Diastasis with Associated Hernias: A Case Series.

Rectus diastases (RD) are caused by a weakening of the abdominal musculature and a widening of the linea alba. Some patients are often erroneously told that they are hernias. Despite the fact that they are not true hernias, they are often associated with true hernias and undergo concomitant repairs. Robotic plication of these diastases has been gaining more widespread use in the past few years, but literature regarding outcomes remains limited. All patients with RD and concomitant ventral hernia that underwent robotic repair were assessed from 2016 to present. Demographics, perioperative morbidity, and outcomes were reviewed, and descriptive analyses were performed. This series consists of 14 patients with an average age of 50.7 years (range 33-78 years), 64% female, and 86% Caucasian. All patients had associated umbilical or ventral/incisional hernia with an average defect size of 7.1cm2 and average mesh size of 254cm2. Robotic transabdominal pre-peritoneal (RTAPP) repair was performed in 67% of cases and robotic extended total extraperitoneal (ReTEP) repair was performed in 33%. Two patients (17%) required conversion to open repair. Hospital length of stay was 0.7 days. There was no morbidity in these patients. At an average follow-up of 2.6 years (range 54-2122 days), the hernia/diastasis recurrence rate is 7.1%. The results of this study suggest that robotic plication with intraperitoneal sublay mesh could be an acceptable surgical approach for RD associated with concomitant ventral hernia repair. Further investigation is required to assess outcomes in a larger group of patients and to determine long-term recurrence and complication rates.

Robotic inguinal hernia repair: is the new Da Vinci single port platform providing any benefit?

The utilization of the robot for inguinal hernia repairs has increased in the past years. The new Da Vinci Single Port (SP) system provides the benefits of single-incision procedures and might overcome the technical difficulties of previous single-incision techniques. The aim of this study was to evaluate the safety and feasibility of the SP transabdominal preperitoneal inguinal hernia repair (SP-TAPP) and compare its outcomes to the robotic multiport technique (MP-TAPP). A prospective cohort of patients who underwent a robotic SP-TAPP and MP-TAPP between 2012 and 2022 was analyzed. Primary endpoints were same-day discharge, morbidity, and inguinal recurrence rates. Secondary endpoints included conversion, operative time, port-site incisional hernia, and chronic pain. MP-TAPP and SP-TAPP were performed in 378 (81.3%) and 87 (18.7%) patients, respectively. Demographics were similar between groups. There were no conversions or intraoperative complications. Mean operative (MP-TAPP: 93.2 vs. SP-TAPP: 78.1min, p = 0.003) and recovery time (MP-TAPP: 160.8 vs SP-TAPP: 112.6min, p < 0.001) were significantly shorter in the SP group. Same-day discharge rate was higher (MP-TAPP: 86.5% vs. SP-TAPP: 97.7%, p = 0.001) after SP-TAPP; 30-day morbidity, readmissions, and chronic pain rates were similar between groups. After a mean follow-up of 30.6months for MP-TAPP and 13.3months for SP-TAPP, inguinal hernia recurrence and port-site incisional rates were similar between groups. Robotic SP-TAPP is safe and feasible. When compared to MP-TAPP, it showed similar postoperative morbidity, higher same-day discharge rates, and a quicker postoperative recovery. Further studies are needed to confirm the benefits of the SP platform.

Comparison among surgical factors in Transabdominal Preperitoneal (TAPP) and Total Extraperitoneal (TEP) Repair conducted in a tertiary care hospital.

Comparison among surgical factors in Transabdominal Preperitoneal (TAPP) and Total Extraperitoneal (TEP) Repair conducted in a tertiary care hospital.

Umbilical Laparoscopic Transabdominal Preperitoneal Repair for Medium-Sized Umbilical Hernia in Overweight and Obese Patients

INTRODUCTION: Despite high prevalence of umbilical hernia, an open anterior approach is still frequently performed. Moreover, suture repair is still routinely applied in cases of small umbilical hernia. However, mesh use may lead to more frequent surgical site infection, especially in obese patients. Some of these limitations may be reconciled by transabdominal-preperitoneal repair (TAPP). The aim of this study was to analyze feasibility, safety and efficacy of umbilical TAPP (u-TAPP). METHODS: A prospective study of early and mid-term outcomes was conducted for all umbilical hernia repair performed in overweight and obese patients. An analysis included 36 patients undergoing elective surgery for primary umbilical hernia between March 2019 and November 2021. The intra- and postoperative data were recorded. All patients reported the outcomes 1 and 3 months after the procedure. RESULTS: The mean width of defect was 26 mm. The operation time was 93.2 ± 22.3 minutes. An area of synthetic mesh in u-TAPP was 164.2 cm2. Median mesh size was 10×15 cm. After 30-day and 3-month follow-up, there was no recurrence or significant postoperative pain. The patients declared their overall satisfaction and quality of life as good or excellent. CONCLUSION: TAPP technique in umbilical hernia repair allows for placement of a large mesh and fulfills current recommendations, especially for patients with additional risk factors, such as obesity or coexistence of diastasis recti. TAPP allows a mesh to be introduced into the preperitoneal space, allowing to avoid direct contact between mesh and intestines. Laparoscopic umbilical TAPP is feasible and safe, but the operation time is longer than with open methods.

V-054 LAPAROSCOPIC REPAIR OF TWO CASES WITH OBTURATOR HERNIA; EARLY DAIGNOSED AND SUCCESSFUL RESULTS

Abstract Aim Obturator hernia is a rare type of groin site hernias. Early diagnosis may prevent intervention on gastrointestinal tract. In this report, we present two octogenarian female patients with early diagnosed obturator hernia. Material &amp; Methods In first case, 83-year-old female admitted to the Emergency Room(ER) for her left groin site pain. Physical examination was unremarkable except mild tenderness on left groin site. There was no abdominal distention. Ultrasound was negative for surgical aspect. Computerized tomography(CT) scans revealed left sided obturator hernia. Laparoscopic trans abdominal pre-peritoneal (TAPP) repair was planned. Peritoneum was opened about 4–5 cm cranial side of the hernia defect and preperitoneal space was prepared. Cone-shaped 5×5 cm polypropylene mesh have placed in the obturator canal. Afterwards 15×15 cm polypropylene mesh was placed to the groin area, covering all possible hernia sites. The mesh was fixed by tuckers and the peritoneal defect was closed. Second case, 84-year-old female admitted to ER with left groin and knee. There was no sign of inguinal hernia on physical examinitation except mild tenderness on left groin site. CT proved the intestinal segment within the left-sided obturator hernia sac. TAPP repair with mesh plug was planned. Peritoneum was opened and previously prepared cone-shaped 15×15 cm polypropylene mesh have placed in the obturator canal and fixed by tuckers. The peritoneal defect was closed and operation completed. Results Both patients were discharged at postoperative day 2. 60 day-postoperative periods were uneventfull. Conclusion The most crucial factor affecting the results is timing of surgery in obturator hernia.