Transabdominal Preperitoneal Research Articles

V-007 Robotic repair of a bilateral recurrent groin hernia in a kidney transplant patient

Abstract Aim Due to the increased frequency of kidney transplantations and the high incidence of inguinal hernia in men, the coincidence of both features is not uncommon. Material & Methods A 58-year-old male patient with a history of a kidney transplantation in the right fossa due to bilateral shrivel kidneys, presented with a bilateral recurrent incisional hernia. Two years before he had an anterior bilateral groin hernia repair; a Liechtenstein repair on the left side and a partial preperitoneal repair with mesh reinforcement on the right side. Results The case was approached via a robot assisted TAPP (transabdominal preperitoneal) procedure to perform the preperitoneal dissection of the myopectineal orifices. At the region of the right inguinal hernia, the normal anatomy was distorted, due to the extraperitoneal course of the donor ureter which was freed accordingly. A partial mesh excision of the previous mesh was performed. The preperitoneal dissection area was covered with a self-gripping mesh. The postoperative course was uneventful. Conclusions The extraperitoneal course of the ureter in a kidney transplant patient challenges the surgical repair of an inguinal hernia. In primary groin hernias an anterior approach seems best suited, but in case of a recurrence after a previous anterior approach, a laparoscopic approach is a possible though challenging surgical option.

V-016 TAPP APPROACH FOR A GIANT INGUINOSCROTAL HERNIA

Abstract Aim We present the case of a patient with giant inguinoscrotal hernia and the laparoscopic approach performed. Material & Methods 54yo Male, no medical history except for BMI41. He is evaluated in outpatient clinic for asymptomatic left inguinoscrotal hernia of ten years of evolution. He denies digestive symptoms. Difficulty in urination without symptoms of obstruction. On examination, 20×15cm left not reducible inguinoscrotal hernia extending to the mid-thigh. Minimally invasive approach, TransAbdominal PrePeritoneal, was performed. The content of the hernia is a long portion of sigma and a large amount of fat from the greater omentum. After returning them to the abdominal cavity with the help of pressure from the outside, the TAPP technique was performed without incident, with localization of elements of the spermatic cord. Polypropylene mesh 12×15cm fixed with tackers and cyanoacrylate is placed. Results the patient was discharged on the 4thPO day with no incidents. Subsequently he developed a large seroma that required percutaneous drainage and heart failure that caused large scrotal edema, resolved with diuretic treatment. Ten months later there is no recurrence. Conclusions Giant inguinoscrotal hernia is a surgical challenge. Anterior or posterior approach, open or minimally invasive, can be performed. Sometimes intestinal resection and/or orchiectomy is required. The need for preoperative conditioning with botulinum toxin and even pneumoperitoneum can be considered. We presume that, when possible, the minimally invasive posterior approach is the best technique for these large defects since it provides the best surgical field in the most resistant plane for inguinal hernia repair.

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

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

P-039 INITIAL EXPERIENCE IN ROBOTIC APPROACH IN ABDOMINAL WALL SURGERY

Abstract Aim To evaluate the results of our robotic hernia repair case series. Material and Methods Prospective and observational study on hernia repair cases operated with a robotic approach. We have performed a descriptive analysis of demographic and surgical variables and short-term complications. Results From October 2021 to January 2023, 64 robotic interventions, including 39 men (60.1%) and 25 women (39.1%). Mean age is 60,66 years (+/- 11,72). Mean Body Mass Index (BMI) is 30,70kg/m2 (+/- 5.58). Interventions: 3 unilateral inguinal hernia (2 recurrents), 16 bilateral inguinal hernia (9 recurrents), 13 primary ventral hernias, 23 incisional hernia, 8 mixed hernias and 1 parastomal hernias. Conversion rate is 1,6% (one case). Techniques in inguinal hernia: 22 rTAPP (Transabdominal Preperitoneal) (85,91min +/- 31.90). In unilateral hernia the mean of intervention time is 50min +/- 25,98 and in bilateral hernia is 95,31min +/- 28,83. Techniques in abdominal hernia: 2 iPOM+ (Laparoscopic Intraperitoneal Onlay Mesh) (127.50 min +/- 3.54), 1 rTAPP (90min), 1 rRives (260min), 28 TARUP (Robotic Transabdominal Retromuscular Umbilical Prosthetic) (135.50 min +/- 54.02), 2 eTEP (Enhanced-view Total Extraperitoneal) (165 min +/- 49.48), 4 rTAR (Transversus Abdominis Muscle Release) (122.50 min +/- 51.07), 2 rLIRA (Laparoscopic Intracorporeal Rectus Aponeuroplasty) (147.50 min +/- 74.25) and 1 Pauli (155 min). Complications: 21 SSO (surgical site occurrence) (32,81%), 2 SSI (surgical site infection) (3.1%), 1 recurrence (1.6%). Conclusions Robotic surgery facilitates the approach of complex incisional hernias and the performance or retromuscular techniques. It doesn`t provide clear benefits in inguinal hernia.

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

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

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

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

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-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 & 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.

V-040 PRIMARY ABANDON-OF-THE-SAC: A CASE REPORT

Abstract Background Inguinal hernia repair is one of the most frequent surgical procedures worldwide. Several minimally invasive approaches have been developed. Laparoscopic hernioplasty offers less pain, faster recovery and a lower incidence of wound infection. However, the best approach in repairing large inguinoscrotal hernias and the optimal management of the distal sac and its risks are still debated. There may be a higher risk of visceral or cord structures damage, ischemic orchitis, seroma or haematoma when opting for a complete dissection of the hernia sac which may extend deep into the scrotum. Objective To show a video of a transabdominal preperitoneal (TAPP) approach using the primary abandon of the sac technique. The aim of this is to reduce the complications above-stated. Method We report a case of a 33 year old man, without previous abdominal surgery, diagnosed with a large right inguinoscrotal hernia, which appeared 1 year ago and became painful. The patient was scheduled electively for a TAPP surgery. Results Surgery was performed by means of day surgery. No intraoperative complications. No seroma nor haematoma detected in the postoperative period. Conclusion Laparoscopic best approach of repairing inguinoscrotal hernias are still debatable. The primary abandon of the sac is a feasible and reproducible technique and is a safe manner to overcome the difficulties of the distal sac management.

OC-107 IMPLEMENTATION OF LAPAROSCOPIC INGUINAL HERNIA REPAIR IN A LOCAL HOSPITAL. 2 YEARS’ EXPERIENCE AND CHALLENGES

Abstract Background More than 30 years have passed since the first laparoscopic inguinal hernioplasty but nowadays less than 5% of patients are currently operated by this technique as recent Spanish national data suggest. Objective To present our experience 2 years after implementation of laparoscopic inguinal hernioplasty in our local hospital and highlight the challenges we faced. Methods Our hospital deals with a high volume of abdominal wall surgery and has more than 20 years experience in ambulatory surgery. A multidisciplinary clinical pathway was implemented. Strict selection criteria were established and pelvitrainer sessions were done. Results From January 2021 until December 2022, 196 laparoscopic repairs were performed: 167 transabdominal preperitoneal (TAPP), 29 totally extraperitoneal (TEP). The main challenge was the learning curve. 5 surgeons with experience in laparoscopic surgery were trained. Until now 2 completed their learning curve for TAPP and began training in TEP approach while the others still need senior assistance. The duration of laparoscopic hernioplasty, the need for deep relaxation and the increased carbon dioxide absorption were the biggest concerns for the Anesthesia team. The cost of new materials could be afforded, even though different sutures and types of mesh fixation devices were used until getting the non-invasive one. Surgical outcomes were good, with few minor complications. Moreover the outpatient rate could be maintained but the average time in waiting list for laparoscopic approach was increased. Conclusion The implementation of a laparoscopic hernioplasty program is feasible and safe but faces many challenges, especially due to long learning curve.

V-030 LAPAROSCOPIC TAPP MCBURNEY'S INCISIONAL HERNIA REPAIR: A CASE REPORT

Abstract Background Lateral incisional hernia surgery represents an underappreciated challenge for general surgeons. McBurney's incisional hernia (L3) after appendectomy is rare, with an incidence between 0.1 and 0.9%. Several studies have found fewer postoperative complications with the laparoscopic approach compared with open approach. Objective To show a video of a transabdominal preperitoneal (TAPP) approach for McBurney's incisional hernia associated with a small right lateral inguinal hernia. Method We report a case of a 52 years old man, with previous open appendectomy in 2013, diagnosed with McBurney's incisional hernia (L3W2R0) and small right inguinal hernia (L1M0F0P). The patient was scheduled for laparoscopic TAPP incisional hernia repair. Results The patient was operated as ambulatory surgery with no intraoperative complications. No recurrence nor other complications detected during short, 4th month, follow up after surgery. Conclusions Minimal invasive hernia repair with preperitoneal mesh of lateral abdominal hernias cause less postoperative pain, have a short hospital stay, lower incidence of surgical site and mesh infection, and possibly can reduce recurrence as a wider mesh overlap of the defect is possible. This technique has shown to be feasible and reproducible in selected cases.

P-092 EARLY OUTCOMES OF ROBOTIC-ASSISTED TRANSABDOMINAL PREPERITONEAL INGUINAL HERNIA REPAIR: A SINGLE-INSTITUTION EXPERIENCE

Abstract Purpose Since the introduction of the Da Vinci robot, robot-assisted hernia repairs have become more common. We aim to report our initial experience of robotic transabdominal preperitoneal (R-TAPP) inguinal hernia repair. Methods A retrospective chart review was performed in patients who underwent R-TAPP inguinal hernia repair with a prosthetic mesh using the Da Vinci platform (Intuitive Surgical Inc). Data were collected for patient characteristics and surgical outcomes. Results A total of 21 patients underwent R-TAPP repair consecutively. The mean age was 54.1 ±16.4 years. Twenty patients (95.2%) were male, and the mean body mass index was 23.8 ± 1.9. Bilateral hernia repairs were performed on 2 (9.5%) patients. Six cases (28.5%) of huge scrotal hernias were performed by R-TAPP. The operation time was 91.8 ± 20.4 min for unilateral inguinal hernia and 154.5 ± 26.2 min for bilateral inguinal hernia. The mean console operative time was 61.4 ± 16.9 min for unilateral inguinal hernia and 128 ± 25.5 min for bilateral inguinal hernia. Scrotal vein injury was identified in one patient intraoperatively. Two minor postoperative complications were reported: one with postoperative ileus and the other with umbilical wound seroma. The length of hospital stay was 3.8 ± 0.9 days. Neither mortality nor conversion to open surgery occurred. Conclusion Our early experience has demonstrated that the R-TAPP inguinal hernia repair is a safe and feasible approach. Cost-effectiveness, optimal procedural steps, and indications for the robotic approach remain to be further investigated.

Incidental Femoral Hernias Diagnosed by Laparoscopic Approach: Does Gender Really Matter?

Introduction: Laparoscopic approach in hernia repair enables to visualize all hernia orifices in the groin bilaterally and it may reveal a hernia in the groin region which had not been diagnosed with preoperative physical examination. Therefore, we aim to show incidence of incidental femoral hernias which are diagnosed during laparoscopic inguinal hernia repair. 
 
 Material and Methods: In this retrospective study 865 cases of inguinal hernia that underwent laparoscopic approach for inguinal hernia repair at the xxx between September 2014 and August 2019 were included. The patients’ demographic data, operative and postoperative course were studied.
 
 Results: Between September 2014 and August 2019 865 cases of inguinal hernia underwent laparoscopic hernia repair in our institute. 822 of patients were male and 43 were female. 841 cases underwent totally extraperitoneal (TEP) and 24 cases had trans-abdominal preperitoneal (TAPP) repair. 3 of the operations had started with TEP approach, due to peritoneal injury finished with TAPP. Inferior epigastric artery injury occurred 6 of TEP and 1 of TAPP patients, there were managed by laparoscopic sealing of the damaged vessels. 58 (41 TEP and 17 TAPP) of patients were diagnosed femoral hernia incidentally thanks to posterior approach of laparoscopic hernia repair within 865 patients (6,7%). 3 of these patients was female and 55 were male. During the operation femoral hernia repair was also performed to them.
 
 Conclusion: In conclusion femoral hernias, which had not been diagnosed preoperatively, can be incidentally diagnosed intraoperatively due to dissection of preperitoneal inguinal canal and hernias can be repaired at the same operation. Although ratio of femoral hernia for female patients is higher than the male patients in the literature, in this report ratio of femoral hernias diagnosed incidentally is similar between females and males.

Laparoscopic Techniques in Treatment of Inguinal Hernia in Patients with Peritoneal Dialysis: Experiences from 15 Cases.

Objective: This study aimed to investigate the feasibility, efficacy, and safety of laparoscopic transabdominal preperitoneal (TAPP) repair in the treatment of inguinal hernia in patients on peritoneal dialysis, and the optimal timing for initiating postoperative peritoneal dialysis. Methods: We conducted a retrospective analysis of the clinical data pertaining to patients on peritoneal dialysis with inguinal hernias treated with TAPP repair in the First Affiliated Hospital of Shandong First Medical University from July 15, 2020 to December 15, 2022. Follow-up observations of the treatment effect were also analyzed. Results: A total of 15 patients underwent TAPP repair with success. Contralateral occult hernias were found in 3 cases intraoperatively and were treated simultaneously. During the operation, it was found that the peritoneal dialysis tube was completely wrapped in the omentum majus in 1 case and incompletely wrapped in 5 cases and was separated smoothly under laparoscopy. Conclusion: For patients on peritoneal dialysis with inguinal hernia, TAPP repair has the advantages of less trauma, simultaneous treatment of contralateral occult hernias, adjustment and fixation of peritoneal dialysis tubes, lower incision complication rates, and lower recurrence rates, compared with open surgery. With the gradual resumption of peritoneal dialysis 7 days postoperatively, TAPP repair can be performed safely and effectively in this population group; thus it is a procedure worth promoting.

Atypical Mayer-Rokitansky-Küster-Hauser Syndrome with Bilateral Inguinal Hernia of Adnexa—Laparoscopic Transabdominal Preperitoneal Repair with Ovarian Plication

Atypical Mayer-Rokitansky-Küster-Hauser Syndrome with Bilateral Inguinal Hernia of Adnexa—Laparoscopic Transabdominal Preperitoneal Repair with Ovarian Plication

No prostate? No problem: robotic inguinal hernia repair after prostatectomy.

Traditional teaching suggests that prior pelvic operations, including prostatectomy, are a contraindication to laparoscopic inguinal hernia repair. Despite the growing use of robotic platforms in inguinal hernia repair, there are few studies describing robotic-assisted inguinal hernia repairs (RIHR) in this patient population. This study aims to demonstrate that RIHR is safe and effective in repairing inguinal hernias in patients who had previously undergone prostatectomy. We retrospectively reviewed RIHR cases performed from March 2017 to October 2021 by a single surgeon at our university-affiliated community hospital. Cases were reviewed for preoperative considerations, operative times and complications, and postoperative outcomes. A total of 30 patients with prior prostatectomy underwent transabdominal preperitoneal (TAPP) RIHR with mesh. Sixteen of the 30 patients had undergone robot-assisted laparoscopic prostatectomy (RALP), while 14 patients underwent open resection. Seven of the patients had received post-resection radiation and 12 had previous non-urologic abdominal operations. When compared to all RIHRs performed over the same period, duration of surgery was increased. There were no conversions to open surgery. Postoperatively, one patient developed a repair site seroma which resolved after 1month. Mean follow-up time was 8.0months. At follow-up, one patient reported experiencing intermittent non-debilitating pain at the repair site and one patient developed an inguinoscrotal abscess of unknown relation to the repair. No patients reported hernia recurrences nor mesh infection. This review suggests that TAPP RIHR can be a safe and effective approach to inguinal hernia repair in patients who have previously undergone prostatectomy, including those who received radiation and those who underwent either open or robotic resections.

Pain and quality of life after laparoscopic unilateral inguinal hernia repair

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

Laparoscopic Transabdominal Preperitoneal Repair of De Garengeot Hernia: A Case Report

Abstract De Garengeot hernia is a rare type of femoral hernia in which the appendix is contained within the hernial sac. Due to its rarity, there is limited evidence regarding its optimal surgical approach. Twenty-five reports of repair using the laparoscopic transabdominal preperitoneal (TAPP) technique have been identified; however, there is a lack of consensus pertaining to preoperative diagnosis and whether concurrent appendicectomy is performed. In addition, there is debate over the use of a covering mesh. A 34-year-old woman presented with a 5-week history of pain in the right groin. On examination, an irreducible, tender mass was identified in the groin. A computed tomography scan illustrated a right femoral hernia containing the appendix, demonstrating features of acute uncomplicated appendicitis. The patient underwent laparoscopic TAPP repair with mesh plus appendicectomy and made an uncomplicated recovery. Here, we present laparoscopic TAPP repair with mesh plus appendicectomy as a safe and feasible surgical method for managing De Garengeot hernia with concurrent uncomplicated appendicitis.

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

PurposeThe processing of the round ligament of uterus in laparoscopic transabdominal preperitoneal (TAPP) repair of inguinal hernia in women has contended. This study aimed to explore whether there is any difference in the surgical outcome and postoperative complications between the two processing modalities, preservation, and transection of the round ligament of uterus, in adult female inguinal hernia patients undergoing TAPP.MethodsRetrospective analysis of 84 female patients (117 sides) who underwent TAPP in XXX Hospital from July 2013 to August 2022. Patient characteristics and technical details of the surgical procedure were collected and divided into two groups according to whether the round ligament of uterus was severed intraoperatively or not. There were 52 cases (77 sides) in the group with preservation of the round ligament of uterus and 32 cases (40 sides) in the group with transection of the round ligament of uterus, comparing the general condition, surgical condition, and the occurrence of postoperative related complications between the 2 groups.ResultsThe operative time for unilateral primary inguinal hernia was (129.2 ± 35.1) and (89.5 ± 42.6) minutes in the preservation and transection groups, respectively. There were no statistical differences between the two groups in terms of age, length of hospital stay, ASA, BMI, history of lower abdominal surgery, type and side of hernia, intraoperative bleeding, and time to surgery for primary bilateral hernia (P > 0.05). In addition, there was likewise no statistical difference in the occurrence of postoperative Clavien–Dindo classification, VAS, seroma, mesh infection, labia majora edema, chronic pain or abnormal sensation in the inguinal region, and hernia recurrence in the two groups as well (P > 0.05).ConclusionThere is no evidence that the transection of the round ligament of the uterus during TAPP has an impact on postoperative complications in patients. However, given the important role of the uterine round ligament in the surgical management of patients with uterine prolapse and the high incidence of uterine prolapse in older women, hernia surgeons should also be aware of the need to protect the round ligament of uterus in older women.