Transabdominal Preperitoneal Hernioplasty Research Articles

EMERGENCY LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL (TAPP) HERNIOPLASTY FOR GARANGEOT'S HERNIA: A CASE REPORT

Abstract Aims This video presentation aims to demonstrate the successful management of a rare and challenging case of Garangeot's hernia through Emergency Laparoscopic Transabdominal Preperitoneal (TAPP) Hernioplasty. The primary objectives include highlighting the surgical technique, intraoperative findings, and postoperative outcomes in the context of this uncommon hernia presentation. Materials and Methods An 84-year-old female presented to the emergency department with signs of femoral hernia incarceration. Upon exploration, a Garangeot's hernia, characterized by the presence of the appendix within a femoral hernia sac, was identified. In light of the emergency and the patient's deteriorating condition, an Emergency Laparoscopic TAPP Hernioplasty was performed. The procedure involved meticulous dissection of the hernia sac, reduction of the herniated appendix and appendectomy, and subsequent mesh reinforcement of the femoral defect. Results The video illustrates the step-by-step approach to Emergency Laparoscopic TAPP Hernioplasty in the context of Garangeot's hernia. Intraoperative findings, including the condition of the herniated appendix and associated anatomical structures, are presented. Postoperative outcomes, including recovery, complications, and follow-up observations, are discussed to provide a comprehensive understanding of the case. Conclusions Emergency Laparoscopic TAPP Hernioplasty emerges as a viable and effective intervention for Garangeot's hernia, offering advantages such as reduced morbidity, quicker recovery, and minimal surgical trauma. This video contributes valuable insights into the management of this rare hernia presentation, emphasizing the role of minimally invasive techniques in achieving successful outcomes.

SMALL BOWEL OBSTRUCTION AS A COMPLICATION OF TRANSABDOMINAL PREPERITONEAL HERNIA REPAIR – AN INTERNAL HERNIA CAUSED BY ADHESIONS TO A BARBED SUTURE

Abstract Background Laparoscopic approach to inguinal hernias is advantageous as it reduces postoperative pain, length of stay and recovery time, while allowing for an easier correction of multiple hernia defects in a single operation. Laparoscopic transabdominal preperitoneal (TAPP) hernioplasty is one such technique. Bowel obstruction as a postoperative complication is rare, and can be due to inadequate peritoneal closure, herniation through disrupted peritoneum or adhesions. Aim We herein report on a case of postoperative small bowel obstruction caused by adhesions to a long, barbed suture. Material and Methods Case presentation, in video format, of a 74-year-old man admitted through the emergency department for small bowel obstruction, 7 days after laparoscopic bilateral TAPP hernioplasty and intraperitoneal underlay mesh (IPUM+) hernioplasty for correction of bilateral inguinal hernia and umbilical hernia. Results After examination, and an inconclusive computerised tomography scan, the patient underwent emergency laparoscopic exploration. We found a small bowel obstruction caused by adhesions to the barbed suture previously used to close the peritoneal flap on the right side. The small bowel was freed from the suture, without need for its resection. Appendicectomy was performed as well. The patient was discharged 3 days later, without further complications. Conclusions Adhesions after peritoneal closure may lead to postoperative small bowel obstruction. Surgeons must be aware of complications associated with any procedures performed, including the rare, since a timely diagnosis is necessary for their patients’ adequate care. Hernia surgeons can minimise this complication by improving their suture technique and avoiding bridges of exposed barbed sutures.

LAPAROSCOPIC TREATMENT OF RIGHT INGUINAL HERNIA RE-RECURRENCE

Abstract We report the case of an 81-year-old man presenting with a right inguinal hernia re-recurrence. He had undergone a laparoscopic transabdominal preperitoneal hernioplasty in 2001. The recurrence occurred in 2021, and therefore, he had to be treated with an open approach. Past medical history included arterial hypertension, COPD, coronary artery stenting for ischemic heart disease, stage II chronic renal failure. Previous surgeries consisted of bilateral iliac arteries, percutaneous angioplasty and stenting with a right femoral arterial access, laminectomy of L3–L5, and laparoscopic cholecystectomy. Surgical procedure Laparoscopy confirmed a right hernia re-recurrence. Herniated ileal loop was completely reduced. Peritoneal incision was performed with a lateral-to-medial approach. The mesh was dissected away from the pre-peritoneal fat. The shrunk mesh was pulled downwards to allow the identification of the epigastric vessels, which were then dissected according to a cranial-to-caudal approach. The large hernia sac was completely reduced thus exposing the re-recurrence orifice. Dissection was carried out towards the Bogros’ space. Epigastric vessels were detached from the mesh thus allowing to expose the medial part of the myopectineal orifice. Cooper’s ligament and pubic symphysis were therefore identified. The epigastric and spermatic vessels were freed from the mesh only after the critical view of the myopectineal orifice (MPO) was achieved. The mesh was completely mobilized from the peritoneum and removed. A “landing zone” was obtained, a 15 × 10 cm self-fixating mesh positioned around the re-recurrence orifice. Peritoneum closure was performed by means of a 3–0 running barbed suture from medial to lateral.

VERY LOW RECCURENCE AT 5-YEAR FOLLOW AFTER TAPP WITH PRO-GRIP IN 1200 PATIENTS

Abstract The aim of this study was to demonstrate the long term safety and the efficacy of the self-gripping Parietex ProGrip™ mesh (Medtronic) used with the laparoscopic approach for inguinal hernia repair. The incidence of chronic pain, post-operative complications, patient satisfaction and hernia recurrence at follow-up after 5 years. Methods Data were collected prospectively using the “hernia-med” register in 1579 primary inguinal hernias. All patients included had undergone surgical repair for inguinal hernia by the laparoscopic transabdominal preperitoneal approach using Parietex ProGrip™ meshes performed in the same hernia referral center in Germany. Pre-, per- and post-operative data were collected, and a follow-up after one and five years was performed prospectively. Complications, pain scored on a 0–10 numeric rating scale (NRS), patient satisfaction and hernia recurrence were assessed. Results The only complications were minor and were post-operative: hematoma/seroma (3 cases), secondary hemorrhage through the trocar's site (5 cases), hematuria, emphysema in the inguinal regions (both sides) and hematoseroma in 3,2%. The 5 year follow-up rate was 76%, respectively 1205 patients. There were only 14 reports of hernia recurrence: 1.2% of the hernias. Most patients (95.9%) were satisfied or very satisfied with their hernia repair with only 1.2% reporting severe pain (NRS score 7–10) and 3.6% reported mild pain. Conclusion This study demonstrates that in experienced hands, inguinal hernia repair surgery performed by laparoscopic transabdominal preperitoneal hernioplasty using Parietex ProGrip™ self-gripping meshes is rapid, efficient and safe with low pain and low hernia recurrence rate. The promising short term results held true also in the long term follow-up.

Lichtenstein versus laparoscopic transabdominal preperitoneal (TAPP) hernia repair: Retrospective study, our experience

Abstract: Surgical correction of inguinal hernias is the most commonly used surgical procedure in the world. Currently only three surgical techniques have been validated, that is the Shouldice technique, the Lichtenstein technique, and laparoscopic techniques such as transabdominal preperitoneal (TAPP) hernioplasty and totally extraperitoneal endoscopic hernioplasty (TEP).The aim of the study: The aim of this study is to show the results in terms of postoperative recovery, complications, length of hospitalization after inguinal hernia surgery in patients who underwent the Lichtenstein and the laparoscopic (TAPP) methods.Material and methods: This is a monocentric, retrospective cohort study, conducted in the period from 2019 to 2023. The research period covered 70 patients who underwent surgery at the Clinic for General and Abdominal Surgery with Glandular Surgery, of the University Clinical Center, Sarajevo. The patients were divided into two groups: Group 1: 20 patients who underwent the TAPP method and Group 2: 50 patients who underwent the Lichtenstein method. All patients underwent surgery performed by two doctors.Results: One woman (1.4%) and 69 men (98.6%) participated in the research. Of the total number, 50 patients (72.5%) were treated with the Lichtenstein technique, and 19 (27.5%) were treated with the TAPP technique (p=0.539). The statistical results did not show a significant difference in the average age between patients who underwent the Lichtenstein and the TAPP technique (T=0.759; p=0.450).Discussion: There was no significant difference in relation to age and type of surgery (T=0.759; p=0.450). There was no statistical difference in the choice of surgical approach in relation to the laterality of the hernia (P<0.001), nor any statistically significant difference between the TAPP and Lichtenstein surgical procedures in relation to BMI T=0.613; p=0.542. Our analyses showed that patients treated with the TAPP technique had a statisticallysignificantly higher probability of shorter postoperative hospitalization compared to those treated with the Lichtenstein technique (B=0.245; p=0.019). Two patients in the study had complications within 30 days (Clavien-Dindo Grade I and Grade IIIB).Conclusion: Using an individual approach for each patient, surgical treatment of hernia using laparoscopic TAPP can be the first choice in patients without comorbidities, without previous pelvic surgery, bilaterality or recurrence of previous surgery (anterior approach). Patients treated with the laparoscopic technique (TAPP) have a shorter hospitalization time, which ultimately affects the economic aspect.

Efficacy of Laparoscopic Iliopubic Tract Repair Plus Transabdominal Preperitoneal Hernioplasty for Treating Inguinal Hernia After Robot-assisted Radical Prostatectomy.

Robot-assisted radical prostatectomy (RARP) is a risk factor for inguinal hernia (IH). Furthermore, in patients who have undergone RARP, the fibrotic scar tissue in the RARP area limits preperitoneal dissection. This study aimed to evaluate the efficacy of performing laparoscopic iliopubic tract repair (IPTR) in addition to transabdominal preperitoneal hernioplasty (TAPPH) to treat IH after RARP. A total of 80 patients with an IH after RARP were treated with TAPPH from January 2013 to October 2020 and were included in this retrospective study. Patients who underwent conventional TAPPH were categorized as the TAPPH group (25 patients with 29 hernias), whereas those who underwent TAPPH with IPTR were categorized as the TAPPH + IPTR group (55 patients with 63 hernias). The IPTR comprised suture fixation of the transversus abdominis aponeurotic arch to the iliopubic tract. All patients had indirect IH. The incidence of intraoperative complications was significantly higher in the TAPPH group than in the TAPPH + IPTR group [13.8% (4/29) vs 0.0% (0/63), P = 0.011]. The average operative time was also significantly shorter in the TAPPH + IPTR group than in the TAPPH group ( P < 0.001). There were no differences between the two groups in the duration of hospitalization, recurrence rate, and pain severity. The addition of laparoscopic IPTR to TAPPH for treating IH after RARP is safe and is associated with a minimal risk of intraoperative complications and a short operative time.

Single-incision laparoscopic transabdominal preperitoneal hernioplasty: 1,054 procedures and experience

PurposeAlthough there have been numerous studies on single-incision laparoscopic inguinal hernia repair (SIL-IHR), the short- and long-term outcomes in patients from a large single institution who underwent single-incision laparoscopic transabdominal preperitoneal hernioplasty (SIL-TAPP) have rarely been reported. The purpose of this study is to evaluate the short- and long-term outcomes of SIL-TAPP and its safety and feasibility in patients from a large single institution.MethodsThe details of 1,054 procedures in 966 patients who underwent SIL-TAPP at the Affiliated Hospital of Nantong University from January 2015 to October 2022 were retrospectively analysed. SIL-TAPP was performed completely through the umbilicus using conventional laparoscopic instruments. Short-term and long-term outcomes of SIL-TAPP were collected by outpatient and telephone follow-ups. In addition, we further compared the operation time, length of postoperative hospital stay, and postoperative complications of patients with simple and complicated unilateral inguinal hernias.ResultsA total of 1,054 procedures were performed for 878 unilateral inguinal hernias and 88 bilateral inguinal hernias. In total, there were 803 (76.2%) indirect inguinal hernias, 192 (18.2%) direct inguinal hernias, 51 (4.8%) femoral hernias and 8 (0.8%) combined hernias. The mean operative time was 35.5 ± 17.0 min for unilateral inguinal hernias and 51.9 ± 25.5 min for bilateral inguinal hernias. There was one (0.1%) conversion to two-incision laparoscopic transabdominal preperitoneal hernioplasty. No intraoperative haemorrhages, inferior epigastric vessel injury or nerve damage occurred. Postoperative complications were minor and could be resolved without surgical intervention. The mean length of hospital stay was 1.3 ± 0.8 days. The median follow-up was 44 months, no trocar hernia occurred, and there was one (0.1%) recurrence. The operation time in the complicated inguinal hernia group was significantly higher than that in the simple inguinal hernia group (38.9 ± 22.3 vs. 35.0 ± 15.6, p = 0.025). The length of postoperative hospital stay and complication rate of the complicated inguinal hernia group were slightly higher than those of the simple inguinal hernia group, but the difference was not statistically significant.ConclusionSIL-TAPP is safe and technically feasible, and both short- and long-term outcomes are acceptable.

V-052 Laparoscopic Treatmenf of Spiegel Strangulated Hernia by TAPP Approach

Abstract Repair of hernia is a very common procedure performed by a general surgeon. Laparoscopic approach has demonstrated advantages over direct approach: less complications, faster recovery and less postoperative pain. In Spiegel hernias, if the ring is less than 2 cm, a simple laparoscopic suture can be performed; however, laparoscopic transabdominal preperitoneal (TAPP) hernioplasty has lower risk of recurrence. We report the case of a woman with and strangulated Spiegel hernia which was attempted by TAPP hernioplastly. 63 year old woman consulted in emergency for a swelling of the left flank an occlusive syndrome. Physical examination found a distended abdomen with presence of a painful mass in the left flank, irreducible. Radiological findings were inconclusive, so an ultrasound was performed which showed an abdominal wall defect of 15×15 mm with an ischemic small bowel loop herniation: strangulated Spiegel hernia. A exploratory laparoscopy was attempted emergently. It found a 2 cm hole at the abdominal wall with 15 cm of ischemic small bowel. Ischemia was confirmed with indocyanine green (ICG). Afterwards, TAPP herniopplasty was performed: peritoneal incision to create a peritoneal flap. The peritoneal sac was reduced and then, we closed the defect. After this, we placed a prosthesis covering the area of weakness in the pre-peritoneal space and fixed with biological glue. At least, we covered the mesh with the peritoneal closure. Finally, we performed a resection of ischemic bowel and isoperistaltic mechanical laterolateral extracorporeally anastomosis. She had an unremarkable post-operative course, and she was discharge on the 4th postoperative day.

Diagnosis and Treatment of Inguinal Hernias after Surgical Treatment of Prostate Cancer, Current State of the Problem.

(1) Purpose: To compare and evaluate the immediate and long-term results of the use of various hernioplasties for the treatment of inguinal hernias after surgical treatment of prostate cancer; to determine the possibility of performing transabdominal preperitoneal (TAPP) hernioplasty and total extraperitoneal (eTEP) hernioplasty in patients with inguinal hernia during surgical treatment of prostate cancer. (2) Method: This study is a clinical analytical prospective study, without the use of randomization. The study included 220 patients with inguinal hernia, who were randomly divided into two groups (group A (n = 100) and group B (n = 120)). Patients in group A received eTEP, and those in group B received TAPP. The end points of the study were the results associated with the operation itself and the prognosis of the disease in the two groups. (3) Results: Group A: five patients had a scrotal hematoma, in 10 cases nosocomial pneumonia or infectious complications from the postoperative wound. The overall rate of early postoperative complications was 15%. In group B, the following postoperative complications were reported: one case of intestinal injury, six cases of acute urinary retention, eight cases of scrotal hematoma and 12 cases of nosocomial pneumonia or infectious complications from the postoperative wound were admitted. The overall incidence of early postoperative complications was 22.5%. There was no statistically significant difference in the incidence of postoperative complications between the two groups (χ2 (3) = 2.54, p > 0.05). (4) Conclusion: During the analysis of the obtained results, no statistically significant difference was found in the duration of hospitalization, the volume of blood loss, the severity of pain syndrome, postoperative complication incidence and recurrence incidence (p > 0.05); however, the comparison groups differed in the duration of the operation: the operation time in group A was much longer compared to group B (p < 0.05).

LAPAROSCOPIC APPROACH IN THE TREATMENT OF INGUINAL HERNIAS IN PATIENTS AFTER RADICAL PROSTATECTOMY: COMPARISON OF TARR AND TER RESULTS

Aim: To compare and evaluate the immediate and long-term results of performing transabdominal preperitoneal hernioplasty (TAPP) and total extraperitoneal hernioplasty (TEP) for the treatment of inguinal hernias after surgical treatment of prostate cancer;Material and method: the study is a clinical analytical prospective study, with the use of randomization. The study included 88 patients with inguinal hernia, who were randomly divided into two groups (group A (n = 44) and group B (n = 44)). Patients in group A received TEP, those in group B received TAPP. The end points of the study were the results associated with the operation itself and the prognosis of the disease in the two groups.Results: Group A: one patient had a scrotal hematoma, in 2 cases nosocomial pneumonia or infectious complications from the postoperative wound. The overall rate of early postoperative complications was 6.8%. In group B, the following postoperative complications were reported: in one case, intestinal injury, 1 case of acute urinary retention, 2 cases of scrotal hematoma. The overall incidence of early postoperative complications was 9.1%. There was no statistically significant difference in the incidence of postoperative complications between the two groups (χ = 0.009, P &gt; 0.05).Conclusion: During the analysis of the obtained results, no statistically significant difference was found in the duration of hospitalization, the volume of blood loss and the severity of the pain syndrome (P&gt; 0.05); however, the comparison groups differed in the duration of the operation: the operation time in group A was longer than in group B. (P＜0.05).

Laparoscopic hydrocelectomy with transabdominal preperitoneal hernioplasty or iliopubic tract repair for treatment of encysted spermatic cord hydrocele.

An encysted spermatic cord hydrocele (ESCH) causes an inguinal swelling resembling an inguinal hernia (IH). An ESCH should be considered as a differential diagnosis of IH. Although laparoscopic operations have been performed to treat ESCHs in pediatric patients, such operations have not been reported in adults. This study was performed to evaluate the outcomes of laparoscopic hydrocelectomy for treatment of ESCHs in adults. The medical charts of 49 patients who underwent laparoscopic transabdominal hydrocelectomy for ESCHs from January 2015 to December 2020 at a single institution were retrospectively reviewed. The patients were divided into those with and without an IH. Laparoscopic hydrocelectomy was performed, and the internal inguinal ring was closed with iliopubic tract repair (IPTR) or transabdominal preperitoneal (TAPP) hernioplasty depending on the presence of an IH. The patients' age, ESCH location, postoperative complications, recurrence, and operating time were examined. The patients' mean age was 46.7 (20-77) years. All patients underwent laparoscopic hydrocelectomy without open conversion. ESCHs were more common on the right side (35/49, 71.4%) than on the left (14/49, 28.6%). The presenting symptom in all patients was inguinal swelling. The ESCH was located inside the inguinal canal in 47 patients and protruded to the abdominal cavity from the inguinal canal in 2 patients. After laparoscopic hydrocelectomy, 32 patients without an IH underwent IPTR and 17 patients with an IH underwent TAPP hernioplasty. The mean operating time was shorter in the IPTR than TAPP hernioplasty group. The postoperative complications and hospital stay were not different between the two groups. There were no recurrences in either group. Laparoscopic hydrocelectomy with IPTR or TAPP hernioplasty is safe and feasible for treatment of ESCHs in adults.

Adding Laparoscopic Iliopubic Tract Repair to Transabdominal Preperitoneal Hernioplasty for Treatment of Recurrent Inguinal Hernia After Totally Extraperitoneal Hernioplasty.

Background: In patients with recurrent inguinal hernia (IH) after totally extraperitoneal (TEP) hernioplasty, re-TEP hernioplasty is difficult because of fibrotic adhesions. Re-laparoscopic hernioplasty is possible by changing the approach from extraperitoneal to transabdominal. If iliopubic tract repair (IPTR), mainly used in the past for the open approach, is added as a laparoscopic procedure, re-laparoscopic hernioplasty is possible when treating recurrent IH. We aimed to evaluate the safety and feasibility of alternate transabdominal preperitoneal (TAPP) hernioplasty supplemented by IPTR for treating recurrent IH after TEP hernioplasty. Methods: We retrospectively evaluated 2600 patients with IHs who underwent TAPP hernioplasty from January 2015 to December 2020. Among patients with recurrent IH, those who underwent primary TEP were included in the study. For reoperation, TAPP hernioplasty was performed and IPTR was added. IPTR was performed by suture closure of the internal inguinal ring by the iliopubic tract and medial aponeurotic arch of the transversus abdominis muscle. Results: Of the 35 patients (33 males and 2 females) with recurrent IH after primary TEP hernioplasty, 51% (18/35) of patients had recurrence within 2 years of the first operation. There were 28 recurrent IHs of the same type as the original, and 7 cases of a different type. The mean TAPP operation time was 41 minutes. Chronic inguinodynia and re-recurrence was not observed. One patient had inferior epigastric vessel injury, which was successfully repaired. Conclusion: Adding laparoscopic IPTR to TAPP hernioplasty is safe feasible treatment for recurrent IH after TEP hernioplasty.

Pain and quality of life after laparoscopic transabdominal preperitoneal hernioplasty with different ways of fixing the peritoneum. Results of early completion randomized clinical trial

To compare and statistically evaluate the severity of pain syndrome and quality of life depending on the method of fixation of the parietal peritoneum during laparoscopic hernia repair (suture fixation or the use of tack fixation). A randomized clinical trial was conducted from May to June 2021 at the Lomonosov Moscow State University Medical Center. It was planned to observe patients for a year. In the first group, the fixation of the parietal peritoneum was performed using suture fixation, in the second group, the peritoneal flap was fixed using a fixation device. In the course of statistical data processing, it was planned to study the dependence of the duration of the operation, the severity of the pain syndrome in the early postoperative period, the frequency of complications, the quality of life of patients in the postoperative period on the chosen method of the fixation of the parietal peritoneum. At the initial stage of the study, 8 patients with inguinal hernias were selected in the first group during randomization, and 6 patients were selected in the second group. Each patient of the second group in the early postoperative period had a more pronounced local pain, protective muscle tension in the projection of fixation of the parietal peritoneum with tacks, which was accompanied by negative psychoemotional reactions, an increase in the dose of analgesic drugs. Due to the revealed features of the early postoperative period in patients of second group, it was considered unethical and inappropriate to continue the study within the protocol. The results obtained do not allow us to draw statistically supported conclusions. The solution of the problem of the peritoneal flap fixation method is possible in two ways: abandoning stapler fixation in favor of suture or conducting additional clinical studies with an analysis of the impact of the choice of peritoneal fixation technique not only on acute and chronic postoperative pain, but on quality of life in the early and delayed postoperative periods.

Exploring Indirect Inguinal Hernia Recurrence Technical Cause Following Laparoscopic Trans-Abdominal Pre-Peritoneal Hernioplasty

Review of literature has revealed no definite cause behind indirect inguinal hernia recurrence following laparoscopic trans-abdominal pre-peritoneal hernioplasty. As a matter of surgeons' preference such cases are preferred to be managed through a different approach; either trans-inguinal pre-peritoneal or even open procedure to reduce the needed dissection effort.

Laparoscopic versus open hernia repair in patients with incarcerated inguinal hernia.

Laparoscopic approach is employed very rarely in the treatment of patients with incarcerated inguinal hernia. The aim of the present study was to evaluate the safety and benefits of laparoscopic hernioplasty (TAPP) in the treatment of incarcerated inguinal hernia. It was a retrospective clinical study focused on comparison of perioperative and postoperative outcomes of laparoscopic and open hernia repair of incarcerated inguinal hernia. All adult patients undergoing surgery for incarcerated inguinal hernia at the University Hospital Ostrava between 2014 and 2018 were included in the study. In total, 31 patients were enrolled into the study (20 patients with open hernia repair and 11 patients with laparoscopic transabdominal preperitoneal hernioplasty [TAPP]). Operative time was shorter in the laparoscopic group (69.5 vs 82.2 min, p=0.444); length of hospital stay was significantly shorter in the TAPP group (3.45 vs 8.5 days, p=0.010). Postoperative complications were more frequent in the open hernia repair group (40% vs 0.0%, p=0.134); the difference was not statistically significant. Laparoscopic hernioplasty provides a safe and effective operating technique for patients with incarcerated inguinal hernia.

A Novel Transabdominal Preperitoneal Hernioplasty Technique in the Repair of Large Inguinal Hernias: The use of Polypropylene Mesh in the form of Plug-patch.

To describe the outcome of modified transabdominal laparoscopic preperitoneal (TAPP) hernioplasty repair with plug-patch of polypropylene mesh. A descriptive study. Alanya Alaaddin Keykubat University Training and Research Hospital, Alanya, Turkey from December 2017 to December 2019. Patients aged 18-70 years, who underwent TAPP hernioplasty at this clinic between December 2017 and 2019 were evaluated retrospectively. Those with a defect diameter of 3 cm and above, which were measured intraoperatively, were considered as large inguinal hernias. A modified TAPP procedure that includes the plug-patch technique, using polyester mesh, similar to that of open inguinal hernia repair, was performed on these patients. Complications and recurrences frequency was noted. This modified TAPP procedure was applied to 35 patients (24 men, 11 women). The defect size was 3-4 cm in 24 patients, and 4 cm in 11 patients. None of the patients developed chronic pain. Five patients had a feeling of fullness in the inguinal region where the repair was performed, and their complaints subsided at the first month of follow-up. Seroma developed in 2 patients, but resolved spontaneously. During the follow-up period, no chronic complications or recurrences were observed. This technique is simple and does not create a serious cost burden on TAPP technique. Furthermore, it can be applied routinely with the advantages of low pain, rapid recovery and acceptable complication rates as well as the reduction of pseudo-recurrence rates. Key Words: Hernia, Laparoscopic repair, Plug-patch technique, Modified TAPP, Mesh.

Feasibility of Laparoscopic Transabdominal Preperitoneal Hernioplasty for Incarcerated Inguinal Hernia.

Background/Objectives:An incarcerated inguinal hernia (IncIH) is defined as an irreducible inguinal hernia. The problems caused by long-term incarceration are adhesion between the incarcerated organ and hernial sac and difficulty in reduction of the edematous incarcerated organ. The present study was performed to evaluate the feasibility of laparoscopic transabdominal preperitoneal (TAPP) hernioplasty to treat chronic IncIH.Methods:This retrospective study included 154 patients aged >20 years who were treated for IncIH from January 1, 2015 to October 31, 2020. Patients were categorized into those with symptoms for ≥ 3 months (chronic IncIH group, 134 patients) and those with symptoms for < 3 months (acute IncIH group, 20 patients).Results:The type of incarcerated organ differed between groups. The most frequently incarcerated organ was the intestine (85%, 17/20) in the acute IncIH group and the omentum (98%, 131/134) in the chronic IncIH group (p < 0.000). Compared with the chronic IncIH group, the acute IncIH group had a higher prevalence of pre-operative inguinal pain (85%, 17/20 vs 3%, 4/134; p < 0.000) and a lower prevalence of adhesion between the incarcerated organ and the hernial sac (5%, 1/20 vs 37%, 49/134; p = 0.011). Organ resection was performed in 1 patient in the acute IncIH group and 19 in the chronic IncIH group.Conclusion:In patients with chronic IncIH, TAPP hernioplasty was used to successfully resolve adhesion between the incarcerated organ and the hernial sac, avoiding organ resection by enabling intra-abdominal reduction in many patients. TAPP hernioplasty may be a feasible surgical method for the treatment of IncIH.

РЕЗУЛЬТАТЫ ЛАПАРОСКОПИЧЕСКОЙ И ТРАДИЦИОННОЙ ГЕРНИОПЛАСТИКИ У ЛИЦ СТАРШИХ ВОЗРАСТНЫХ ГРУПП И МОРФОЛОГИЧЕСКИЕ ИЗМЕНЕНИЯ ТКАНЕЙ ПАХОВОГО КАНАЛА

Objective: Comparative evaluation of the results of laparoscopic (LHP) and conventional (CHP) hernioplasty in older patients (OP) and assessment of morphological changes in the tissues of the inguinal canal. Methods: The results of surgical treatment of 88 OP with inguinal hernias were studied. The main group consisted of 53 (60.2%) patients who underwent LHP, the control group included 35 (39.8%) patients after CHP; among them 77 (87.5%) patients had primary hernias, and 11 (12.5%) – recurrent hernias. The age of the patients varied from 60 to 84 years. In the main group patients underwent laparoscopic transabdominal preperitoneal (TAPP) hernioplasty. In the control group, various types of plasty of the posterior wall of the inguinal canal were applied: autoplasty using local tissues, Bassini and Postempsky repair. Muscle, aponeurotic and adipose tissues of the inguinal canal were sampled for morphological examination. Results: For all studied parameters (surgery duration, in-hospital duration, duration of complete rehabilitation), statistically significantly better results were obtained in in the LHP compared with CHP (p&lt;0.05). Although the differences in complications were not statistically significant (Cox F test: p&gt;0.05), the higher number of complications and their later onset tended to be seen in the CHP group compared with LHP. In patients with small hernias, decreased density of muscle tissue with increased density of the connective tissue were noted, while in patients with large hernias, thinning of the muscle tissue prevail, with expansion of dystrophic adipose tissue observed in all cases. Conclusion: The immediate results of LHP in OP showed its higher effectiveness compared with CHP. Significant changes in the tissues of the inguinal canal found in OP indicate their decreased resilience and potentially delayed reparation processes. Keywords: Inguinal hernia, older age groups, inguinal canal, pathology, laparoscopic hernioplasty, conventional hernioplasty.

Four years of experience in plastic surgery of anterior abdominal wall hernias with mesh implants made of titanium thread

To evaluate the results of using titanium thread mesh implants in the treatment of anterior abdominal wall hernias. This article evaluates the titanium thread mesh implant used by us in the treatment of 240 patients with anterior abdominal wall hernias; describes the features of this type of implants and the technical features of various types of operations using them. The overall rate of postoperative complications was 2.9%. Hernia recurrence was observed in 2.4% of patients after laparoscopic transabdominal preperitoneal hernioplasty. The use of a mesh implant made of titanium thread did not reveal any specific complications for this implant. At the stage of gaining experience with a mesh implant made of titanium thread, technical difficulties may occur when placing and fixing it, which increases the duration of surgery.

Single incision laparoscopic totally extraperitoneal hernioplasty: lessons learned from 1,231 procedures.

PurposeAlthough there are many articles about single incision laparoscopic (SIL) hernioplasty, a large-scale study or article about its long-term outcome has not been reported yet. The aim of this study is to assess short- and long-term outcomes of SIL totally extraperitoneal (TEP) hernia repair with large number of cases.MethodsA prospectively collected database containing details of 1,231 procedures in 1,129 consecutive patients who underwent SIL-TEP hernia repair between June 2010 and December 2017 at a single institution was retrospectively analyzed. SIL-TEP hernia repair was performed using a glove single port device and standard laparoscopic instruments. Recurrence rate of SIL-TEP hernia repair was analyzed by a telephone questionnaire.ResultsAmong 1,129 patients, 1,027 (91.0%) had unilateral hernia and 102 (9.0%) had bilateral hernia. There were 12 (1.1%) conversions to single or 3 ports laparoscopic transabdominal preperitoneal hernioplasty or Lichtenstein repair. Mean operative time was 40.3 minutes for unilateral hernia and 61.6 minutes for bilateral hernia. Intraoperative complication rate was 21.8%. Most intraoperative complications were peritoneum or sac tearing (20.1%). Postoperative complications occurred in 97 (8.6%) cases, most of which were minor morbidity except for 1 mesh infection. Five-year recurrence rate was 4%.ConclusionSIL-TEP hernia repair is safe and technically feasible with acceptable short- and long-term outcomes. Large-scale randomized controlled trials comparing SIL-TEP hernia repair with conventional laparoscopic TEP are needed to confirm these results.