Transabdominal Preperitoneal Inguinal Hernia Repair Research Articles

USE OF BIOLOGIC GLUE IN TAPP. TRICKS AND CHALLENGES

Abstract Aim The fixation of the mesh in transabdominal preperitoneal inguinal hernia repair (TAPP) and the closing of the peritoneal flap are key parts of the operation. This is accomplished with sutures or tackers. The use of biologic glue is an acceptable alternative with the possible advantages of being safer and less painful than the other options. Its use however poses its own set of challenges. Materials and Methods 24 patients underwent TAPP repair for inguinal hernia, using biologic glue to fix the mesh and close the peritoneal flap. The practical challenges of its use were studied. Results No problems were encountered in the fixation of the mesh. In the closing of the peritoneal flap, tackers were used as an adjunct in the first 10 cases. After that, the operation was completed only using glue. Conclusions Various conclusions were drawn from the use of glue. First, it works best in a dry environment and with a lightweight microporous mesh, so that the glue can seep through the pores. Second it will not “fix” large creases of the mesh, although this also means a suboptimal positioning of the mesh. Third, it requires gentle moves during withdrawal, as the tip can stick to the tissues, and appliance of a wet gauze after every use, as the clotted glue can block the tip. All in all, after a learning curve period, it can be a safe and effective alternative to sutures and tackers in TAPP.

Robotic-Assisted Inguinal Hernia Repair with The Dexter System™: A Prospective Multicentre Clinical Investigation

Abstract Background Robot-assisted transabdominal preperitoneal inguinal hernia repair (rTAPP) is established as safe and feasible with various robotic platforms. The Dexter robotic system is an open platform with a sterile surgeon’s console, two robotic instrument arms, and one robotic endoscope arm. Aims We conducted a prospective multicentre study (ClinicalTrials.gov NCT05873582) to assess the safety and performance of this new robotic platform. Methods Three centres in France, Germany, and Switzerland participated. The primary objectives of the study were to document the successful completion of the rTAPP procedures and to collect data on the occurrence of adverse events and device-related events perioperatively and up to 30 days post-surgery. The procedures were performed by three surgeons with varying levels of experience in robotic systems, including novice, intermediate and expert. Results Fifty patients were operated for inguinal hernia repair (33 unilateral, 17 bilateral). The mean age and BMI of the patients were 60 years (±15) and 25.7 kg/cm2 (±3.3), respectively. All surgeries were successfully completed as planned using three standard laparoscopy trocars sized 10/12mm. Each procedure was performed with robotic assistance, and there were no conversions to open surgery. No intra-operative complications, device deficiency, or adverse events of Clavien-Dindo Grade III to V occurred. The mean skin-to-skin operative time was 55 min (±14) for unilateral hernia repair and 95 min (±22) for bilateral hernia repair. The mean robotic console time was 34 min (±12) for unilateral hernia and 68 min (±21) for bilateral hernia repairs. The patients were discharged within 1day (± 1 day) after surgery. Conclusion Our rTAPP experience with the Dexter system confirms feasibility, safety, and comparable operative times to other robotic platforms. This study demonstrates the practicality and safety of the robotic techniques, positioning the Dexter system as a valuable tool in hernia repair.

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

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

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

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

Simultaneous resection of a neuroendocrine tumor in an incidental Meckel’s diverticulum with transabdominal preperitoneal hernial repair: a case report

BackgroundAs laparoscopic surgery becomes more prevalent worldwide, Meckel’s diverticula are increasingly being discovered incidentally during surgery. There is no consensus on whether to follow up or resect such diverticula, which are usually asymptomatic. In cases of transabdominal preperitoneal inguinal hernia repair, resection of such a diverticulum might add the risk of mesh infection. Thus, it is unclear whether simultaneous intestinal resection is advisable.Case presentationA 64-year-old man diagnosed with a left indirect inguinal hernia underwent laparoscopic inguinal hernia repair, during which a 2-cm Meckel’s diverticulum located contralateral to the mesentery of the ileum approximately 30 cm from Bauhin’s valve was detected incidentally. Because of the potential risk of future complications such as hemorrhage, diverticulitis, or tumor development, wedge resection of the ileum was performed extracorporeally through an extended umbilical port site after completion of the hernia repair. Pathological examination revealed a neuroendocrine tumor (G1) in Meckel’s diverticulum, which was successfully resected without any mesh infection or postoperative complications.DiscussionOur patient’s clinical course raises two important issues. First, a Meckel’s diverticulum detected incidentally during laparoscopic surgery should be resected promptly because malignant tumors within such diverticula have frequently been reported. Second, simultaneous resection with hernia repair using mesh seems to be as safe as other clean-contaminated surgery.ConclusionsManagement of incidental Meckel’s diverticula should be selected by appropriate assessment for the risk of malignancy and complications.

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

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

Comparison of modified tumescent and conventional laparoscopic transabdominal preperitoneal inguinal hernia repair: a retrospective clinical study.

Laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair poses certain challenges to less experienced surgeons. This study was performed to compare the clinical outcomes of modified tumescent laparoscopic TAPP (MT-TAPP) inguinal hernia repair versus conventional laparoscopic TAPP (CL-TAPP) inguinal hernia repair. We retrospectively analyzed the perioperative data of patients with inguinal hernias who underwent either MT-TAPP repair (n = 57) or CL-TAPP repair (n = 54) at the General Surgery Department of Nanjing Yimin Hospital from November 2019 to June 2023. The durations of the total operation and the preperitoneal space dissection were shorter in the MT-TAPP than CL-TAPP group. The estimated blood loss volume was lower in the MT-TAPP than CL-TAPP group. The visual analogue scale scores recorded at the 12- and 24-hour postoperative time points showed significantly greater reductions in the MT-TAPP than CL-TAPP group. Using liquid injection and gauze dissection is both safe and practical. This technique results in a shortened total operation time, less time spent on preperitoneal space dissection, decreased estimated blood loss, and less severe postoperative pain.

A Randomized Trial Investigating the Laparoscopic Transabdominal Preperitoneal Approach for Recurrent Inguinal Hernia Repair

Background: Repairing a recurrent hernia is a challenging endeavor due to the pre-existing weakened tissues and altered anatomy. Among the available approaches, the open posterior preperitoneal approach has demonstrated significantly better outcomes compared to the anterior approach. Additionally, the laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair represents an evolving technique with the advantages of minimally invasive surgery. The objective of our study is to perform a comparative analysis of these three approaches for the repair of recurrent inguinal hernias, focusing on complications and the occurrence of early recurrences. This research aims to provide valuable insights into the most effective and safe approach for managing this challenging surgical condition. Methods: In our study, we conducted a randomized allocation of 200 patients into three equal groups: Group A, Group B, and Group C. Patients in Group A underwent the open posterior preperitoneal approach, while those in Group B received transinguinal anterior tension-free repair. Group C patients underwent the laparoscopic transabdominal preperitoneal (TAPP) procedure. The primary endpoint of our study was to assess the recurrence of inguinal hernias following the respective surgical approaches. Results: Our study yielded several noteworthy findings. The mean hospital stay, time to return to work, and time off from work were all shorter in Group C when compared to Groups A and B. Chronic postoperative pain was observed in 13.33% of patients in Group A, 30% of patients in Group B, and 10% of patients in Group C. Notably, the overall complication rate was lower in both Groups A and C at 19.7%, while Group B had a higher complication rate of 34.36%. Conclusion: In the context of recurrent inguinal hernia repair, our study findings suggest that the laparoscopic and open posterior approaches are equally effective in terms of operative outcomes. The open preperitoneal hernia repair stands out as a cost-effective option with a low recurrence rate. Patients undergoing this procedure experience a relatively short postoperative recovery period and report minimal postoperative pain. This approach has demonstrated significantly better outcomes compared to the commonly used anterior approach.

RAWS4all project: validation of a new silicone model for robotic TAPP inguinal hernia repair.

Trans-abdominal pre-peritoneal (TAPP) hernia repair is a complex procedure that presents several challenges. Even though, due to the high prevalence of inguinal hernia, TAPP technique is increasing in frequency and robotic Abdominal Wall Surgery (rAWS) is emerging as a valuable tool in this regard. Although inguinal TAPP procedure principles have been published and simulation is needed, the availability of validated models remains scarce. A new low-cost model was developed to simulate inguinal rTAPP repair. For validity assessment, a new TAPP-specific fidelity questionnaire and assessment scale were developed to compare the performance of novices and experts in the simulated procedure. The models used were assessed at 60min for execution and quality score. Twenty-five residents and specialists from all over the country participated in this study. Execution, quality, and global performance was higher in the seniors group compared to juniors (8.91 vs 6.36, p = 0.02; 8.09 vs 5.14, p < .001; and 17 vs. 11,5, p < .001, respectively). Overall fidelity was assessed as being very high [4.41 (3.5-5.0), α = .918] as well as face [4.31 (3.0-5.0), α = .867] and content validity [4.44 (3.2-5.0), α = .803]. Participants strongly agreed that the model is adequate to be used with the DaVinci® Robot [4.52 (3.5-5.0), α = .758]. This study shows face, content, and construct validity of the model for inguinal TAPP simulation, including for robotic surgery. Therefore, the model can be a valuable tool for learning, understanding, practicing, and mastering the TAPP technique prior to participating in the operating room.

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

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

Early outcomes of robotic transabdominal preperitoneal inguinal hernia repair: a retrospective single-institution study in Korea.

Robotic hernia repair has increased in popularity since the introduction of da Vinci robots (Intuitive Surgical). However, we lack quantitative analyses of its potential benefits. Herein, we report our initial experience with robotic transabdominal preperitoneal (R-TAPP) inguinal hernia repair. We retrospectively reviewed the data from patients who underwent R-TAPP inguinal hernia repair with a prosthetic mesh using the da Vinci platform. Data on patient characteristics and surgical outcomes were also collected. Twenty-one patients (including 20 male patients [95.2%]) with a mean age of 54.1 ±16.4 years and body mass index of 23.8 ± 1.9 kg/m2 underwent R-TAPP inguinal hernia repair. Bilateral hernia repair was performed in two patients (9.5%), and six patients (28.5%) with scrotal hernia underwent R-TAPP hernia repair. A sigmoid colon sliding hernia was present in three patients (14.3%). The mean operation and console times were 91.8 ± 20.4 minutes and 154.5 ± 26.2 minutes, and 61.4 ± 16.9 minutes and 128.0 ± 25.5 minutes for unilateral and bilateral inguinal hernia, respectively. Spermatic vessel injury was identified intraoperatively in one patient. Two minor postoperative complications, postoperative ileus, and wound seroma were reported. The mean duration of hospitalization was 3.8 ± 0.9 days. No recurrence or conversion to open surgery was required. Our findings suggest that R-TAPP inguinal hernia repair is safe and feasible. Its cost-effectiveness, optimal procedural steps, and indications for a robotic approach require further investigation.

No evidence for fixation of mesh in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair: a systematic review and meta-analysis of randomized controlled trials

ObjectiveTo investigate the differences in hernia recurrence and chronic postoperative inguinal pain (CPIP) in randomized, controlled trials comparing fixation and non-fixation of the mesh in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair.MethodsA multi-database systematic search was conducted for randomized, controlled trials comparing fixation versus non-fixation of the mesh in TAPP inguinal hernia repair. All eligible papers were assessed for risk of bias using the revised Cochrane risk of bias tool for randomized trials (RoB 2.0). Quality of evidence was evaluated using the GRADE system. Meta-analyses were performed regarding recurrence and CPIP using RevMan.ResultsSeven prospective, randomized controlled trials were included. Laparoscopic TAPP inguinal hernia repair was performed in 1732 patients with 737 procedures performed without fixation and 995 procedures with fixation of the mesh. Despite all trials being RCTs, the trials were limited by substantial bias and the quality of evidence was low regarding hernia recurrence and very low regarding CPIP. Pooled estimates from meta-analyses were an OR of 2.80 (95% CI 0.61–12.77) for hernia recurrence and a mean difference in visual analogue scale (VAS) of 0.17 (95% CI 0.90–1.24) for CPIP, respectively.ConclusionThe current evidence is very uncertain and mesh fixation may have little to no effect regarding hernia recurrence and chronic postoperative inguinal pain in patients operated with TAPP inguinal hernia repair.

Differences in the learning curve of robotic transabdominal preperitoneal inguinal hernia repair according to surgeon’s robotic experience

PurposeIn this study, we aim to analyze the learning curve of each step of robotic transabdominal pre-peritoneal inguinal hernia repair (rTAPP) in two surgeons with varying degrees of expertise with the robotic platform but no experience with laparoscopic hernia repair.MethodsData on 124 rTAPP cases performed by two surgeons were retrospectively reviewed. Cumulative sum (CUSUM) analysis was applied to visualize the learning curve of rTAPP on operation time of each step of the procedure [the peritoneal flap creation (T1), the completion of the critical view of the myopectineal orifice (T2), the mesh application (T3) and the peritoneal flap closure (T4)]. Each intraoperative and postoperative outcome was compared according to surgeon’s experience with the robotic platform and learning phase. The robotic surgeon mentored the surgeon-in-training and was present during all surgeries in his learning period.ResultsThe surgeon in training with the robotic platform showed a learning phase till the 20th procedure followed by a gradual improvement in performances. The expert surgeon showed a learning phase till the 35th procedure after which a constant decrease of operative time was recorded till the last procedure included. The operative times of each step of the procedures of both surgeons were significantly improved after the learning phase. In the late phase, the surgeon in training could achieve operative times in T2 and T3, which are similar to those of an experienced robotic surgeon with no experience with TAPP before the completion of the learning phase.ConclusionsIn conclusion, the learning phase of rTAPP surgery may vary between 20 and 35 cases, depending on the surgeon’s experience in robotic surgery.

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

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

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

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

P-044 FEASIBILITY AND SAFETY OF A NEW ‘ON-DEMAND ROBOTICS' PLATFORM FOR INGUINAL HERNIA REPAIR

Abstract Aim To assess the feasibility, safety, and efficiency of a novel ‘on-demand robotics' platform for inguinal hernia repair. Materials &amp; Methods A robotic system consisting in a sterile surgeon console, two robotic instrument arms, and one robotic endoscope arm, was evaluated. This ‘on-demand robotics' platform allows surgeons to remain sterile and combine work at the surgeon console and at the patient bed, e.g. in case of emergency management. This open platform also integrates with existing operating room (OR) equipment such as 3D laparoscopic camera, insufflator, energy devices and trocars. We present the first series of 16 transabdominal preperitoneal inguinal hernia repair procedures (9 unilateral, 7 bilateral) performed with the robotic system. Safety outcomes and skin-to-skin procedure times were documented. All procedures were performed by one surgeon with extensive laparoscopic surgery experience. Results All 16 patients were successfully treated with no device-related adverse events. Most patients were discharged on the same day. 14 patients had reached 30 day follow-up with no morbidity and maintained outcome. Skin-to-skin procedure time was 64 and 84 minutes for unilateral and bilateral procedures respectively. Unilateral mean robotic times transitioned from 73 to 54 minutes between the 5 first and the last 4 cases, indicative of a fast learning curve. Conclusions “On-demand” robotic repair of inguinal hernia is feasible and safe. The described platform provides direct patient access to the sterile surgeon, and uses existing OR equipment. Surgeon's prior laparoscopic experience may also shorten learning curve.

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.

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.

Initial Experience of Robot-Assisted Transabdominal Preperitoneal (TAPP) Inguinal Hernia Repair by a Single Surgeon in South Korea.

Background and Objectives: Inguinal hernia is a common surgical disease. Traditional open herniorrhaphy has been replaced by laparoscopic herniorrhaphy. Nowadays, many attempts at robotic herniorrhaphy have been reported in western countries, but there have been no reports in South Korea. The purpose of this study is to report our initial experience with robotic inguinal hernia surgery, compared to laparoscopic inguinal hernia surgery. Materials and Methods: We analyzed the clinical data from 100 patients who received inguinal hernia surgery in our hospital from November 2020 to June 2022. Fifty patients underwent laparoscopic surgery, and 50 patients underwent robotic surgery using the da Vinci Xi system. All hernia surgeries were performed by a single surgeon using the transabdominal preperitoneal (TAPP) method. Results: The mean operation time and hospital stay were not statistically different. On the first postoperative day, the visual analog scale (VAS) pain score was significantly lower in the robotic surgery group (2.9 ± 0.5 versus 2.5 ± 0.7, p = 0.015). Cumulative sum analysis revealed an approximately 12-case learning curve for robotic-assisted TAPP hernia surgery. Conclusions: Robotic-assisted TAPP inguinal hernia surgery is technically acceptable to surgeons who have performed laparoscopic inguinal hernia surgery, and the learning curve is relatively short. It is thought to be a good step toward learning other robot-assisted operations.

Early Outcomes of Laparoscopic Transabdominal Preperitoneal (TAPP) Repair.

Background Inguinal hernia repair is one of the commonest general surgical procedures performed all over the world. The introduction of synthetic mesh and laparoscopic repair has revolutionized inguinal hernia surgery in the recent past. Laparoscopic transabdominal preperitoneal (TAPP) repair is now considered a well-established procedure with minimal complications and short hospital stay and less recurrence. The TAPP approach gives a good view of the inguinal anatomy and a better understanding of the sac contents. The learning curve associated with TAPP repair is much less as compared to total extraperitoneal (TEP) repair. The aim of this study was to assess the effectiveness of TAPP repair for inguinal hernia in terms of the duration of surgery, hospital stay, complications, and recurrence rate. Method From March 1, 2019,to February 28, 2021, a total of 60 patients with inguinal hernias between ages 25 and 70 years were included in the study. A preoperative anesthesia assessment was done, and informed written consent was taken from all patients. The TAPP procedure was performed with polypropylene mesh in all cases, and surgery was performed by a surgeon with more than five years of laparoscopic experience. Results The total number of patients included in the study was 60. All patients were male. The mean±standard deviation (SD) age of the patients was 54.6±11.4 years. Unilateral primary inguinal hernia was present in 46 (76.6%) cases, recurrent in eight (13.3%) cases, and primary bilateral in six (10%) cases. The mean±SD duration of surgery for unilateral inguinal hernia was 59.1±15.7 minutes, and for bilateral hernia, it was 83.5±12.6 minutes.The mean hospital stay was 3.6±1.5 days. Scrotal swelling was noted as a common complicationin seven (11.6%) cases, surgical site infection (SSI) in three (5%), mesh infection in two (3.3%), urinary retention in two (3.3%), and chronic pain in one (1.6%). No recurrence was noted. Conclusion Transabdominal preperitoneal repair for inguinal hernia is a very effective procedure with a short learning curve and minimal complication rate. The hospital stay is less, and recurrence is very low.