Transabdominal Preperitoneal Procedure Research Articles

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.

Transabdominal Pre-Peritoneal Versus Totally Extraperitoneal Laparoscopic Techniques for Inguinal Hernia Repair in Eastern Nepal

Background: Inguinal hernia is one of the most common surgical problems in the world, with a high risk in men. The treatment modalities have evolved from open to laparoscopic procedures. Laparoscopic procedures are getting attention and widespread utilization among surgeons. The choice between the two procedures is still a debate between the surgeons. This study aims to compare the transabdominal pre-peritoneal approach to the totally extraperitoneal approach in its perioperative outcomes. Materials and Methods: A prospective analytical study was conducted on 86 adult patients, who underwent laparoscopic inguinal hernia reduction between June 2022 to June 2023 at Nobel Medical College Teaching Hospital in Biratnagar, Nepal. The patients were randomized into two groups of 43 participants each and were analyzed on different variables. Results: All of the 86 patients included in the study were male. Among them, 30.23% of patients had direct inguinal hernia. There were 12.79% of patients with bilateral hernias. There was a statistically significant difference in the duration of operation among the patients undergoing totally extraperitoneal and transabdominal preperitoneal hernia repair. Total duration of hospital stay was shorter in totally extraperitonealand postoperative pain was slightly lesser in totally extraperitoneal procedure. The intraoperative and postoperative complications among totally extraperitoneal and transabdominal preperitoneal hernia repair were comparable. There was no conversion to open procedure or recurrence of hernia during the study period. The return to daily life took longer in the transabdominal preperitoneal procedure than in the totally extraperitoneal hernia repair. Conclusion: Totally extraperitoneal hernia repairhas an advantage over transabdominal preperitoneal hernia repairin terms of shorter operative time, postoperative pain, duration of hospital stays, and return to daily life.

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.

Laparoscopic Hernia Repair: Tapp Versus Tep. A Single Centre Experience

Summary Surgery for inguinal hernia is currently the most common surgical procedure worldwide, and every year over 20 million patients undergo open or laparoscopic hernia repair. Two generally accepted endoscopic approaches are transabdominal preperitoneal procedure (TAPP) and total extraperitoneal procedure (TEP). For nine years (2010 – 2018), 48 patients with inguinal hernia had laparoscopic hernia repair (TAPP or TEP) at Villarobledo General Hospital. Forty-three patients (89.6%)) were male, and five (10.4%) were female. Of these, ten had right inguinal hernia (RIH), 18 - left inguinal hernia (LIH), 12 - bilateral inguinal hernia (BIH), 6 had recurrent unilateral inguinal hernia (RUIH), and 2 had recurrent bilateral inguinal hernia (RBIH). In 33 patients (68.7%), transabdominal preperitoneal laparoscopic hernia repair (TAPP) was performed. Total extraperitoneal laparoscopic hernia repair (TEP) was performed on 15 patients (12%). In 8 patients (16.6%), simultaneous surgical procedures were performed: umbilical hernioplasty in 4 (8.3%) patients and laparoscopic cholecystectomy in 4 (8.3%) patients. There were no conversions in any of the surgical procedures. The average operative time was 77 minutes. Twenty-six patients underwent one-day surgery, 18 were in the hospital for one day, and four patients were discharged on the second postoperative day following surgery. In 7 patients (14%), recurrences occurred: in the first postoperative year - 1 patient; in the second year after surgery - 3 patients; in the third after surgery - 2 patients; and in the sixth year - 1 patient. The recurrence rate was 2 in 33 patients after TAPP (6%) versus 5 in 15 patients after TEP (33%), Chi-squared=5.91 (p=0.015). In one patient, perforation of the bladder occurred after TEP and was managed conservatively using a urethral catheter and preperitoneal drainage. TAPP and TEP had a considerable discrepancy in recurrence rates. Such discrepancy in recurrences is probably due to the higher complexity of the TEP technique and the required supervising of experienced surgeons during the learning curve.

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 &amp; 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-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.

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.

Robotic Inguinal Hernia Repair - Update 2022 during the SARS-COVID-19 Pandemic.

Inguinal hernia repair is one of the most common surgical procedures performed by general surgeons. Numerous articles have shown that robotic inguinal hernia repair is safe and effective, but also more costly than other hernia repair techniques. The robotic platform uses high-definition visualization and articulating instruments. A growing number of surgeons are using this technology to refine and obtain a critical view of the myopectineal orifice for hernia repair while lessening the pain associated with the open surgical approach. Lower insufflation pressures and good results without Foley catheterization have been reported. This report presents an update, with a focus on the past 3 years during the SARS COVID-19 pandemic, of a series of robotic, laparoscopic inguinal hernia repairs by a single surgeon with extensive laparoscopic hernia experience at a single institution, along with a review of the recent current literature. Over 3000 laparoscopic inguinal hernia operations have been performed by the author since 1990. One hundred-fifty-eight were performed from April 2020 to November 2022, in addition to the previously reported 420 robotic TAPP (trans-abdominal pre-peritoneal) procedures performed from April 2012 to March 2020. Hospital records and follow-up care were prospectively reviewed and the patient's age, sex, American Society of Anesthesia (ASA) class and operative time were obtained. Follow-up was done at 2 weeks and 6 weeks following surgery. All patients consented to the use of their data in the study. Ninety-four percent (94%) of the patients were male. The average age was 64.3 years (range 18-91). Co-morbidities included hypertension, hypercholesterolemia, prostatism and GERD, among others. BMI was between 19 and 37.1 (mean 26.1). In 23 patients (15%), an umbilical hernia repair was performed concomitantly. OR time ranged from 25 to 90 minutes (mean 51.8). Complications were uncommon and urinary retention (2.5%) was an infrequent post-operative occurrence. 1) Use of a lower insufflation pressure (8-12 mm Hg) was routine. 2) Use of a structural mesh (4x6 inches) gave satisfactory results. 3) While fixation of the mesh was not necessary, fibrin sealant was used routinely. 4) Urinary retention was infrequent, and did not require pre- or intra-op Foley catheterization if the patient voided immediately prior to surgery. Finally, 5) OR time was consistently less than 1 hour. These results support the conclusion that robotic inguinal hernia repair is safe and effective.

Influence of the learning curve on the immediate postoperative pain intensity after laparoscopic inguinal hernioplasty.

Inguinal hernia repairs represent one of the most commonly performed surgical operations worldwide. As more experience has been gained over the past decades with laparoscopic techniques, they are now widely used also for the repair of primary and unilateral inguinal hernias, representing a safe and effective alternative. One of the major concerns of patients undergoing inguinal hernia repair is postoperative pain and socio-professional reintegration. This study started from the hypothesis that the learning curve could influence postoperative pain intensity after laparoscopic inguinal hernioplasty. A retrospective - comparative study was performed, including a general surgeon's first consecutive cases (n=87) of TAPP (transabdominal preperitoneal procedure) hernioplasty procedures with implantation of self-gripping surgical prosthesis were investigated. The evaluation of clinical and surgical aspects resulted in similar values in case of the studied groups. A reduction in surgical time was observed in case of patients operated after completing the learning curve (p = 0.0005) On the first postoperative day patients complained mostly about persistent and severe type of pain. Average Pain Index calculated with help of Simple Numeric Pain Scale resulted in similar values. Length of analgesic treatment showed no significant differences. Although higher intensity pain was mostly caracteristic in case of patients operated during the learning process, no significant relationship between learning curve and postoperative pain intensity were highlited. TAPP can be a safe technique for young surgeons as well, with the right study program the procedure can be mastered safely.

Transabdominal preperitoneal versus hybrid procedures for treating irreducible inguinal hernias: A retrospective controlled study

BackgroundInguinal hernia is a common condition; however, irreducible inguinal hernias are rare. In this retrospective study, two laparoscopic procedures for irreducible inguinal hernia were compared. Materials and methodsThe study cohort comprised 88 patients who had undergone laparoscopic repair of primary irreducible inguinal hernias between 1 June 2011 and 31 December 2019. The patients were retrospectively divided into Hybrid (Group H) and Standard Transabdominal Preperitoneal (TAPP) Groups (Group S). Patient characteristics, hernia details, and intraoperative and postoperative complications were compared between study groups. ResultsThere were no significant differences between the two groups in baseline characteristics, including age, sex, body mass index, hernia type, operation time, hospital stay, cost, and duration of follow-up. No recurrence or surgical site infection occurred in either group. There were no significant differences between the two groups in incidence of spermatic vessel injury (0% vs. 2.04%, P = 0.370), vas deferens injury (0% vs. 6.12%, P = 0.116), epigastric vessels injury (0% vs. 4.08%, P = 0.202), scrotal hematoma (7.69% vs. 2.04%, P = 0.206), dysuria (5.13% vs. 8.16%, P = 0.575), fever (17.95% vs. 16.32%, P = 0.841), seroma (25.64% vs. 32.65%, P = 0.474), chronic pain (0% vs. 2.04%, P = 0.370), sensation of a foreign body (2.56% vs. 2.04%, P = 0.870), or pain on ejaculation (0% vs. 2.04%, P = 0.370). The incidence of acute pain was higher in Group H than in Group S (43.59% vs. 8.16%, P = 0.000). ConclusionThe hybrid TAPP procedure is a safe and feasible means of treating irreducible inguinal hernias. Though it is associated with a higher incidence of postoperative acute pain than the standard TAPP procedure, it may have advantages in avoiding injuries to the vas deferens and spermatic vessels.

Total extra-peritoneal inguinal hernia repair: experience in a tertiary care hospital of Bangladesh

Background: Open hernioplasty, a traditional procedure, is practiced for decades all over the world, for inguinal hernia repair and the newer procedure of total extraperitoneal (TEP) inguinal hernia repair is the current trend. Aim of this study was to share the experience of TEP inguinal hernia repair.&#x0D; Methods: This retrospective observational study was done from April, 2012 to March, 2021 at BIRDEM General Hospital, Dhaka, Bangladesh. Patients with inguinal hernia reporting to BIRDEM outpatient department (OPD) were counseled for TEP repair. Those who consented were treated electively with a TEP repair for a unilateral or bilateral hernia defect, either direct or indirect. All procedures were completed with patients under general anaesthesia. Polypropylene mesh was placed in preperitoneal space. Followed up records were noted at one week, one month, one and two years after surgery. Patients’ age, hernia types and locations, complications, length of stay in hospital, return to work and recurrence were noted.&#x0D; Results: Total patients were 118 including one female. Patients were between 22 and 72 years. All of them had primary hernias and 72% of them underwent unilateral repairs. One of the cases required conversion to transabdominal preperitoneal procedure. In five patients (4.2%) intraoperative complication occurred and postoperative courses were complicated in 8 patients (6.7%). Patients were able to resume their daily activities after a mean period of 7 days (3 to 10 days). There was no mortality.&#x0D; Conclusion: In patients with uncomplicated inguinal hernias, TEP is associated with a very low overall risk of serious complications and recurrence with a very good functional outcome. It is equally applicable with bilateral inguinal hernias without added risk.&#x0D; BIRDEM Med J 2023; 13(1): 44-48

Evaluation of the Factors Influencing on Intraoperative Difficulty Scores of Laparoscopic Transabdominal Preperitoneal Inguinal Hernia Repair.

Background: Inguinal hernias are the leading surgical diseases in the world. There are different surgical procedures reported for the treatment. Some problems are thought to be encountered when performing laparoscopic surgery in these patients, such as risk of severe complications and the prolonged operative duration. Aim: The objective of this study was to specify the complexity of the transabdominal preperitoneal (TAPP) procedure by using an intraoperative scoring system and examine the scores with these patients' predictive factors. Materials and Methods: A prospective study was conducted in patients who underwent inguinal hernia surgery with TAPP. Previous lower abdominal surgery, previous (open) hernia surgery, body mass index (BMI), type of hernia, duration of the surgery, scoring the difficulty of the operation in five various stages using the visual analog scale (VAS) score (1. Mobilizing the peritoneum/dissection of the inferior peritoneal flap. 2. Dissection of internal ring or vas deference or hernia sac. 3. Visualization of Cooper's ligament. 4. Mesh placement. 5. Peritoneal closure.) and the time of discharge were recorded. Results: In this study, 137 patients were included. "BMI" and "previous lower abdominal surgery" have significantly higher scores, time of surgery, and hospital stay compared with other risk factors (P < .005). Conclusion: This study showed that patient's BMI and previous lower abdominal surgery could create technical difficulty with the TAPP procedure, but it is not necessary to avoid this laparoscopic technique because of these situations and can be performed safely.

A Comparison of outcome between Transabdominal Preperitoneal (TAPP) and Lichtenstein operation for primary inguinal hernia repair – An institutional study

Introduction: Inguinal hernia repairs are one of the most common operations in general surgery. Apart from the classical open repairs, minimally invasive approaches are increasingly preferred to manage groin hernia repair. However, the optimal surgical approach still remains controversial.&#x0D; Methods: This is a prospective observational study done in Shree Birendra Hospital, a 750- bedded tertiary care military hospital located in Kathmandu from July 2021 to December 2021. A total of 120 patients operated for inguinal hernia by either open Lichtenstein repair or Transabdominal Preperitoneal (TAPP) in the department of surgery were included in this study.&#x0D; Results: The mean age of patients between open Lichtenstein repair and TAPP was 59.3 (22-79) and 63.4 (27-70) years respectively. The majority of patients were male among both the groups constituting of more than 95%. The mean intraoperative duration among the two groups was 44.12±7.23 minutes and 77.43±8.77minutes, respectively (p=0.021). The mean postoperative pain was less in TAPP procedure compared to open procedure (p=0.037). The mean duration of the postoperative hospital stay was 2± 1.12 and 1±0.79 respectively. At the three-month evaluation, there were four cases of recurrence of which one of them underwent open procedure while three underwent TAPP procedure.&#x0D; Conclusion: Both the open Lichtenstein repair and the TAPP procedures are safe and effective in the repair of primary inguinal hernia. In a view of postoperative pain, seroma formation and length of hospital stay TAPP procedure has been found superior to open procedure in our study.

Automatic surgical phase recognition in laparoscopic inguinal hernia repair with artificial intelligence.

Because of the complexity of the intra-abdominal anatomy in the posterior approach, a longer learning curve has been observed in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair. Consequently, automatic tools using artificial intelligence (AI) to monitor TAPP procedures and assess learning curves are required. The primary objective of this study was to establish a deep learning-based automated surgical phase recognition system for TAPP. A secondary objective was to investigate the relationship between surgical skills and phase duration. This study enrolled 119 patients who underwent the TAPP procedure. The surgical videos were annotated (delineated in time) and split into seven surgical phases (preparation, peritoneal flap incision, peritoneal flap dissection, hernia dissection, mesh deployment, mesh fixation, peritoneal flap closure, and additional closure). An AI model was trained to automatically recognize surgical phases from videos. The relationship between phase duration and surgical skills were also evaluated. A fourfold cross-validation was used to assess the performance of the AI model. The accuracy was 88.81 and 85.82%, in unilateral and bilateral cases, respectively. In unilateral hernia cases, the duration of peritoneal incision (p = 0.003) and hernia dissection (p = 0.014) detected via AI were significantly shorter for experts than for trainees. An automated surgical phase recognition system was established for TAPP using deep learning with a high accuracy. Our AI-based system can be useful for the automatic monitoring of surgery progress, improving OR efficiency, evaluating surgical skills and video-based surgical education. Specific phase durations detected via the AI model were significantly associated with the surgeons' learning curve.

Laparoscopic inguinal hernia repair: Clinical features

Background: Since the early 1990s, laparoscopic techniques have share the scene on general surgery; the initial operations with laparoscopic inguinal herniorraphy were reported in 1992. Trans-abdominal preperitoneal (TAPP) inguinal herniorraphy starts with detailed laparoscopic exploration of both inguinal region and intraperitoneal area. Afterwards a second incision perform to the peritoneal layer to minimise the extent of hernia sac and maintain a shield for prosthetic mesh to lay on the other side of inguinal wall on preperitoneal space. The aim of this study was to demonstrate the rates of recurrence and postoperative complications of TAPP procedure.Methods: In this retrospective study 21 cases of inguinal hernia that underwent TAPP procedure included. All cases operated by the same surgical team and with the same surgical technique.Results: Within 4 weeks, 71.4% of the patients reportedly had completely recovered from surgery. By 8weeks, 100% reportedly had complete resolution of postoperative symptoms. No serious intraoperative complications occurred. No cases required conversion to open surgery. In 1 patient (%4.7) urinary retention has occured as the only early postoperative complication. Two patients (%9.5) described numbness without pain in the distribution of the lateral femoral cutaneous nerve. One patient (%4.7) had mild testicular tenderness. None of these patients required pain medication or other interventions. On the follow-up time no recurrence has occured.Conclusion: In this study we demonstrate the very low rates of TAPP in respect of intra/postoperative complication–especially low rates of inguinal pain-, recurrence and improved time to return daily activities.

Comparison between TAPP & Lichtenstein techniques for inguinal hernia repair: A retrospective cohort study

BackgroundWorldwide, inguinal hernia repair is one of the commonest surgeries. The best treatment option to primary hernia has been investigated, but there still remains lack of evidence about the ideal approach. Therefore, this study aimed to compare the outcomes of inguinal hernia repair using transabdominal preperitoneal procedure (TAPP) & Lichtenstein techniques. Materials and methodsThis was a retrospective cohort study, conducted at Department of General & Minimal Invasive Surgery, SKIMS Medical College, Bemina, Srinagar. For performing the analysis, we used SPSS. Continuous variables were expressed as mean and standard deviation, and the categorical ones were presented as frequencies and percentages. ResultsA total of 60 patients were included (30 in each group). The mean age of the patients in both groups was around 54 years, and all patients were males. In unilateral cases the operating time was greater in the TAPP group than the Lichtenstein group (p < 0.001); however, in the bilateral cases, the operating time was significantly greater in the Lichtenstein than the TAPP group (p = 0.003). The pain scores, in unilateral cases, were significantly lower in the TAPP group than the Lichtenstein group (p < 0.001). The overall complication rate in the TAPP group was 6.7% while in the Lichtenstein group it was at 23.3%. In unilateral and bilateral cases, the patients significantly returned to work earlier in the TAPP group than those in the Lichtenstein group (p < 0.001). ConclusionTAPP and Lichtenstein techniques are both safe and reliable techniques for inguinal hernia repair. However, TAPP repair showed lesser post-operative pain, earlier discharge from the hospital, earlier return to usual activities, better cosmetic outcomes, and less persisting pain. However, there was no significant difference in the complication rate and TAPP repair was more costly for the patient.

Inguinal hernia repair via laparoscopic transabdominal preperitoneal (TAPP) method: Our 2 years clinical results

Aim: Inguinal hernia repair is one of the most common surgeries in General Surgery practice. Although different surgical procedures have been used for the treatment of hernias, minimally invasive approaches are increasingly preferred to manage hernia repair. The aim of this study is to evaluate our 2-year laparoscopic transabdominal preperitoneal (TAPP) hernia repair outcomes. Materials and Methods: The data of patients who were diagnosed with inguinal hernia and who underwent the TAPP procedure between the dates of December 2017 and December 2019 were evaluated retrospectively.Results: Ninety-six patients were included in this study. Of these patients, 89 were male and 7 were female. The mean age was 46 (range between 22 and 76). Fifty six (58.3%) cases had right inguinal hernia, 22 (22.9%) cases had left inguinal hernia and 18 (18.7%) cases had bilateral inguinal hernia. The mean hospital stay was 1.06 (1-3) days. In the early postoperative period we observed for minor complications such as seroma, hydrocele, epididymitis, and hematoma. Three patients experienced chronic pain. Recurrence was observed in 3 patients during follow-up. No major complications were seen.Conclusion: Laparoscopic hernia repair is an efficient and attractive method because it offers better cosmetic results, earlier recovery, less pain, shortened hospital stay and early return to daily activities. However, the learning process for performing this procedure is more difficult than for the open method. Therefore, the learning curve of laparoscopic hernia surgery is longer. It has been reported that there is a difference in the rate of recurrence in surgeons trained in the laparoscopic method after specialization. We believe that this method can be applied safely by people who have received laparoscopic hernia surgery training.

FEMORAL HERNIA: UNCOMMON, BUT ASSOCIATED WITH POTENTIALLY SEVERE COMPLICATIONS.

ABSTRACT Background: Although the laparoscopic access is becoming the preferable treatment for femoral hernia, there are only few studies on this important subject. Aim: To assess the outcomes of the totally extraperitoneal laparoscopic (TEP) access in the treatment of femoral hernia. Methods: Data of 62 patients with femoral hernia who underwent herniorrhaphy were retrospectively reviewed. The diagnosis of femoral hernia was established by clinical and/or imaging exams in 55 patients and by laparoscopic findings in seven. Results: There were 55 (88.7%) females and 7 (11.3%) males, with female to male ratio of 8:1. The mean age was of 58.9±15.9 years, ranging from 22 to 92 years. Most patients (n=53; 85.5%) had single hernia and the remaining (n=9; 14.5%) bilateral, making a total of 71 hernias operated. Prior lower abdominal operations were recorded in 21 (33.9%) patients. Conversion to laparoscopic transabdominal preperitoneal procedure was performed in four (6.5%). Open herniorrhaphy was needed in two (3.2%), one with spontaneous enterocutaneous fistula in the groin region (Richter’s hernia) and the another with incidental perforation of the adjacent small bowel that occurred during dissection of hernia sac. There was no mortality. Conclusion:Femoral hernia is uncommon, and it may be associated with potentially severe complications. Most femoral hernias may be successfully treated with totally extraperitoneal laparoscopic access, with low conversion and complication rates.

Drainage decreases the seroma incidence in laparoscopic transabdominal preperitoneal (TAPP) hernia repair for large inguinoscrotal hernias

BackgroundSeroma is a common and inevitable postoperative complication in transabdominal preperitoneal (TAPP) hernia repair, especially in patients with large inguinoscrotal hernias. However, studies have rarely reported drainage in TAPP for large inguinoscrotal hernias. MethodsSixty-five patients with 78 large indirect inguinoscrotal hernias who underwent TAPP procedure with drainage between September 2016 and December 2019 were enrolled in this study. 181 patients with Type Ⅲ indirect inguinal hernias (European Hernia Society (EHS) classification, hernia defect >3 cm) who underwent TAPP without drainage (no-drainage group) between January 2019 and December 2019 were included for a comparison. In the drainage group, a 12-Fr drainage tube was inserted into the distal hernia sac via the preperitoneal space to decrease the incidence of seroma. ResultsThere was no conversion to open procedures in all the patients. The operative time (56.5 ± 8.4 VS 54.8 ± 9.6 min, unilateral; 95.8 ± 10.4 VS 92.1 ± 13.9 min, bilateral), blood loss (5.9 ± 1.9 VS 5.6 ± 1.7 mL), visual analogue scale score on postoperative day 1 (2.3 ± 0.5 VS 2.2 ± 0.5) and postoperative hospital stay (1.1 ± 0.3 VS 1.0 ± 0.2 days) in the drainage group were equivalent to those in the no-drainage group (p > 0.05). The mean length of drainage was 5.2 ± 1.3 days. The drainage group had a significantly lower incidence of seroma than the no-drainage group (1.5% VS 9.4%, p = 0.037). The postoperative complications including haematoma, recurrence and chronic pain were comparable in the two groups. ConclusionDrainage with appropriate duration is a feasible, safe and effective measure to decrease the incidence of seroma in TAPP for patients with large inguinoscrotal hernias.

Effect of carbon dioxide pneumoperitoneum on acid-base balance during laparoscopic inguinal hernia repair: a prospective randomized controlled study.

In this study, we aimed to compare the effects of CO2 pneumoperitoneum on acid-base balance during transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP) procedures for repair of inguinal hernias. The study cohort comprised 100 patients who underwent repair of primary inguinal hernias from 1 June to 30 November 2019. The patients were randomly allocated to TAPP and TEP groups. Their acid-base balance was analyzed by comparing the results of blood gas analysis before and after the operative procedures and dynamic transcutaneous CO2 (TcCO2) changes during the procedures. There were no statistically significant differences among groups in demographics, including sex, age, and hernia type. There were also no significant differences between the two groups in anesthesia time, incidence of perioperative complications, or type of management of the hernia sac (all P > 0.05). The operation time was shorter for the TEP than the TAPP group (P < 0.01). In terms of CO2 metabolism and acid-base balance, the following differences between the two groups were statistically significant: changes in PaCO2 (7.54 ± 3.36 vs. 20.36 ± 7.60mmHg, P < 0.01), changes in TcCO2 (8.86 ± 3.57 vs. 17.40 ± 8.03mmHg, P < 0.01), rate of change in TcCO2 (0.22 ± 0.11 vs. 1.03 ± 0.56, P < 0.01), and changes in pH (- 0.05 ± 0.28 vs. - 0.15 ± 0.76, P < 0.01). TAPP and TEP can achieve good results in the treatment of inguinal hernia. Although no serious complications occurred, TEP procedures may cause more serious CO2 accumulation and quicker acidosis than TAPP procedures.