Transabdominal Preperitoneal Technique Research Articles

Pain After Transabdominal Preperitoneal (TAPP) or Totally Extraperitoneal (TEP) Technique for Unilateral Inguinal Hernia: A Randomized Controlled Trial.

IntroductionLaparoscopic inguinal hernia repair is the most commonly performed surgery in many hospitals. This study aimed to compare the outcome of the transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) techniques in unilateral, uncomplicated inguinal Hernia.Material and methodsThis prospective randomized study was conducted in a tertiary care hospital in North India from November 2018 to March 2020. Sixty-eight male patients of unilateral, uncomplicated inguinal hernia were enrolled for laparoscopic hernia repair. The first group of 34 patients underwent TAPP repair and the second group of 34 patients underwent TEP repair under general anesthesia (GA). Both groups were compared for intraoperative or postoperative complications, analgesic requirements, postoperative pain, length of hospital stay, resumption of routine activity, and patient satisfaction scores. Fisher's exact test or Chi-square test were used for nominal data and the median or interquartile range was used for ordinal data.ResultsThe mean operative time for TAPP was more than that for the TEP group (101 vs 76, p<0.001). The TAPP group exhibited significantly less postoperative pain at six hours, 24 hours and seven days than TEP (p<0.001) and an insignificant difference at three months of the follow-up period (p=0.188). Additional analgesics requirement was less in the TAPP group, although the difference was not significant (p=0.099). Seroma formation was found in four patients (11.8%) in the TEP group and two patients (5.9%) in the TAPP group (p= 0.672). Length of postoperative hospital stay (p=0.907), resumption of routine activity (p=0.732), and patient satisfaction scores (p=0.492) during follow-up were similar in both groups and were also insignificant.ConclusionThe TAPP technique is slightly better than TEP for inguinal hernia in terms of lesser postoperative pain with similar chances of complications and other outcomes.

Implementation and Validation of a Novel and Inexpensive Training Model for Laparoscopic Inguinal Hernia Repair.

Purpose: The aim of this study was to develop and validate a reproducible low-cost model useful for the development and acquisition of skills and competencies required for endoscopic hernia repairs. Methods: Ten general surgery residents (PGY3) were instructed to construct the model and perform the maneuvers necessary for the simulation of laparoscopic inguinal hernioplasty by the trans-abdominal pre-peritoneal (TAPP) technique. They practiced for 4weeks in the model, and the time required to perform simulated hernioplasty by the laparoscopic TAPP technique in the initial session was compared to the time required after 4weeks of training. Results: The time required to perform the exercise was significantly lower than in the initial session (p < 0.01). The time required by residents to complete the exercise in the initial session was significantly longer than that used by expert surgeons in the same task (p < 0.01), and although a significant difference persisted, this difference was substantially reduced to 3.60min after the residents completed 4-week training in the model (p < 0.01). An independent expert, blinded to the level of training of the person who performed the exercise, could recognize all residents as novices and all experienced surgeons as experts in the initial session of the exercise with the model, but after 4 weeks of training, they did not recognize 4 of the 10 residents as novices (p < 0.05). Conclusion: The routine implementation of training in this model could be very useful in the laparoscopic inguinal hernioplasty teaching-learning process.

Lichtenstein versus transabdominal preperitoneal (TAPP) inguinal hernia repair for unilateral non recurrent hernia: A multicenter short term randomized comparative study of clinical outcomes

BackgroundThe repair of inguinal hernia is still one of the most prevalent surgical procedures done worldwide. Among all repair techniques, open Lichtenstein repair is the most globally conducted. In the past few decades, laparoscopic technique for inguinal hernia repair has increased technical demand. Trans-abdominal pre-peritoneal (TAPP) technique is the main approach, which is featured by less postoperative pain and early recovery. ObjectiveThe current work is a short-term study to make a comparison between open Lichtenstein repair of inguinal hernia as well as laparoscopic trans-abdominal preperitoneal repair of inguinal hernia (TAPP) for unilateral non recurrent hernia regarding intraoperative, postoperative complications and hospital stay. Patients and methodsThe present prospective randomized study recruited 100 male subjects from General Surgery Department of Al-Azhar University Hospitals and Ain Shams university hospitals suffering from oblique inguinal hernia (unilateral non recurrent hernia) with an age above 18 years and good overall health, who were randomized into two groups: Group A: 49 cases were subjected to laparoscopic trans-abdominal pre-peritoneal repair (TAPP). Group B: 51 cases were subjected to open Lichtenstein repair. ResultsThis study detected less post-operative pain day 0, day 1, day 7 and 1 month postoperatively. There was no significant difference at 6 months post-operatively. ConclusionFinally, we concluded that TAPP repair for inguinal hernia (unilateral non recurrent hernia) safer with less early post-operative pain. Also, it has fewer complications, with a significantly longer operative time.

Resultados de la utilización de malla única en la reparación laparoscópica transabdominal (TAPP) de hernias inguinales bilaterales directas

Background: The laparoscopic approach has clear advantages for repairing bilateral hernias and recurrent hernias. The use of a single mesh as an option in the laparoscopic treatment of direct bilateral inguinal hernias with the transabdominal preperitoneal (TAPP) technique, may reduce the recurrence rate and chronic pain. Objective: The aim of this study is to analyze the benefits of single mesh for the treatment of bilateral inguinal hernias with the TAPP technique. Material and methods: We conducted a retrospective analysis of patients with bilateral direct inguinal hernias undergoing laparoscopic hernia repair with the TAPP technique using a single mesh. Results: Between January 2016 and January 207 177 patients underwent inguinal hernia repair. Of the 93 patients with bilateral hernias, a single mesh was used in 39, which were included in this study. Conclusion: The use of a single mesh is a safe option for the laparoscopic treatment of direct bilateral inguinal hernias with the TAPP technique.

Outcomes and Learning Curve in Total Extra Peritoneal Hernia repair.

ABSTRACT Background: A hernia surgery can be performed via the classical open technique, or laparoscopically. However, the later techniques viz. total extraperitoneal repair and transabdominal pre-peritoneal techniques are allied to a steep learning curve. Aim and Objectives: In this study, we aim to define the learning curve associated with a TEP inguinal hernia repair. Materials and Methods: We conducted a prospective study, of 125 patients with inguinal hernia posted for laparoscopic inguinal hernia repair by a total extra peritoneal technique, to assess the learning curve. Two surgeons: surgeon 1 (assessee, junior surgeon) and surgeon 2 (assessor, senior surgeon) were chosen. The learning curve was assessed for surgeon 1, who was a general laparoscopic surgeon, not performing laparoscopic hernia repair, while surgeon 2 was regularly performing laparoscopic hernia repairs. The study period was between January 2018 and January 2022. A direct comparison was made, based on operative time, peritoneal laceration, vascular injury, conversion rates, hospital stay and complications. Results: Out of 125 patients, 50 patients were operated by the surgeon 1 and 75 were operated by surgeon 2. Mean operating time by surgeon 2 was 52 ± 4.5 minutes, and 66 ± 4.18 minutes for surgeon 1 with a p value of 0.0005. This was the only statistically significant variable, while surgical complications like peritoneal laceration, vascular injury or conversions to TAPP were statistically insignificant. Conclusion: Surgeon 1 (Assessee) required to perform 10 TEP surgeries to overcome the learning curve. Therefore, surgeons with a prior experience in laparoscopic surgery needs a shorter learning curve as compared to a beginner in laparoscopic surgery, when it comes to laparoendoscopic groin hernia repair.

LAPAROSCOPIC INGUINAL HERNIA REPAIR: THE LONG-TERM ASSESSMENT OF CHRONIC PAIN AND QUALITY OF LIFE.

Laparoscopic approaches to inguinal hernia repair include transabdominal extraperitoneal and transabdominal preperitoneal, both of which are widely performed and employ mesh. Indicators of success for these surgical procedures include incidence of complications, time to return to daily activities, incidence of postoperative chronic pain, and the long-term postoperative patient satisfaction. This study aimed to evaluate and compare long-term postoperative incidence of chronic pain and overall quality of life among patients undergoing transabdominal extraperitoneal or transabdominal preperitoneal inguinal hernia repair. This was a retrospective cross-sectional study. Medical records were analyzed, and the SF-36 questionnaire and Visual Analog Scale were applied to assess quality of life and chronic pain in patients undergoing laparoscopic inguinal hernia repair between January 2017 and February 2021. A total of 167 patients status post laparoscopic inguinal hernia repair, who were 3 months postoperatively or longer, were included in the study. Among the early complications seen, seroma was most common in the transabdominal preperitoneal group (p=0.04). Subsequently, 40 of the initial 167 patients answered to the survey instrument (SF-36 and Visual Analog Scale). Mean patient-reported pain (Visual Analog Scale score) was statistically similar between groups, with 1.29 for transabdominal preperitoneal and 1.68 for transabdominal extraperitoneal (p=0.92). In the domains evaluated by the SF-36, there was no significant difference between the samples. Both transabdominal extraperitoneal and transabdominal preperitoneal techniques for hernia repair have similar results in the late postoperative period regarding quality of life and prevalence of chronic pain. They are also comparable in terms of major early postoperative complications, except for seroma, with a higher incidence in patients undergoing transabdominal preperitoneal.

Critical view of the myopectineal orifice: a scoring system to objectively evaluate transabdominal preperitoneal inguinal hernia repair.

More than 20 million inguinal hernia repair (IHR) procedures are performed worldwide every year. The critical view of the myopectineal orifice (CV of the MPO) is a stepwise guide to the achievement and standardization of minimally invasive IHR (MI IHR). We propose a scoring system as an objective method for fulfillment of the CV of the MPO. The scoring system was employed for evaluation of the transabdominal preperitoneal (TAPP) technique in 15 video-recorded procedures. Two variants of the score were used: the simple CV of the MPO score (s-CVMPO score) and the extended CV of the MPO score (e-CVMPO score). The inter-rater agreement and internal consistency for both scores and the correlation between the two scores were assessed. Inter-rater agreement with respect to satisfactory/unsatisfactory achievement of the CV of the MPO was high for both the s-CVMPO and e-CVMPO scores (κ = 1, p < 0.001). The Finn coefficient for inter-rater agreement was 0.97 for the s-CVMPO score and 0.99 for the e-CVMPO score (p < 0.001 for both). Both the s-CVMPO and e-CVMPO scores showed internal consistency with Cronbach's α of 0.89 and 0.87, respectively. The correlation coefficient between the two scores for the average score of each procedure was ρ = 0.96 (p < 0.001). The CVMPO score is a reliable tool for expert evaluation of TAPP repair. Implementing the CVMPO score facilitates objective assessment of the safety and quality of the procedure.

P126 LAPAROSCOPIC TREATMENT OF HYDROCELE IN FEMORAL CANAL: A CASE REPORT

Abstract Aim The hydrocele of the femoral canal (Femorocele) is one of the rarest entities of femoral hernia (1). All of the reported cases were an intraoperative diagnosis and were treated with an open approach. We are reporting, the probably first femorocele diagnosed and treated laparoscopically. Material and Methods A 57-years-old female patient was presented in our outpatient clinic with pain and an unclear lump in the groin area for 6 months. The sonographic examination revealed a cystic structure in the groin area resampling Nuck’s cyst. An elective laparoscopic exploration and transabdominal preperitoneal (TAPP) repair was planned. Results A laparoscopic exploration was carried out. Intraoperatively, the cystic structure was not found in the Nuck’s Canal, but in the femoral canal as a content of a femoral hernia with some pre-peritoneal fat. By the extraction of the cyst, a gush of clear fluid was noted. After the usual preparation of the preperitoneal area, a mesh was placed in TAPP technique. Conclusions This rare variety of femoral hernias, femorocele, is commonly misdiagnosed as a strangulated hernia or Nuck’s cyst (as in this case) among other differential diagnoses (2). All published femorocele cases were treated with an open approach. As demonstrated here, such unclear cases can be laparoscopically explored and treated accordingly.

P139 LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL REPAIR FOR SMALL AND MEDIUM PRIMARY UMBILICAL AND MIDLINE HERNIAS

Abstract Aim Complications of open mesh repair for primary umbilical and midline hernias (PUMH) may lead to significant re-admissions and follow-up costs. Although laparoscopic intraperitoneal onlay mesh repair reduces infection rates, especially in overweight patients, it’s controversial in these hernias, mainly due to potential adhesions’ formation. Laparoscopic transabdominal preperitoneal technique (lap-TAPP) may address these issues, as it combines advantages of both open and laparoscopic approaches. The aim of this study is to present the initial results of lap-TAPP for PUMH in regard to its feasibility and complication rates. Material and Methods We evaluated 25 consecutive cases of lap-TAPP repair for PUMH. Patients’s characteristics, intraoperative findings, and postoperative complications after 30-days follow-up were analyzed. Results 21 male and 4 female patients were included in analysis (mean BMI 29.8 kg/m2). Surgery time was 82 minutes (55-120). We found 20 umbilical and 11 epigastric linea alba hernias. Mesh size was 144cm2 (120-225); mean hernia defect width was 25mm (10-40). In 9 patients (36%) the peritoneal rents were created which were easily closed with sutures. All patients were discharged on 1 POD with no complications. After 30-days we found no recurrences or bulging, no pain complaints. We found one subcutaneous small hematoma with no need for intervention. Conclusions Laparoscopic TAPP for small and medium PUMH is a safe and feasible technique with low complication rate. However, this method is technically demanding and time consuming while performed with laparoscopic approach as it requires precise and subtle plane dissection, and non-ergonomic closure hernia defect.

Inguinal hernia – epidemiology, risk factors, treatment methods (literature review)

Inguinal hernias (IH) are widespread in the human population and occur in 27–43 % of men and 3–6 % of women. Many risk factors for IH have been overestimated in the last decade: male gender is considered the leading factor (the ratio between men and women is approximately 1:7), less significant factors are heredity (most significant for women), physical activity (more significant for men), age (peak prevalence of IH occurs at 5 years and 70–80 years), congenital or acquired connective tissue dysplasia, history of prostatectomy, low body mass index.Hernioplasty with the use of synthetic mesh prostheses remains the most popular technique for surgical correction of IH. Performing non-prosthetic hernioplasty is only recommended if mesh prostheses are not available, for example in poor countries. In open hernioplasty using mesh prostheses, different methods are used today: Plug &amp; Patch, Prolene Hernia System, Parietene Progrip, sutureless plastic according to Trabucco, Stoppa, preperitoneal techniques TIPP (trans-inguinal pre-peritoneal), TREPP (transrectus pre-peritoneal), TEP (total extraperitoneal), however, none of them showed significant advantages over the gold standard of open hernioplasty – tensionfree repair according to Liechtenstein.Laparoscopic IH correction is represented by the TAPP (transabdominal preperitoneal) technique, performed through the abdominal cavity, and TEP (total extraperitoneal) – extraperitoneal prosthetic hernioplasty. None of them has a significant advantage in the treatment of IH; therefore, when choosing a treatment method, the surgeon should be guided by the cost of the operation and the level of proficiency in one or another hernioplasty technique.

Comparison of intraocular pressure during laparoscopic totally extraperitoneal (TEP) versus transabdominal preperitoneal (TAPP) inguinal hernia repair.

Laparoscopic totally extraperitoneal (TEP) repair and transabdominal preperitoneal (TAPP) repair are standard laparoscopic procedures for inguinal hernia repair. Some evidence has shown that pneumoperitoneum can cause an increase in intraocular pressure (IOP) during surgery. This study aimed to compare intraoperative IOP following extraperitoneal CO2 insufflation with the TEP approach and intraperitoneal CO2 insufflation with the TAPP approach. This study is a prospective cohort study. Patients who had inguinal hernias suitable for laparoscopic inguinal hernia repair were assigned to undergo the TEP or TAPP approach. We measured preoperative, intraoperative, and postoperative IOP. The IOP of the TEP and TAPP groups was evaluated using a t test. The relations between peak inspiratory pressure (PIP), mean arterial pressure (MAP), and end-tidal CO2 (EtCO2) were estimated using ANOVA. Univariate and multivariate analyses were performed to determine the factors associated with IOP. There were 50 patients in this study (TEP group n = 25, TAPP group n = 25). The change in intraoperative IOP from the preoperative measurement to the measurement after CO2 insufflation was not statistically significant in either the TEP or TAPP group (p value = 0.357). There was no significant difference in intraoperative IOP change between the TEP and TAPP groups. Intraoperative MAP and PIP were related to IOP, but intraoperative EtCO2 was not. There was no significant intraoperative IOP change during laparoscopic inguinal hernia repair. Both the TEP and TAPP techniques can be performed safely without increasing intraoperative IOP.

Peritoneal Pocket Hernia—Avoidable Complication Following TAPP with Meticulous Closure Technique of Peritoneal Flaps

The paper presents the case of a young woman, 29 years of age recently operated by TAPP for right inguinal hernia, who was readmitted to our clinic for intense pain in the lower abdominal floor and right iliac fossa with features of intestinal obstruction of 24 h of duration. Intraoperatively, we observed intestinal occlusion due to an incarcerated ileal loop at the level of a peritoneal gap of approximately 2 cm in diameter, in the flap suture area, after transabdominal preperitoneal patch technique (TAPP). Moreover, the phlegmonous appendix was encountered in the properitoneal space, fixed at the level of the polypropylene mesh. Appendectomy and peritoneal defect closure were performed, with quick postoperative recovery. In recent years, minimally invasive techniques are increasingly being adopted for the repair of inguinal hernias because in addition to the rapid recovery and aesthetic advantage they are associated with a low risk of complications, and the use of the net meshes reduces the recurrence rate to 1–6%. In the case presented, the early postoperative complication was major and rare, associating intestinal obstruction with ileal loop incarceration in a peritoneal breach with acute phlegmonous appendicitis. This complication could be easily avoidable with meticulous closure of peritoneal flap after the TAPP procedure, preventing the contact between the intraperitoneal viscera and the mesh. In any patient following laparoscopic surgery, relaparoscopy must be performed sooner rather than later for timely diagnosis and management of a complication.

Comparison of Early and Late Period Outcomes of Transabdominal Preperitoneal (TAPP) Technique and Lichtenstein Technique in Repair of Bilateral Inguinal Hernia

Comparison of Early and Late Period Outcomes of Transabdominal Preperitoneal (TAPP) Technique and Lichtenstein Technique in Repair of Bilateral Inguinal Hernia

Tratamiento laparoscópico de la hernia inguinal por técnica transabdominal preperitoneal. Análisis retrospectivo de una serie de casos

El objetivo del presente trabajo es reportar y analizar nuestra experiencia con la técnica endoscópica transabdominal preperitoneal (TAPP) en el tratamiento de la hernia inguinal. Métodos: Estudio retrospectivo mediante la revisión de nuestra base de datos electrónica y las historias clínicas en físico de la Clínica Santa Sofía, de los pacientes con diagnóstico de hernia inguinal tratados por los autores en los últimos 8 años. Se incluyeron para el análisis los casos con abordaje laparoscópico, recolectándose sexo, edad, diagnóstico pre e intraoperatorio, procedimientos adicionales, tiempo quirúrgico, complicaciones perioperatorias, tiempo de hospitalización, y morbilidad. Resultados: Se recolectaron 158 intervenciones de hernias inguinales en 102 pacientes, 89 hombres y 13 mujeres, de las cuales 135 (85,4%) fueron por abordaje laparoscópico tipo TAPP. Mediante la laparoscopia se modificó el diagnóstico preoperatorio en 17 pacientes (16,6%). El tiempo quirúrgico promedio fue de 50,5±11,6 minutos, y se presentaron 3 complicaciones perioperatorias y 4 tardías, para una morbilidad total de 5,1%. La estancia hospitalaria fue de 1±0,08 días y el tiempo de seguimiento promedio fue de 7,5±15,4 meses, detectándose 3 recidivas (2,2%) en ese período. Cinco pacientes presentaron dolor crónico posoperatorio, ninguno debilitante, que cedió gradualmente en todos los casos utilizando analgésicos comunes. Conclusiones: La técnica TAPP es una alternativa válida en el tratamiento de la hernia inguinal. Sus principales ventajas son las de optimizar el diagnóstico, permitiendo la reparación en un solo tiempo de hernias no diagnosticadas clínicamente, y su baja incidencia de dolor posoperatorio crónico.

Evaluation of early post-operative pain and seroma formation in transabdominal pre-peritoneal (TAPP) repair of groin hernias with light weight mesh placement.

Objectives: To share our experience with laparoscopic surgery using TAPP technique, for groin hernias using light weight parietene mesh, to find out early post operative pain and foreign body sensation as complications. Study Design: Cross sectional study. Setting: Department of Surgery Khyber Teaching Hospital Peshawar. Period: January 2018 till August 2018. Material &amp; Methods: A sample of 100 patients was recruited into study. All patients underwent standard transabdominal preperitonial repair with light weight Mesh. Data was collected by predesigned Performa and analyzed with SPSS 21. Results: Out of 100 patients 98% were male, 2% female, mean age was 43.2± 5.3years (minimum 17years and maximum 64years). Regarding frequency of type of hernia data showed 68% patients had indirect inguinal hernia while 32% patients had direct inguinal hernia. 65% patients had right sided inguinal hernia, 26% left sided while 9% had bilateral inguinal hernia. Post operative hospital stay showed hematoma in 5% patients, seroma in 12% patients, wound infection in 8% of patients while foreign body sensation in 4% patients. Conclusion: Most of the patients presented were of middle age. Indirect inguinal hernia was more frequent than direct inguinal hernia. Common complications apart from pain were seroma formation, hematoma, wound infection and foreign body sensation.

Polypropylene mesh versus double face mesh in totally extraperitoneal laparoscopic inguinal hernia repair

Background Inguinal hernia is the commonest type of hernia. Repair of the inguinal hernia is one of the most widely recognized surgeries done all over the world. With the advancement in knowledge, laparoscopic hernioplasty has become very popular, accounting for ∼15–20% of hernia repair, with great results. Objectives In this study, we have tried to determine if there is a significant difference between using conventional polypropylene mesh and double face mesh (polypropylene+vicryl) in totally extraperitoneal (TEP) laparoscopic hernia repair. Patients and methods This study had been conducted on 20 patients with inguinal hernia, who were divided into two groups. Group A represented patients who underwent TEP repair of an inguinal hernia using polypropylene mesh, and group B represented patients who underwent TEP repair of inguinal hernia with double face mesh. Results Regarding operative time, same operative time was seen in both groups. Nevertheless, much longer time was noticed in case of the peritoneal tear in group A. There were no intraoperative complications encountered in both groups, such as bleeding, visceral injuries, and conversion to transabdominal preperitoneal or open technique; however, peritoneal tear occurred in both groups. Regarding the postoperative period, there was no difference in the postoperative parameters between both groups, including pain, hospital stay, and recurrence. Nevertheless, the cost in the double face mesh group is significantly higher than polypropylene mesh group. Conclusion TEP approach is an acceptable procedure for inguinal hernia repair with less visceral and vascular injuries. There was no difference in outcome between TEP repair of inguinal hernia either using the polypropylene or double face mesh. Randomized studies on a larger number of patients are needed to confirm the results.

Ultrasound-versus visual-guided transversus abdominis plane block prior to transabdominal preperitoneal ingunial hernia repair. A retrospective cohort study

BackgroundThe transversus abdominis plane block is a regional anesthesia technique. Recently, its impact on early chronic pain and the cumulative need of analgesic medication following inguinal hernia repair is being monitored. In terms of effectiveness and patient safety, it remains unclear whether the approach should be conducted preoperatively through ultrasound guidance, or through intraoperative visual guidance.The study at hand aims to provide more evidence on this topic. MethodsA monocentric retrospective matched pair analysis was performed. The intraoperative visual guided and ultrasound guided -transversus abdominis plane block prior to inguinal hernia repair in transabdominal preperitoneal technique were consecutively compared in regard to analgesic effectiveness and complication rate. The data of individuals who were operated on from June 2007 to February 2019 were analyzed. The matching criteria were ASA-Score, Gender, Age ( ±6 years), and hernia size (<1,5 cm, 1,5-3 cm, >1,5 cm). ResultsA total of 116 patients were enrolled. Both groups were homogenous in terms of age, gender contribution, body mass index, ASA-Score, hernia type, and size. The pain score at the postoperative anesthesia care unit was lower in the ultrasound-guided-transversus abdominis plane group without being statistically significant (VAS-Score: 0.67 vs.0.84). Patients of the ultrasound-guided-transversus abdominis plane group received significantly less metamizole on the day of operation (1.29 g (0.96) vs. 1.68 g (0.70), p = 0.015). ConclusionDue to our findings, we assume that the ultrasound-guided-transversus abdominis plane -Block may reduce postoperative pain and analgesic consumption more effectively than the visual-guided-transversus abdominis plane lock. Further prospective clinical trials are mandatory.

Comparative Study between Unilateral Inguinal Hernia by Open Technique versus TAPP Repair

Abstract Background: Inguinal hernia repair is one of the most widely performed surgical procedure. Amongst the techniques used, the Open Lichtenstein Repair (OLR) is still the most widely performed. However, in the last decade there has been an increased interest in the laparoscopic approach for inguinal hernia repair, mainly represented as the Trans-Abdominal Pre-Peritoneal (TAPP) technique. As described in recent studies, TAPP approach entails the benefits of minimally invasive surgery, such as less pain and earlyrecovery. Aim of Study: This study aims to compare between lich-tenstein repair of inguinal hernia and transabdominal preperi-toneal repair of inguinal hernia (TAPP) as regard their hospital stay, post-operative complications and short-term recurrence. Patients and Methods: Our study was carried out on (40) male patients with inguinal hernia attendees Kobry El-Qobba Military and Alzahraa Hospital; Al-Azhar University between April 2019-Octoper 2019, 20 patients underwent laparoscopic Trans-Abdominal Pre-Peritoneal (TAPP) repair and 20 patients underwent open Lichtenstein repair. Results: In our study the mean operative time was (97.50 ±19.97) minute for TAPP, (70.30±19.55) minute for open Lichtenstein repair. None of our patients had intra-operative complications such as (vascular injury... etc). There was one patient with wound infection (5%) for TAPP repair versus two patients seroma (10%), one patient hematoma (5%) and one patient wound infection (5%) but the difference between both groups was statistically insignificant. There was no significant difference in terms of hernia recurrence. This study confirmed less post-operative pain day 0, day 1 and day 7 post-operatively. There was no significant difference in 1 and 6 month post-operatively. Conclusion: Our study showed that laparoscopic TAPP approach for inguinal hernia repair is safe and reduces early post-operative pain. Furthermore, it is related to less compli-cations. Significantly although it takes a longer operative time.

Kết quả sớm điều trị thoát vị bẹn ở người trưởng thành bằng phẫu thuật nội soi xuyên thành bụng đặt tấm lưới Prolen ngoài phúc mạc tại Bệnh viện Trung ương Huế - Cơ sở 2

Tóm tắt Đặt vấn đề: Thoát vị bẹn là bệnh lý phổ biến trong ngoại khoa, đặc biệt lĩnh vực ngoại tiêu hóa. Từ khi phẫu thuật nội soi ra đời và ứng dụng tấm nhân tạo trong điều trị thoát vị bẹn, đã có những thay đổi trên thế giới về điều trị cho người bệnh thoát vị bẹn. Phương pháp phẫu thuật nội soi đặt tấm nhân tạo đường xuyên phúc mạc TAPP (Trans-Abdominal Pre-Peritoneal) có nhiều ưu điểm như đường cong huấn luyện ngắn, phát hiện thoát vị bẹn đối bên và điều trị cả trường hợp có biến chứng, nên được nhiều phẫu thuật viên trẻ lựa chọn. Phương pháp nghiên cứu: Nghiên cứu tiến cứu, lâm sàng mô tả, theo dõi dọc 19 người bệnh với 21 trường hợp thoát vị bẹn được phẫu thuật TAPP tại Bệnh viện Trung ương Huế - Cơ sở 2 từ tháng 12/2018 đến 3/2019. Kết quả: Tuổi trung bình 66,8 ± 14,35. Thoát vị bẹn nghẹt 4,8%. Thoát vị bẹn cầm tù 9,5%. Thời gian phẫu thuật trung bình một bên 65,3 ± 19,6 phút, hai bên 102,5 ± 12,5 phút. Thời gian hậu phẫu trung bình 4,1 ± 1,6 ngày. Phát hiện 2 trường hợp thoát vị bẹn đối bên. Sau 3 tháng không có trường hợp nào tái phát. Kết luận: Phẫu thuật TAPP là một phẫu thuật an toàn, hiệu quả có thể ứng dụng rộng rãi. Abstract Introduction: Inguinal hernia repair is one of the most common operation performed in general surgery, especially in digestive field. Since the introduction of laparoscopic repair and application of synthetic mesh to treatment, the trends have changed in the last decade in treatment for inguinal hernia. The laparascopic trans-abdominal pre-peritoneal (TAPP) has a short learning cure. TAPP has many advantages, such as wide dissection, contralateral side checkup, treatment strangulated hernia and incarcerated hernia, a short learning cure has been the first choice for surgeons. Materials and Methods: Study subjects included 19 patients with 21 inguinal hernia cases treated by laparoscopic trans-abdominal pre-peritoneal (TAPP) technique at the Hue Central Hospital - Base 2 from 12/2018 though 3/2019. Descriptive and prospective follow-up study. Results: The mean age was 66,8 ± 14,35 years old. Strangulated hernia and incarcerated hernia respectively accounted for 4,8% and 9.5% of cases. The mean durations of unilateral inguinal hernia repair and bilateral inguinal repair were 65,3 ± 19,6 mins and 102,5 ± 12,5 mins, respectively. Mean duration of postoperative stay was 4,1 ± 1,6 days. 2 case (3.2%) with contralateral inguinal hernia were detected. At 3-months evaluation, there was no recurrence. Conclusion: TAPP is a safe and effective surgical technique; should be encouraged and widely applied in different levels hospitals. Keyword: inguinal hernia, TAPP, laparoscopic surgery, mesh.

Laparoscopic Transabdominal Preperitoneal Technique for Inguinal Hernia Repair in Adults.

BackgroundInguinal hernia repair is one of the most commonly performed operations in general surgery, especially in the digestive field. Since the introduction of laparoscopic repair as well as using a synthetic mesh, the surgical trends have changed in the last decade in treating inguinal hernias. The laparoscopic transabdominal preperitoneal gives a better view of the inguinal anatomy, and the procedure also has a short learning curve. We aim to evaluate the safety and early outcome of the laparoscopic transabdominal preperitoneal technique for inguinal hernia repair using a Prolene® mesh (Ethicon Somerville, NJ, USA).MethodsA prospective study was carried out among 31 adult patients with 34 inguinal hernia cases. They underwent the laparoscopic transabdominal preperitoneal technique with a Prolene mesh at the Hue Central Hospital from December 2018 through May 2019.ResultsThe mean age was 60.4 ± 11.8, and 96.8% of cases were male. Strangulated hernia and incarcerated hernia accounted for 2.9% and 8.8% of cases, respectively. The mean duration of unilateral inguinal hernia repair and bilateral inguinal repair was 57.1 ± 17.3 minutes and 80.3 ± 10.6 minutes, respectively. The mean duration of the postoperative hospital stay was 3.9 ± 1.4 days. One (3.2%) case with contralateral inguinal hernia was detected intraoperatively. An early and three-month postoperative evaluation showed that 93.5% and 96.8% of cases were categorized as “very good”, respectively. At the three-month evaluation, one case was reported with sensation disorder of the inguinal area, and there was no recurrence.ConclusionsLaparoscopic transabdominal preperitoneal inguinal hernia repair is a safe and feasible technique. It allows surgeons to explore the opposite site and resolve the combined peritoneal diseases.