Analysis of clinical effect on 19 cases of inguinal hernia treated by laparoscopic totally extraperitoneal repair / 国际外科学杂志

Objective To investigate the effect of laparoscopic total extraperitoneal tension-free hernia repair (TEP) in the treatment of inguinal hernia with absorbable biological mesh.Methods A retrospective analysis of the clinical data of 19 patients with inguinal hernia with biological mesh was performed from September 2015 to September 2016 in Shengjing Hospital of China Medical University.The average operative time,average incision pain time,average postoperative venting time,average hospital stay,average operative cost,and long-term chronic pain,postoperative complications,and recurrence rate were observed.Results All the 19 patients were successfully operated.The average operation time was (35.0 ± 4.0) min,the average incision pain time was (1.5 ± 0.6) d,and the average postoperative venting time was (1.5 ± 1.2) d.The average hospital stay was (4.5 ±0.9) d,the average surgery cost was (23 534.6 ± 1 259.9) yuan.Two patients developed swelling of the scrotum after surgery,and one patient developed postoperative fat liquefaction.All patients were followed up for 1 year by telephone,with no recurrence,no serious complications,and chronic pain discomfort.Conclusions The application of absorbable biopsy TEP is a good and reliable way to treat inguinal hernia.Postoperative patients have mild pain and low complication rate.There is no recurrence in recent follow-up,and the short-term effect is satisfactory.It is a reliable method for the treatment of inguinal hernia.The cost is high,and can be selected according to age and individual needs.

Clinical Application of Total Extraperitoneal Inguinal Hernia Repair Under Two Laparoscopes / 中国微创外科杂志

Objective To study the feasibility and the efficacy of total extraperitoneal repair (TEP) under two laparoscopes.Methods Clinical data of 51 patients with inguinal hernia who underwent TEP under two laparoscopes from July 2015 to March 2016 in our hospital were analyzed retrospectively.During TEP,we added a 5-mm laparoscope for monitoring and exploration in the abdominal cavity.Results All the operations of TEP under two laparoscopes were successful.The operation time lasted 42-176 min with a mean of (74 ±27) min.The intraoperative blood loss was 5-30 ml with a mean of (12.8 ±5.9) ml.The length of postoperative hospital stay was 2-7 days with a mean of (4.0 ± 1.1) days.The percentage of postoperative complications was 11.8％ (6/51),including inguinal area seroma which accounted for 2.0％ (1/51),inguinal region pain accounting for 3.9％ (2/51),and postoperative urinary retention for 5.9％ (3/51).No infection was found.The follow-up period ranged from 3 to 11 months (mean,7 months),no recurrence was observed during this period.Conclusions TEP under two laparoscopes can treat inguinal hernia precisely.It is also helpful to find compound inguinal hernia and occult inguinal hernia.

SUTI (Single Umbilical Tangential Incision) Laparoscopic TEP Inguinal Hernia Repair

PURPOSE: Single port laparoscopic inguinal hernia repair has been performed to further reduce port related morbidities and to improve the cosmetic outcome. However, the cosmetic result of single port laparoscopic totally extraperitoneal inguinal hernia repair (TEP) has not been superior to that of transabdominal preperitoneal hernia repair (TAPP). The aim of this study is to introduce and assess the Single Umbilical Tangential Incision (SUTI) for Lap-TEP repair. METHODS: Forty one hernia repairs of 34 patients were performed using SUTI-TEP method. SUTI was made all along the inferolateral skin of the umbilical pit and a vertical incision of less than one centimeter was made in the supra- or infraumbilical skin if needed; the total length of the incision was 2~2.5 cm. SILS(TM) port and conventional instruments were used for the procedure. RESULTS: All procedures were completed without conversion to the conventional TEP procedure. Mean operation time was 73 minutes for unilateral primary hernia, 119 minutes for bilateral primary hernia, 88.5 minutes for unilateral recurrent hernia, and 120 minutes for bilateral recurrent hernia. There were two cases of wound seroma and four cases of urinary retention postoperatively. Other significant complications were not noted. There was no recurrence of hernia during the follow-up period of one to 24 months. At routine follow-up visit at three months postoperative, the scar was barely visible and overall level of patient satisfaction was very high. CONCLUSION: The SUTI-TEP inguinal hernia repair is safe and shows superior cosmetic results. Further studies are required in order to assess the long-term outcome.

Long-term Outcomes of Laparoscopic Totally Extraperitoneal Inguinal Herniorrhaphy

PURPOSE: Laparoscopic inguinal herniorrhaphy, especially laparoscopic TEP repair, has become a standard method of inguinal herniorrhaphy. Favorable short-term results of laparoscopic inguinal hernia repair, compared with open surgery, have been reported, however, data on the long-term outcome are limited. Based now on more than 55 months of follow-up, we report here on the long-term results for patients who underwent laparoscopic TEP inguinal hernia repair. METHODS: Between January 2002 and December 2007, of patients who underwent laparoscopic TEP repair for an inguinal hernia by a single surgeon, 180 patients who have had a follow-up check with a physical examination or telephone interview were enrolled. RESULTS: A total of 196 TEP procedures in 180 patients (age range 15~88 years; men, 88.3%) were performed successfully without conversion to transabdominal preperitoneal (TAPP) or open surgery. During the follow-up period of more than 55 months (55~20 months), chronic inguinal discomfort or pain was noted in 14 patients (n=14, 7.7% per patient or 7.1% per repair) and the severity of pain was mild (n=11), moderate (n=2), or severe (n=1). In most patients, occurrence of groin pain was very infrequent and the duration of the pain varied from a few seconds to a few minutes. There was one suspicious recurrence (0.5%), which was comparable to that of open surgery. Four cases of mesh infection (2.03%) were noted. Chronic mesh infection may be more frequent than previously reported. Otherwise, most of the patients were satisfied with their results. CONCLUSION: According to the long-term results of the study, laparoscopic TEP is a safe procedure for repair of inguinal hernia, with a low incidence of chronic pain and very low recurrence rate. However, among mesh-related complications, mesh infections have become increasingly important. For clinicians the possibility of mesh infection should be promptly considered in any patient who has undergone hernia surgery involving mesh, and who has any manifestations of abdominal wall.

Laparoscopic totally extraperitoneal repair without suprapubic port: comparison with conventional totally extraperitoneal repair / 대한외과학회지

PURPOSE: We have treated 24 patients through laparoscopic totally extraperitoneal (TEP) repair without suprapubic port by using reliability and reducing the invasiveness of two surgery. This study is aimed to assess the safety and feasibility of the TEP repair without suprapubic port compared to conventional TEP repair. METHODS: From September 2007 to 11 May 2010, we compared two groups that suffer from inguinal hernias. One is comprised of 24 patients who were treated without suprapubic port laparoscopic totally extraperitoneal repair (Group A), and the other is comprised of 100 patients who were treated with conventional laparoscopic totally extraperitoneal repair (Group B). Data regarding patient demographics (sex, age, site of hernia, and the type of hernia), operating time, postoperative hospital stay, the use of analgesics, and complications were prospectively collected. RESULTS: There was no significant difference noted between two groups in relation to sex, age, site, and the type of hernia. The mean operating time and postoperative hospital stay was longer for the Group B (62.9 minutes, 3.55 days) than for the Group A (59.0 minutes, 2.54 days) (P = 0.389, P < 0.001). Postoperative urinary retention, seroma, wound infection were respectively 4.2%, 8.3%, 0% in Group A, and 12.0%, 8.0%, 7% in group B. There was difference between the two groups, but not statistical significance. Group B used more analgesics than Group A (0.33 vs. 0.48), but it wasn't significant statistically (P = 0.234). CONCLUSION: Although prospective randomized studies with long-term follow-up evaluation are needed to confirm our study between laparoscopic totally extraperitoneal repair without suprapubic-port and conventional laparoscopic totally extraperitoneal repair, our method have some advantages in postoperative pain, urinary retention, operating time, postoperative hospital stay, and cosmetic effect.

Laparoscopic total extraperitoneal repair of lumbar hernia / 대한외과학회지

Lumbar hernia is a rare surgical entity without a standard method of repair. With advancements in laparoscopic techniques, successful lumbar herniorrhaphy can be achieved by the creation of a completely extraperitoneal working space and secure fixation of a wide posterior mesh. We present a total extraperitoneal laparoendoscopic repair of lumbar hernia, which allowed for minimal invasiveness while providing excellent anatomical identification, easy mobilization of contents and wide secure mesh fixation. A total extraperitoneal method of lumbar hernia repair by laparoscopic approach is feasible and may be an ideal option.

A Totally Extraperitoneal (TEP) Laparoscopic Approach to Incarcerated Inguinal Hernia / 대한내시경복강경외과학회지

PURPOSE: Laparoscopic herniorrhaphy (LH) has an advantage for evaluating the viability of incarcerated bowel. In this retrospective study, we aimed to review the data for use of the TEP technique in treating incarcerated hernias in order to document the feasibility of the laparoscopic procedure. METHODS: During a 2-year period from January 2008 to December 2009, one surgeon (C.S) at our institution operated on 27 patients with acutely (n=3) or chronically (n=24) incarcerated hernia. Incarcerated hernias were divided into acute or chronic types arbitrarily, based on who had symptoms of acute abdominal pain and signs of intestinal obstruction. For acute cases, the TEP procedure was done following laparoscopic transperitoneal evaluation to assess viability of the incarcerated bowel. RESULTS: All patients except one having a femoral hernia were male. Mean age was 41 years old (range, 25~75). No case converted from a laparoscopic to an open procedure. Two acute incarcerated cases contained a segment of small bowel and the other contained small bowel and omentum. All acute cases were operated on successfully on an emergency basis by laparoscopic TEP repair. All chronic cases contained omentum without bowel. In one case of acute and seven cases of chronic type, a small inguinal incision was made to reduce hernia contents. No recurrence was noticed at a mean of 13 months of follow-up. CONCLUSION: If there is no entrapment of bowel in chronic incarcerated cases, the TEP procedure will be satisfactory. It may be reasonable, however, to evaluate viability of bowel transperitoneally before doing a TEP procedure in acute cases.

The Incidence of the Occult Contralateral Hernia in Patients Undergoing Total Extraperitoneal (TEP) Repair of a Left Inguinal Hernia / 대한내시경복강경외과학회지

PURPOSE: Laparoscopic herniorrhaphy (LH) can be used to examine the asymptomatic contralateral side and repair occult contralateral hernias coincidentally with reduced morbidity. In this prospective study, we evaluated the results of diagnostic exploration of the right side during total extraperitoneal (TEP) laparoscopic repair of left side inguinal hernias. METHODS: A prospective study of 100 consecutive male patients undergoing TEP repair by a single surgeon (C.S) between January and June 2008 was conducted. Two cases that had transabdominal preperitoneal (TAPP) prosthetic repair and one intraperitoneal onlay mesh (IPOM) were excluded. We routinely explored the contralateral side to determine the incidence of right side occult hernia. RESULTS: The mean age was 52 (range; 18~82 years). Among the 100 patients, 17 had bilateral, 52 right and 31 left hernias on physical examination prior to surgery. Three of 31 diagnosed preoperatively as left inguinal hernia were confirmed to have occult right hernias (3/31, 9.7%). Among the three patients, two patients with a direct type had the same type of hernia as on the contralateral side (2/10, 20%). Another one patient with an indirect type had direct type of hernia on the contralateral side (1/21, 4.8%). CONCLUSION: Given the low incidence of contralateral side occult hernia with indirect types of hernias, routine exploration may not be indicated during TEP repair. However, it might be, reasonable to explore the contralateral side in patients with a direct type of hernia because of the higher incidence of contralateral occult hernias.

Laparoscopic Total Extraperitoneal Repair for Inguinal Hernia: Reports of 269 Cases / 中国微创外科杂志

Objective To summarize the clinical experiences and efficacy of laparoscopic total extraperitoneal repair(TEP) for inguinal hernia.Methods From April 2004 to August 2006,294 TEP operations was performed on 269 patients with inguinal hernia by using laparoscopy under epidural or general anesthesia.Among the patients,175 had indirect hernia,40 direct hernias,25 bilateral hernias,and 29 recurrent hernias.Results The operation was completed without converting to open surgeries in all the cases.The mean operation time was(63.1?37.5) min,blood loss(12.3 ?8.2) ml,and hospital stay(3.7 ?1.4) d.Of the patients,24 had peritoneal tearing(8.2%,24/269),4 had groin hematoma(2.4%,4/269),and 2 had foreign body sensation(0.7%,2/269).The patients were followed up for 6-12 months(median,9 months),the recurrence rate was 1.0%(3/294). Conclusion Laparoscopic TEP is safe and effective for patients with inguinal hernia.