Experiencia actual en el abordaje laparoscópico transabdominal preperitoneal de hernias inguinales en el Servicio de Cirugía General del Hospital Nacional: periodo 2018-2022

Introducción: la hernia inguinal es uno de los principales motivos de consulta quirúrgica y su reparación es uno de los procedimientos más comunes en cirugía. Objetivo: determinar la experiencia en el abordaje laparoscópico de las hernias inguinales por técnica transabdominal preperitoneal en el Servicio de Cirugía General del Centro Médico Nacional-Hospital Nacional. Metodología: estudio observacional descriptivo retrospectivo de corte temporal transversal. En pacientes de 16 a 90 años de edad con diagnóstico de hernia inguinal internados en el Servicio de Cirugía General del Centro Médico Nacional-Hospital Nacional para hernioplastia electiva. Resultados: se llevaron a cabo 30 hernioplastias por técnica técnica trans-abdominal pre-peritoneal de los cuales el 73 % fue realizado en hombres y 27 % en mujeres; se identificó una media de edad de 48,4 años, el grupo etario con mayor frecuencia fue de 38 a 48 años. En el examen físico pre quirúrgico se encontraron hernias inguinales unilaterales en el 76.6 % y bilaterales en el 23.3 %; en la mayor parte de los pacientes las hernias fueron primarias en el 86.6 %y recidivada en el 13.3 %. El tiempo quirúrgico en promedio fue de 93.1 minutos; con un tiempo máximo de 120 minutos y mínimo de 60 minutos. El tiempo de hospitalización en el 100 % de los pacientes fue de 48 h. De las complicaciones post operatorias se establece que el 76.6 % no presento ningún tipo de complicación; el 20 % presentó seroma como complicación principal y 3.3 % infección del sitio quirúrgico. Conclusión: debido a su alta frecuencia y a su impacto en la incapacidad laboral y social, las hernias inguinales representan una de las patologías quirúrgicas más importantes con bajas tasas de complicaciones post operatorias y corta estancia hospitalaria.

Introduction: inguinal hernia is one of the main reasons TAPP, e-TEP (Totally extraperitoneal with extended vision) for surgical consultation and its repair is one of the most common surgical procedures. Objective: to determine the experience in the laparoscopic approach of inguinal hernias by preperitoneal transabdominal technique in the Servicio de Cirugía General of the Centro Médico Nacional-Hospital Nacional. Methodology: retrospective descriptive observational study of cross-sectional time. In patients from 16 to 90 years of age with a diagnosis of inguinal hernia admitted to the Servicio de Cirugía General of the Centro Médico Nacional-Hospital Nacional for elective hernioplasty. Results: 30 hernioplasties were carried out by the TAPP technique, of which 73 % were performed in men and 27 % in women; a mean age of 48.4 years was identified, the age group most frequently being 38 to 48 years. In the pre-surgical physical examination, unilateral inguinal hernias were found in 76.6 % and bilateral in 23.3 %; in most of the patients the hernias were primary in 86.6 % and recurred in 13.3 %. Average surgical time was 93.1 minutes; with a maximum time of 120 minutes and a minimum of 60 minutes. The hospitalization time in 100 % of the patients was 48 hours. Of the post-operative complications, it is established that 76.6% did not present any type of complication; 20 % presented seroma as the main complication and 3.3 % surgical site infection. Conclusion: due to its high frequency and its impact on work and social disability, inguinal hernias represent one of the most important surgical pathologies with low rates of postoperative complications and short hospital stay.

A Comparative Study between E-TEP vs IPOM Hernia Repair

Background: A ventral hernia is a hernia which can be occur at any location along the midline (vertical center) of the abdomen wall. It can be classified as spontaneous (primary) or acquired (secondary). Also, there are basically 3 types of ventral hernia and these are: Epigastric or stomach area hernia, Umbilical or belly button hernia and the Incisional hernia.Material & Methods:This was a prospective observational comparative study. The total sample size for this study 38 and among these 18 cases were from e-TEP and 20 cases were from IPOM. The study period was from December 2019- December 2021. The stratified sampling method was followed for this study as an eligibility criterion for age of the respondents was set for this study.Results:The presence of co-morbidities was found in both e-TEP and IPOM. High blood pressure was seen in 7(38.89%) cases in e-TEP and 8(40%) cases in IPOM and followed by stroke in 4(22.22%) and 5(25%), Hypothyroidism in 1(5.56%) and 1(5%), Cancer in 2(11.11%) and 2(10%), Diabetes in 4(22.225) and 4(20%). Location of Hernia in right 7(38.89%) and 8(40%) and in left side was 11(61.11%) and 12(60%). In assessing the condition of disease, it was found that ventral hernia was in 4(22.22%) and 5(25%), Umbilical hernia in 6(33.33%) and 6(30%), Epigastric hernia 8(44.44%) and 9(45%). The Mean and SD of Defect size of lesion 71.4�.1 and 76�.2.Conclusions:The above study showed that the e-TEP repair had shown promising results and was being widely accepted. It results less presence of co-morbidities and less complications when compared to IPOM repair.

Cirugía laparoscópica de la hernia inguinal en el Centro Nacional de Cirugía de Mínimo Acceso / Laparoscopic Surgery for Inguinal Hernia at the National Center for Minimal Access Surgery

Introducción: La hernia inguinal, es una de las enfermedades quirúrgicas que más polémicas ha provocado a través de la historia, existen disimiles clasificaciones e incontables técnicas para su reparación. Objetivo: Mostrar los resultados del tratamiento quirúrgico laparoscópico de la hernia inguinal en el Centro Nacional de Cirugía de Mínimo Acceso. Métodos: Se realizó un estudio retrospectivo y descriptivo de 737 pacientes intervenidos con el diagnóstico de hernia inguinal por cirugía laparoscópica en el Centro Nacional de Cirugía de Mínimo Acceso, en el período comprendido entre enero del 2011 hasta diciembre el 2018. Resultados: Se mostró la efectividad de las técnicas laparoscópicas, con un bajo índice de recidiva, de 1,4 por ciento, bajo índice de conversión, con 0,5 por ciento, la inguinodinia se presentó en 5 pacientes para un 0,5 por ciento y predominó el seroma entre las complicaciones postoperatorias. Conclusiones: La cirugía laparoscópica en la hernia inguinal es una opción segura y eficaz en el tratamiento de la enfermedad(AU)

Introduction: Inguinal hernia has been one of the most controversial surgical diseases throughout history. There are several classifications and countless techniques for inguinal hernia repair. Objective: To show the outcomes of laparoscopic surgical treatment of inguinal hernia at the National Center for Minimal Access Surgery. Methods: A retrospective and descriptive study was carried out of 737 patients with a diagnosis of inguinal hernia operated on by laparoscopic surgery, in the period from January 2011 to December 2018, at the National Center for Minimal Access Surgery. Results: The effectiveness of laparoscopic techniques was shown, with a low recurrence rate of 1.4 percent and a low conversion rate of 0.5 percent, while inguinodynia appeared in five patients, accounting for 0.5 percent, and postoperative seroma was a predominating complication. Conclusions: Laparoscopic surgery is a safe and effective treatment option for in inguinal hernia(AU)

Application of membrane anatomy theory in totally extraperitoneal inguinal hernia repair / 中华胃肠外科杂志

Trocar placement and camera-dissection in the midline is the most commonly applied method for total extraperitoneal inguinal hernia repair (TEP), for which the theory of membrane anatomy has guiding significance. We hereby applies the theories and concepts, such as "fascia lining", "multi-layer", "inter-fascial planes", "combined inter-fascial plane" and "plane transition", to elucidate the key steps of TEP, for instance, space creation, hernia sac dissection, mesh flattening. Camera-dissection is performed along the posterior sheath of the rectus abdominis. Firstly, the camera enters retro-rectus space locating between the rectus abdominis and the transversalis fascia (TF). There are inferior epigastric vessels and their branches in the retro-rectus space, thus over-dissection should be avoided. Secondly, the camera goes downward through the TF into the pre-peritoneal space. The pre-peritoneal space is divided into the parietal plane and visceral plane by pre-peritoneal fascia (PPF). Both bladder and spermatic cord components locate on the visceral plane. Dissection of the median area should be implemented on the parietal plane, namely "surgical space", to protect the bladder. The parietal plane is the "holy plane" of TEP. Dissection of the indirect hernia area should be implemented on the visceral plane, namely "anatomical space", to protect the spermatic cord components. The reduction of direct hernia could be understood as the easy separation of TF and PPF. The reduction of indirect hernia is relatively difficult separation of peritoneum and spermatic cord components. During the transition of parietal and visceral planes, PPF (especially the pre-peritoneal loop) should be dissected for complete parietalization, in order to flatten the mesh.

Evaluation of mesh fixation versus non-fixation in laparoscopic mesh hernioplasty in inguinal hernias

 Background: Laparoscopic inguinal hernia repair (LIHR) is usually done by two methods, which vary in approach to the preperitoneal space; transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP). This study aimed at comparing the effect of mesh fixation and non-fixation in terms of operative time, hospital stay, analgesic requirement, complications and cost analysis with respect to fixation device in LIHR.Methods: This prospective randomized comparative study included 60 patients of inguinal hernias admitted to the Department of Surgery at Rajendra Hospital, G.M.C, Patiala from July 2016 to September 2017 (duration of study was 15 months). Cases were divided into two groups by draw of lots with group A as mesh fixation (n=30) and group B as non-fixation (n=30).Results: The results were calculated with chi square test (p value). Results were found to be not significant in two groups in the terms of postoperative analgesia, complications i.e. (intraoperative, postoperative and long term) postoperative hospital stay and time to return for work. The cost of procedure was found to be very high in Group A and results were highly significant (p<0.001).Conclusion: LIHR repair without mesh fixation shows advantages over mesh fixation, which includes significant less cost of surgery, with comparable intraoperative, postoperative and long-term complications (with no increase in hernia recurrence), hospital stay and mean operative time. Hence, our study favours LIHR without mesh fixation a valuable alterative option.

Complicações referentes à correção videolaparoscópica de hérnia inguinal: um estudo comparativo entre as técnicas TEP e TAPP realizado em um hospital terciário / Complications related to inguinal hernia videolaparoscopic repair: a comparative study between TEP and TAPP techniques in a terciary hospital

Hérnias de parede abdominal estão entre as enfermidades mais comuns na prática cirúrgica. Atualmente, duas técnicas videolaparoscópicas são utilizadas: totalmente extraperitoneal (TEP) e transabdominal pré-peritoneal (TAPP). Este estudo busca descrever e comparar as características clínico-epidemiológicas dos pacientes submetidos a herniorrafia videolaparoscópica por essas técnicas Para tal, foram analisados prontuários de pacientes atendidos no serviço de cirurgia geral do Hospital Cruz Vermelha Brasileira - Curitiba, entre novembro de 2009 e dezembro de 2018. Trata-se de um estudo transversal analítico com coleta de dados retrospectiva. Os dados evidenciaram uma prevalência em homens, idade média de 50 anos e hérnia inguinal à direita. Quando comparadas, não houve associação entre frequência de complicações e técnica utilizada. Hérnias que acometem o lado esquerdo, tendem a recidivar com maior frequência. O estudo reforça a recomendação da literatura: a técnica preferencial deve ser escolhida conforme experiência do cirurgião.

Abdominal wall hernias are among the most common diseases in surgical practice. Currently, two videolaparoscopic techniques are used: totally extraperitoneal (TEP) and pre-peritoneal transabdominal (TAPP). This study aims to describe and quantify the clinical and epidemiological characteristics of patients submitted to videolaparoscopic herniorrhaphy by these techniques, in order to identify which is the preferred one. For that, charts from patients who underwent treatment in the general surgery service of the Brazilian Red Cross Hospital - Curitiba, during November 2009 and February 2018, were analyzed. This is a cross-sectional analytical study with retrospective data collection. The data showed a prevalence of men, mean age of 50 years and right inguinal hernia. When compared, there was no association between the frequency of complications and the technique used. Hernias that affect the left side tend to recur more frequently. The study reinforces the recommendation of the literature: the preferred technique should be chosen according to the experience of the surgeon.

Atención de pacientes con enfermedad herniaria de la región inguinocrural / Care of patients with hernia disease of the inguinocrural region

Este trabajo se realiza con el fin de unificar criterios y favorecer nuestra atención clínica quirúrgica actual en las acciones de salud de los cirujanos y así poder brindar una atención homogénea y de calidad, mediante la implementación de la educación de pacientes así como la prevención, identificando factores de riesgos y enfocado en la detección de diagnóstico temprano y oportuno, con el fin de evitar complicaciones y evolución inadecuada de la enfermedad.

Sub-lethal dose of Bacillus sphaericus suppresses vector competence of Anopheles dirus for Plasmodium yoelii by up-regulating the Imd signaling pathway

Objective: To investigate the effect of sublethal dose of Bacillus sphaericus (Bs) 2 362 strain on the malaria transmission ability of Anopheles (An.) dirus (Hainan strain) and its molecular mechanism. Methods: Firstly, the fourth instar larvae of An. dirus was treated with sublethal dose of Bacillus sphaericus. The surviving larvae were then collected and placed into mosquito cages, where they were hatched into adult mosquitoes. These mosquitoes were recorded as Bs group. Meanwhile, the control group was set without any treatment. Then, for infection with Plasmodium yoelii BY265 RFP, 3- to 5-day old female adults were kept at 24 °C and fed on Plasmodium yoelii BY265 RFP-infected Kunming mice with a gametocytemia above 0.5%. On day 9-11 post infection, mosquitoes were dissected, and the oocysts on the midguts were examined under a fluorescence microscope. Thirdly, total RNA was extracted from mosquitoes of Bs group and the control group at different time-points respectively, and the cDNA were synthesized later. Finally, SYBR quantitative PCR was conducted to investigate the expression of Imd pathway anti-malaria molecules at different time-points, including TEP1 and Rel2, in Bs and control group mosquitoes. Results: Bs treatment remarkably reduced the infection rate of Plasmodium from 23.71% (124/523) to 16.23% (87/536) (Chi-square test, P=0.002 0.05). Additionally, the intensities of melanized oocysts were compared between the two groups, and no significant difference was found, either (P=0.566>0.05). Interestingly, compared with the control group, the expression levels of TEP1 and Rel2 in Bs group were obviously up-regulated in larval, adult and infected mosquitoes. Especially in 3 dpi and 7 dpi, the expression level of TEP1 in Bs group was nearly 4 times higher than that of the control group, while Rel2 reached to approximately 7 times. Conclusions: We firstly found that the sublethal dose of Bs significantly suppressed the vector competence of An. dirus to malaria parasites, which revealed a new important role of Bs on the basis of killing mosquito larvae. Furthermore, the Imd signaling pathway might play an effective way in Bs impacting the vector competence of An. dirus through upregulating the expression of NF-kB transcription factor Rel2, enhancing the expression of TEP1, which killed the Plasmodium, but not through melanization.

A comprehensive study on complications of laparoscopic inguinal hernia repair

Background: Laparoscopic hernia repair has been in use for some time now and has been found to cause lesser postoperative pain and earlier recovery when compared with open methods of hernia repair although they are associated with higher costs and a steep learning curve. The various complications associated with laparoscopic hernia repair needs to be studied and compared with open methods. Aim: The aim of this study was to understand the intraoperative and postoperative complications of laparoscopic inguinal hernia repair and formulate methods to prevent them. Materials and methods: This is an observational study consisting of 50 patients who underwent laparoscopic inguinal hernia repair (TEP, TAPP) in our institution from September 2014 to March 2016. Intra operative and postoperative complications were documented. The following factors were considered: Type of hernia, Type of hernia vs complications, Operation time, Operation time vs complications, Post-operative hospital stay. Results: The mean operative time was 66.8 min. There were no major complications. There were 4 minor complications namely – surgical emphysema, groin pain, shoulder pain, scrotal pain. Surgical emphysema (21 patients, 42%) depends upon operation time. Groin pain (11 patients – 22% all are indirect) depends upon type of hernia mainly in indirect type, because of the dissection carried out for separating indirect sac. Shoulder pain (6 patients, 12%) is directly proportional to the time of surgery (all were >90 min) probably due to retention of CO2 which lead to diaphragmatic indentation. Scrotal edema (6 patients, 12%) depends upon the type of hernia as it occurred only in indirect hernias due to the dissection for indirect sac. All these minor complications subsided with supportive care without any surgical intervention. Mean postoperative hospital stay - 2.6 days. Laparoscopic hernia repair has a steep learning curve and time consuming initially T. Babu Antony, S. Krishna Bharath. A comprehensive study on complications of laparoscopic inguinal hernia repair. IAIM, 2017; 4(2): 6-10. Page 7 Conclusion: Laparoscopic hernia repair has a steep learning curve and fearsome complications but once mastered, it is a safe and effective technique with early postoperative recovery. In our study we encountered only minor complications all those complications were managed conservatively

Experiencia inicial en el tratamiento laparoscópico de la hernia inguinal en la ii cátedra de clínica quirúrgica, hospital de clínicas. FCM-UMA / Initial experience in laparoscopic inguinal hernioplasty in ii service of surgery, hospital de clinicas. FCM-UMA

Introducción: Las hernias inguinales representan el 75 % de todas las hernias de la pared abdominal, y con un riesgo de por vida de 27 % en hombres y 3 % en las mujeres. La reparación de estas hernias es uno de los procedimientos quirúrgicos más utilizados en el mundo. En la década de los 90, la progresiva evolución de la cirugía hacia técnicas mínimamente invasivas culmina con la aparición de la cirugía laparoscópica. Objetivo: describir nuestra experiencia en el tratamiento de las hernias inguinales por videolaparoscopia. Pacientes y métodos: Estudio observacional, descriptivo, retrospectivo, de corte transversal. Se presentan 25 casos de pacientes sometidos a el tratamiento de la hernia inguinal por el abordaje video laparoscópico (TEP-TAPP), en el periodo 2010-2015 Resultados: En este estudio tuvimos en el 100% de los casos pacientes de sexo masculino. El tiempo de evolución de la enfermedad en promedio fueron de 20 meses. Los diagnósticos pre operatorios fueron hernia inguinal izquierda no complicada en 8 pacientes, hernia inguinal derecha no complicada en 12 pacientes y hernia inguinal bilateral no complicada en 5 pacientes. Las técnicas empleadas fueron TEP (Totalmente extra peritoneal) en 5 pacientes y TAPP (Trans-Abdominal Pre-Peritoneal) en 20 pacientes. En todos los casos, el medio de fijación fue con tacker helicoidal de titanio. En promedio la estancia hospitalaria fue de 1,8 días. El tiempo quirúrgico, en promedio fue de 83 minutos. En cuanto a las complicaciones, hemos tenido 3 pacientes con complicaciones post quirúrgicas seroma, inguinodinia e infección del sitio quirúrgico. Conclusión: Actualmente, el tratamiento quirúrgico de la hernia inguinal tiene muy buenos resultados por vía laparoscopia, comparadas con las técnicas abiertas, faltando aun seguimiento de los pacientes en el tiempo para tener resultados concluyentes acerca de la eficacia de la técnica.

Introduction: Inguinal hernia are the 75% of the abdominal wall hernia, with a risk during all life of 27% in male gender and 3% in female. The treatment of this disease is one of the most common procedures in the world. At 90´s, the evolution of the minimal invasive approach ends with the laparoscopic surgery appearance. Objective: to describe our initial experience in the laparoscopic approach of inguinal hernia. Patients and method: An observational, retrospective study of 25 patients who underwent TAPP or TEP approach for hernia disease. Results: All of 25 patients were male gender. The average of disease evolution until surgery was 20 moths.Pre-ops diagnosis were: left inguinal hernia in 8 cases, right inguinal hernia in 12 cases and bilateral hernia in 5 cases. We performed TEP approach in 5 patients and 20 TAPP approach in 20 patients. The fixation was with titanium tackers in all cases. Average of discharge from hospital was 1,8 days. The surgical time average was 83 minutes. 3 patients had some morbidity, included: seroma, inguinodynia and surgical site infection Conclusion: Actually, the laparoscopic approach for the inguinal hernia treatment have very good results comparing to open approach, but we need more patients follow up to establish the efficacy of the technique.

Combined psychopharmacological and psychosocial approaches and the relevance of therapeutic jurisprudence and religion in the successful management of battered woman's syndrome: A case report

INTRODUCTION: Although Battered Woman Syndrome is not listed in the DSM 5 and the ICD 10 as an official diagnosis, it is undeniable that women suffering Intimate Partner Violence (IPV) experience the same cycle of violence, suffer from a common range of symptoms, and have a predictable prognosis. While psychosocial guidelines and support are available, like in our Women and Child Protection Units (WCPU), there is also a gap in the clinical guidelines in treating and managing these cases, which might present with a combination of posttraumatic and depressive symptomatology. In this report, we discuss the case of a 32 year old woman who was subjected to severe physical and emotional abuse by her longtime romantic partner. She consulted at our center seeking help for a psychiatric evaluation for the case she was going to pursue in court but it was apparent she was suffering from posttraumatic, somatic, and depressive symptoms. Supportive therapy was initially done and she was started on Escitalopram and low dose Quetiapine for sleep problems. As her case started gathering steam, issues about the court process, possible setback with her church and possible retaliation from her partner weighed heavily on her. Possible issues were discussed beforehand and successfully faced up to her partner in a church related tribunal and in the fiscal's office. Using an Eye Movement Desensitization and Reprocessing(EMDR) variant, Unfinished Trauma Episode Protocol (U-TEP), her posttraumatic symptoms were eventually addressed. As she started having faith in the legal system and her church, she had restored self-esteem, was active in her social circle and become an advocate in helping other women get proper treatment and to fight for their rights. Besides the clinician advocated treatment along with the services delivered via the WCPU network, the perception of getting justice from social institutions like the judiciary and the church helped in the recovery of this patient. Clinicians dealing with Battered Woman Syndrome should be aware of issues the patient might go through the stages of her fight and that the process of seeking for justice is also a process of mental healing.

Peces marinos de la Reserva Biológica Isla del Caño: Estructura de las comunidades de peces de arrecife y lista taxonómica actualizada de los peces costeros / Marine Fishes of Caño Island Biological Reserve: Reef fish community structure and updated list for the coastal fish

Resumen El presente trabajo tuvo como objetivos 1) Describir la estructura de la comunidad de peces de arrecife de la Isla del Caño y 2) Completar una lista de las especies de peces costeros registrados hasta el día de hoy. Para el primer objetivo, se realizaron 50 censos de cilindro en 10 lugares alrededor de la Isla del Caño, en los cuales se contabilizaron 79 especies pertenecientes a 32 familias. La familia más abundante fue Pomacentridae, y la especie más abundante fue Chromis atrilobata. Los peces planctívoros y carnívoros fueron los más abundantes. En los análisis realizados, destacó la existencia de una relación entre la cobertura coralina y la presencia de peces herbívoros ramoneadores. Adicionalmente, al comparar la composición de especies por sitio, se encontró que El Barco cuenta con una presencia abundante de pargos. Para el segundo objetivo, se recopilaron los registros publicados de especies para la Isla y se adicionaron 35 nuevos registros, para un total de 212 especies; lo cual representa aproximadamente 17% de la diversidad de peces costeros en el Pacífico Tropical Oriental. Este trabajo presenta una línea de base para el monitoreo de peces en esta área marina protegida.

Abstract Biogeographically, the Caño Island Biological Reserve (CIBR) is of strategic importance, since it is located in the center of the Panamic Province (Costa Rica and Panama), characterized by a peak in fish species richness within the Tropical Eastern Pacific (TEP). Despite its importance, fish community structure around the island has not been deeply studied, and coastal fish diversity records need to be updated. The aims of the study were: 1) to describe the community structure of the reef fish community of CIBR and 2) to update the list of the coastal fish species recorded until today. For the first objective, 50 stationary fish counts were conducted at 10 locations around Caño Island, in which 79 species, belonging to 32 families, were registered. The most abundant family was Pomacentridae, and the most abundant species was Chromis atrilobata. Planktivorous and carnivorous fish were the most abundant. The existence of a relationship between coral cover and the presence of herbivorous grazers was highlighted within the analysis. Additionally, species composition was compared by site and this revealed that "El Barco" has an abundant presence of snappers. For the second objective, published fish species records were collected for the CIBR and 35 new records were added, for a total of 212 coastal fish species, which represents approximately 17% of coastal fish diversity in the TEP. This work presents a baseline for fish monitoring and mangement measures in this marine protected area. Rev. Biol. Trop. 63 (Suppl. 1): 97-116. Epub 2015 April 01.

Laparoscopic Totally Extraperitoneal Hernia Repair after Radical Prostatectomy or Lower Abdominal Surgery Except for Appendectomy: Experience of 35 Cases

PURPOSE: Laparoscopic totally extraperitoneal (TEP) hernia repair is known to be relatively difficult in cases with a history of lower abdominal surgery. We assess the feasibility of laparoscopic TEP hernia repair in those patients. METHODS: Thirty five patients with a previous history of radical prostatectomy or lower abdominal surgery who underwent laparoscopic TEP hernia repair for inguinal hernia were reviewed retrospectively. All operations were performed by a single experienced surgeon. RESULTS: Thirty three out of the 35 patients (94%) were men. Laparoscopic TEP hernia repair was performed successfully in 30 out of 35 cases. Twenty five cases (71%) were right inguinal hernia, 6 cases (17%) were left hernias, and 4 cases (11%) had an inguinal hernia on both sides. Five cases were converted to transabdominal preperitoneal (TAPP) (n=3) or open methods (n=2). Mean operation time was 111 minutes. The patient group with previous radical prostatectomy was the largest (n=22, 63%) and required a longer operation time (124 minutes). Blood loss was less than 50 cc in all cases. Average hospital stay was 1.2 days after surgery. Voiding difficulties requiring catheterization were observed in 13 cases (37%). CONCLUSION: Laparoscopic TEP hernia repair for a patient with previous history of radical prostatectomy or lower abdominal surgery except for appendectomy can be safely performed by an experienced surgeon, but is not recommended as a standard choice because of a longer operation time and higher conversion rate.

The Learning Curve of the Beginner Surgeon with Supervisor for Laparoscopic Totally Extraperitoneal Repair

PURPOSE: Despite acceptance of laparoscopic totally extraperitoneal (TEP) repair for repair of inguinal hernia, it is still considered to require a prolonged learning curve. We hypothesized that there would be differences in the learning curve for laparoscopic TEP repair among beginner surgeons with or without a supervisor. The current study was conducted to observe the learning curve for laparoscopic TEP repair performed by a surgeon without a supervisor. METHODS: A retrospective analysis of the consecutive 143 patients was conducted to document patients' demographics, hernia types, operative time, and operative outcomes after the operation. Patients were divided into 7 consecutive groups, each comprising 20 patients. RESULTS: The mean age of the study population was 52.5 years (+/- 18.9 SD), ranging from 16 to 89 years. The learning curve of this technique was almost horizontal throughout the time course. The mean operative time was quite stable among each group. Comparison of the mean operation time and the length of hospital stay among each group did not show significant differences. There was one recurrence in group V. CONCLUSION: The learning curve for laparoscopic TEP repair is not that prolonged if there is an experienced specialized supervisor and opportunities to observe the entire procedure performed by the supervisor are available. It is not the laparoscopic instrument skills but the way the procedure is performed that is important for successful outcomes.

Mesh Encircling Total Extraperitoneal (TEP) Repair of Inguinal Hernia without a Fixation Material or Preformed Mesh: Overlay Closure of Slit Without Additional Mesh

PURPOSE: Mesh non-fixation in TEP is associated with lower cost and shorter operative time, and it is safe and recommended when performed by an experienced surgeon. In performance of TEP surgery using a non-fixation mesh, particularly by a non-experienced surgeon, prevention of mesh migration is an important issue for mesh application. The aim of this study was to report on a fixation method using a non-preformed mesh encircling a cord structure without the use of tacks, staples, or fibrin sealants in TEP surgery. METHODS: A total of 41 patients who had undergone mesh-encircling TEP without fixation from December 2008 (first case of surgery) to June 2012 were analyzed. RESULTS: The mean follow-up period was 23.2 months (12~35 months). Three patients complained of scrotal discomfort, and one patient complained of scrotal edema, but they were resolved with conservative management. There was no recurrence during the follow up period. CONCLUSION: The method of mesh-encircling TEP without fixation material and no additional mesh in which the slit of the mesh is wrapped around the cord structure using an overlay suture is a simple and safe technique without compromising recurrence or chronic pain.

THE ANALYSIS OF OPEN AND LAPAROSCOPIC TECHNIQUES FOR TENSION -FREE HERNIA REPAIR FOR PATIENTS WITH BILATERAL INGUINAL HERNIA / 现代医院

Objective To analyze the value of open tension -free hemiorrhaghy ( OTFH) and laparoscopic totally extraperitoneal prosthesis ( LTEP) repair in patients with bilateral inguinal hernia .Methods A retrospective method was used to compare the clinical data of 115 patients with bilateral hernias , of which 61 cases received LTEP and 54 cases underwent OTFH , from June 2011 to December 2013, in our hospital .Results The mean operative time of LTEP group (88.2 ±15.6 min) was longer than the OTFH group(75.7 ±21.6) min (p<0.05).The dura-tion of hospitalization in LTEP group(2.6 ±1.1) day was shorter than OTFH group(4.2 ±2.1) d (p<0.05).Hos-pitalization expense of LTEP group (12 012.0 ±2 325.2) yuan was higher than the OTFH group (9 291.3 ±2 010.1) yuan (p<0.05).The incision pain by VAS points was gradually decreased in 24 hours, 48 hours, 72 hours after op-eration, and LTEP group was significant lower than OTFH group in the same time point .In LTEP group 3 case had laceration of peritoneum but turn to no other prosthesis , and 2 cases had acute urinary retentions .11 acute urinary re-tentions occurred in OTFH group , and 2 cases had chronic pain in inguinal area and 1 cases of fat liquefaction .No recurrence was found during a follow -up period of 6 to 24 months in both of 2 groups .Conclusion Both LTEP and OTFH are safe and accessible techniques for patients with bilateral inguinal hernia .OTFH is feasible, and has short process and low cost which is suitable for primary hospitals to carry out .OTFH has the advantages of little trauma , faster postoperative recovery and less complications which is worth promoting in future .

Achieving the Preperitoneal Space in Totally Extraperitoneal Inguinal Hernia Repair: Dissection with or without a Balloon Dissector

PURPOSE: A balloon dissector is widely used to achieve the preperitoneal space in totally extraperitoneal (TEP) inguinal hernia repair. The aim of this study was to compare the operative results of TEP cases performed with (the balloon dissection group) or without (the plain dissection group) a balloon dissector. METHODS: A retrospective analysis was conducted with a consecutive series of inguinal hernia repairs performed by a single surgeon in OOO Hospital between April 2008 and April 2012. All 128 patients with full-length video recordings were included. The distribution of the operation method was altered during the study period, from dissection with a balloon dissector to without it. RESULTS: Of 128 cases, 57 belonged to the balloon dissection group and the other 71 belonged to the plain dissection group. The demographic features and clinical characteristics were similar in both groups. Mean operation time (57.7 vs. 45.6 min, p<0.001) and laparoscopic recording time (31.6 vs. 25.0 min, p=0.004) were significantly shorter in the plain dissection group without differences in the degree of bloodstaining and the frequency of peritoneal tearing. Postoperative complications did not differ between the two groups. CONCLUSION: Plain dissection may be a safe and feasible alternative method of achieving the preperitoneal space in TEP by an experienced surgeon.

Laparoscopic Inguinal Hernia Repair: A Review of 1,000 Cases

PURPOSE: We reviewed our data compiled prospectively for evaluation of post-operative complications and recurrence of laparoscopic inguinal hernia repair. METHODS: Among the 1000 patients (age, > or =20 years old) who were undergone laparoscopic inguinal hernia surgery from January 2007 to July 2011, the age, sex, location, hernia type, operation time, postoperative morbidity, and conversion of 992 patients were analyzed. RESULTS: Among 992 patients, 919 (92.6%) were male and the mean age was 54.2 years (range, 20~90). Operation times (m inutes) for unilateral and bilateral hernia were 40.0 and 53.4, respectively. Mean operation time (minutes) showed a decrease over time, as that for the first half of all cases was 43.5 and that for the second half was 39.7 (p<0.001). Seven cases of conversion (post-radical prostatectomy hernia=7) were recorded to TAPP (n=3) or IPOM (n=4) from TEP. Eleven cases of postoperative catheterization (1.1%), five cases of port site seroma (0.5%), one case of mesh removal due to infection, 24 cases of seroma/hematoma (2.4%), 26 cases of neuralgia (2.6%), and four cases of bleeding with a drop in hemoglobin of more than 3 mg% (0.4%) were also recorded. There were three cases of recurrence (0.35%) at the median follow-up of 46 months (range, 20 to 70 months). CONCLUSION: Laparoscopic inguinal hernia repair can be performed safely, with low rates of complication and recurrence. This technique achieves good results combined with the benefits of minimally invasive surgery. We should be cautious in order to avoid postoperative bleeding, especially in cases of TEP.

Synchronous Cholecystectomy and Totally Extraperitoneal (TEP) Herniorrhaphy Using an Umbilical Incision

Two or more procedures maybe combined into a single surgical event using an abdominal laparoscopic surgery technique. Synchronous operations can provide patients with the advantage of a single hospital stay, single anesthetic exposure and single recovery period. Cholecystectomy and totally extraperitoneal (TEP) herniorrhaphy should be performed in both extremities and in different spaces of the abdomen. As described in this report, laparoendoscopic single site surgery (LESS), synchronous cholecystectomy and TEP herniorrhaphy were successfully performed using an umbilical incision in a single surgical event.

The learning curve for laparoscopic totally extraperitoneal herniorrhaphy by moving average / 대한외과학회지

PURPOSE: Laparoscopic totally extraperitoneal (TEP) herniorrhaphy has been recognized as a treatment option for inguinal hernia. The objective of this study was to clarify the learning curve for laparoscopic TEP herniorrhaphy using the moving average method. METHODS: A total of 90 patients underwent laparoscopic TEP herniorrhaphy by a single surgeon between March 2009 and March 2011. We analyzed medical records including the demographic data, operating time, hospital stay, and postoperative complications. RESULTS: The mean operating time of the initial 30 cases (learning period group) was 66.3 minutes. After the initial 30 cases were performed, the time decreased to 52.8 minutes in the later 60 cases (experienced period group, P = 0.015). This represents the operating time becoming stabilized and then decreasing as the number of performed cases accumulates. Hospital stay was shorter and frequency of pain control, and complication rate were lower in the experienced period, however, there was no statistical significance. CONCLUSION: We suggest that number of patients needed for the learning curve for laparoscopic TEP herniorrhaphy should be 30 cases. The operating time for laparoscopic TEP herniorrhaphy stabilizes after 40 cases in moving average analysis.