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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.
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Inguinal hernia is a common surgical disease, and most patients need surgical treatment. In recent years, minimally invasive surgery based on laparoscopy has been popularized in hernia surgery. With the release of clinical guidelines, the progress of instruments and materials, the update of treatment concepts and anatomical knowledge, laparoscopic inguinal hernia repair, especially laparoscopic total extraperitoneal hernia repair (TEP), is developing towards a more accurate and minimally invasive direction. Based on literatures in recent years and combined with clinical practice, the authors explore the advances in clinical application of laparoscopic TEP.
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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)
Subject(s)
Humans , Postoperative Complications , Laparoscopy/methods , Hernia, Inguinal/diagnosis , Effectiveness , Epidemiology, Descriptive , Retrospective StudiesABSTRACT
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.
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Humans , Male , Abdominal Wall , Hernia, Inguinal/surgery , Herniorrhaphy , Laparoscopy , Peritoneum/surgery , Surgical MeshABSTRACT
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.
RESUMO Racional: Embora o acesso laparoscópico esteja se tornando o tratamento preferencial para a hérnia femoral, poucos são os estudos sobre esse importante assunto. Objetivo: Avaliar os resultados do acesso laparoscópico totalmente extraperitoneal no tratamento da hérnia femoral. Métodos: Os dados de 62 pacientes com hérnia femoral que foram submetidos a herniorrafia foram revisados retrospectivamente. O diagnóstico foi estabelecido por exames clínicos e/ou de imagem em 55 pacientes e por achados laparoscópicos em sete. Resultados: Havia 55 (88,7%) mulheres e 7 (11,3%) homens, com proporção feminino/masculino de 8: 1. A média de idade foi de 58,9±15,9 anos (22-92). A maioria (n=53, 85,5%) apresentava hérnia única e o restante (n=9, 14,5%) bilaterais, perfazendo um total de 71 hérnias femorais operadas. Operações prévias no abdome inferior foram registradas em 21 (33,9%) pacientes. A conversão para procedimento pré-peritoneal transabdominal laparoscópico foi realizada em quatro (6,5%). Herniorrafia aberta foi necessária em dois pacientes (3,2%), um com fístula enterocutânea espontânea na região da virilha (hérnia de Richter) e o outro com perfuração incidental do intestino delgado adjacente que ocorreu durante a dissecção do saco herniário. Não houve mortalidade. Conclusão: A hérnia femoral é incomum e pode estar associada a complicações potencialmente graves. A maioria das hérnias femorais pode ser tratada com sucesso através do acesso laparoscópico totalmente extraperitoneal, com baixas taxas de conversão e complicações.
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Humans , Male , Female , Adult , Aged , Laparoscopy , Hernia, Femoral/surgery , Hernia, Inguinal/surgery , Retrospective Studies , Treatment Outcome , Herniorrhaphy/adverse effects , Groin/surgery , Middle AgedABSTRACT
Background: Chronic groin pain (inguinodynia) following inguinal hernia repair is a significant, though under-reported problem. Mild pain lasting for a few days is common following mesh inguinal hernia repair. However, moderate to severe pain persisting more than 3 months after inguinal herniorrhaphy should be considered as pathological. The main aim of this study was to assess the incidence of inguinodynia in inguinal hernia repair patients at a tertiary centre.Methods: This non-randomized retrospective study was undertaken in the department of general surgery, SMIMER Hospital, Surat, Gujarat, India from August 2016 to July 2019. Total 940 patients were operated for inguinal hernia repair during this period. Out of these 940 patients, only 460 patients could be traced for clinical evaluation as Surat is an industrial city with very high percentage of migrant population and so only, they were included in the study.Results: In this study, total 460 patients were included, in which 310 patients were operated for open inguinal hernia repair and 150 patients were operated for laparoscopic hernia repair. Total 102 (22.17%) patients has developed inguinodynia out of 460 patients evaluated in this series. Incidence of inguinodynia is more in open inguinal hernia repair than laparoscopic inguinal hernia repair i.e., 24.83% versus 16.67%. Incidence of testicular complication in inguinodynia patients is more in open inguinal hernia repair and non in laparoscopic repair.Conclusions: Authors conclude that overall incidence of inguinodynia is 22.17% and incidence of inguinodynia is higher in open hernia repair in comparison to laparoscopic hernia repair (24.83% versus 16.67%). The incidence of mild inguinodynia is approximately eight times more common than severe inguinodynia.
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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.
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Objective:To investigate the feasibility and applicability of laparoscopic totally extraperitoneal (TEP) inguinal hernia repair by using one-point-suturing fixed soft mesh.Methods:90 male patients were retrospectively analyzed from Jan.2013 to Mar.2015,all of them were diagnosed with unilateral inguinal hernia and treated with TEP surgery.Among them,there were 55 patients with free of air bag and free of fixed TEP (free fixed group) and 35 patients with free of air bag and fixed by one-point-suturing TEP (one-point-suturing fixed group),all of patients were used by soft mesh.They were analyzed about their differences of postoperative pain,gastrointestinal function recovery time,the postoperative feeding time,the bedside movement time,the hospitalization time,and the incidence of postoperative complications.Results:Compared with the free fixed group,the operation time of the one-point-suturing fixed group was significantly shorter,the bedside movement time earlier,gastrointestinal function recovery time earlier,the postoperative feeding time earlier(P＜0.05),but the difference were not statistically significant in intraoperative blood loss,the postoperative pain,the hospitalization time,the incidence of postoperative seroma (P＞0.05),and therewere no recurrence in both groups.Conclusion:Compared with the free fixed TEP,the one-point-suturing fixed TEP has significantly shorter operation time,reduce the operation difficulty,and make the postoperative recovery faster,so it is safe,feasible and appropriate to application.
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Objective To investigate the effect of laparoscopic totally extraperitoneal (TEP) on sexual function in young and middle-aged patients with inguinal hernia. Methods 147 male with inguinal hernia treated by TEP from January 2014 to Feberary 2016 were included in the observation group, while 133 male with inguinal hernia treated by laparoscopic transabdominal preperitoneal (TAPP) during the same time were included in the control group. The effect of surgery and changes on sexual function between the two groups were retrospective analyzed and compared. Results The operative time, length of hospital stay, time of postoperative pain and in the observation group shorter than in the control group. The differences between the two groups were statistically significant (P < 0.05). The level of seminal alpha glucosidase, fructose contents and acid phosphatase in the observation group were higher than in the control group at 12 months after surgery. The differences between the two groups were statistically significant (P < 0.05). There were a small number of complications in both groups. After symptomatic treatment, all complications were cured. The ratio of complications and recurrences of the two groups have no significantly differences (P > 0.05). Conclusion Compared with laparoscopic TAPP, laparoscopic TEP can shorten the time of postoperative recovery, and will not increase the complications and recurrences. It is good for recovery of semen quality. It is worthy of attention.
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Background: The occurrence of groin hernias is so common that the overall lifetime risk of developing one is 15% in male and about 5% in female. The most significant advances to impact inguinal hernia repair have been the addition of prosthetic materials to conventional repair and the introduction of laparoscopy to general surgical procedures. Materials and Methods: A total of 100 consecutive consenting cases who presented with a primary diagnosis of uncomplicated inguinal hernia to the Department of General Surgery at Father Muller Medical College Hospital from the period December 2013 to January 2016. Following a detailed history and clinical diagnosis a provisional diagnosis was made and the investigations. The following details regarding the patient were collected age of the patient, symptoms, and their duration, treatment given, complications if any, duration of hospital stay, and duration of return to work. Results: In our study, the mean age was 47.43 years and the most common age group when hernia occurred was 35-54 years with 54% of the cases. 97% were males and 3% females. Swelling was the most common presenting. Most hernias 43% occurred on the right side, followed by 18% on the left and 39% had bilateral involvement. The duration of surgery in the totally extraperitoneal (TEP) group the mean duration was 47.60 min the transabdominal preperitoneal (TAPP) group the mean duration was 48.90 min. The only post-operative complication occurred in our study was urinary retention. Conclusion: There is statistically significant difference between the two groups, namely, TEP and TAPP with respect to the duration of surgery and resuming routine activity postoperatively. The only finding of significance is the post-operative complication was urinary retention; this is not a major one, and this contributed an increase in the post-operative hospital stay being increased in the TEP group than the TAPP group with a two-tailed P = 0.
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Objective To summarize the clinical experience of laparoscopic total extraperitoneal hernia repair (TEP) combined with varicocele ligation for treating inguinal hernia combining with varicocele (VC).Methods Clinical data of 22 patients of inguinal hernia complicated with varicocele from April 2011 to April 2016 was retrospectively analyzed. All the patients were treated by TEP combined with high ligation of spermatic vein. Then monitor and analyzed clinical indexes intra- and postoperatively.Results The mean operation time was (55.0 ± 9.0) min, mean intraoperative blood loss was (5.5 ± 2.8) ml, all patients can eat after anesthesia recovery and off-bed after staying in bed for 24 hours; all patients don’t need postoperative analgesia; only 1 case suffered seroma postoperative; the average hospitalization time was (4.7 ± 0.9) days; postoperative follow-up of 1 to 5 year without recurrence.Conclusion The surgical effect of TEP combined with varicocele ligation is confirmed with less invasive, faster postoperative recovery and achieving an obvious social and economical effect, it is worthy of deserving further clinical application.
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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 .
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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.
Subject(s)
Humans , Cicatrix , Follow-Up Studies , Hernia , Hernia, Inguinal , Herniorrhaphy , Patient Satisfaction , Recurrence , Seroma , Skin , Urinary Retention , Wounds and InjuriesABSTRACT
Objective To investigate the feasibility and applicability of free airbags,free fixed totally extraperitoneal laparoscopic inguinal hernia repair (TEP) treatment of inguinal hernia.Methods In Baotou Medical College,Department of General Surgery,the First Affiliated Hospital,the 40 cases of patients confirmed with inguinal hernia surgery were choosed from Jan.2010 to Dec.2012 as the observed object,depending on the surgical methods.Divided the cases into the TEP group and the open surgery group to observe statistics including postoperative pain,extent of gastrointestinal function recovery time,the time of bedside movement,the number of days of hospitalization,the incidence of postoperative complications,hospital fees indicators.Results The operation time of TEP group was about 20 minutes longer than the open group and the difference was statistically significant (P ＜ 0.05).Compared with the open group,TEP group' s postoperative pain was milder,postoperative feeding time,the time of bedside movement and postoperative exhaust time were earlier,hospital stays were shoter,incidence of postoperative complications was lower,the differences were statistically significant (P ＜ 0.05).The difference was not statistically significant in hospital costs(P ＞ 0.05).Conclusion TEP inguinal hernia greater advantages compared with traditional open surgery,may be appropriate to carry out in my area.
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PURPOSE: Laparoscopic hernioplasty is a standard procedure used for the repair of inguinal hernia. However, due to the technical and anatomical complexities associated with this treatment and the requirement for long surgery time as compared to other methods, the use of laparoscopic hernioplasty remains questionable. This study compared the results of two surgical repair methods: totally extraperitoneal (TEP) hernia repair and the Prolene hernia system (PHS). METHODS: A retrospective review was conducted of all patients who underwent TEP (154 cases) and PHS (126 cases) from January 2008 to December 2010 as performed by a surgeon at our hospital. Operating time, length of hospital stay, recurrence rate, surgical site infection rate, wound hematoma rate and scrotum swelling rate were all compared. RESULTS: For the TEP treatment cases the mean operating time was 59.5 min, mean hospital stay was 4.9 days, there were 2 cases (1.3%) of recurrence, one case (0.6%) of surgical site infection, 20 cases (12.9%) of wound hematoma and 8 cases (5.2%) of scrotum swelling. In the case including treatment by PHS the mean operating time was 39.6 min, mean hospital stay was 5.4 days, there were no cases of recurrence, there were 2 cases (1.7%) of surgical site infection, 11 cases (9.5%) of wound hematoma and 12 cases (10.3%) of scrotum swelling. There were no cases involving neurogenic pain or chronic pain. CONCLUSION: Both PHS and TEP are safe and effective procedures for repairing inguinal hernia. Thus, with consideration of variable patient conditions and other factors, either PHS or TEP are recommended as viable procedures for treating inguinal hernia.
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Humans , Hematoma , Hernia , Hernia, Inguinal , Herniorrhaphy , Hydrogen-Ion Concentration , Length of Stay , Polypropylenes , Pyrazines , Recurrence , Retrospective Studies , ScrotumABSTRACT
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.
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Humans , Male , Abdominal Wall , Chronic Pain , Follow-Up Studies , Groin , Hernia , Hernia, Inguinal , Herniorrhaphy , Incidence , Interviews as Topic , Laparoscopy , Physical Examination , Pyrazines , RecurrenceABSTRACT
PURPOSE: Recently, laparoscopic totally extraperitoneal (TEP) inguinal hernia repair has established itself as a safe and effective treatment for inguinal hernia. Nevertheless, there are difficulties in learning the technique. In particular, patients with a medical history of having undergone lower abdominal surgery are generally excluded from laparoscopic hernia repair due to the technical difficulty of the procedure. This study evaluated the early surgical outcome and examined the feasibility of techniques for laparoscopic TEP inguinal hernia repair in patients who had previously undergone lower abdominal surgery. METHODS: Ten cases of laparoscopic TEP inguinal hernia repair in patients with a prior history of lower abdominal surgery between November 2006 and January 2010 were reviewed. All cases were treated by a single highly experienced laparoscopic surgeon. RESULTS: Previous operations included 5 cases of radical prostatectomies for prostate cancer, 2 cases of open suprapubic prostatectomies for benign prostate hypertrophy, 2 cases of radical cystectomies for bladder cancer and 1 case of laparoscopic low anterior resection for rectal cancer. In all 10 cases, the patients were male with 9 cases involving an indirect hernia and 1 case involving a direct hernia. The mean operation time was 136.5+/-33.7 minutes, and in 1 case, the surgical method was converted to the transabdominal preperitoneal approach. Postoperatively, there were 3 cases of urinary retention, and the administration of analgesics were required 1.0+/-0.6 times on average. The mean length of hospitalization was 1.2+/-0.8 days. During the mean 18 month (1~36 months) follow-up period, there was no recurrence and chronic pain but 1 case of mesh infection was encountered 6 months after TEP repair. CONCLUSION: Although the laparoscopic TEP inguinal hernia repair can be carried out safely on patients with previous lower abdominal surgery, it needs to be carried out by fully trained surgeons with sufficient experience in the TEP technique. Nevertheless, more extensive experience and a longer follow-up period will be needed to evaluate the feasibility and efficiency of the TEP approach.
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Humans , Male , Analgesics , Chronic Pain , Cystectomy , Follow-Up Studies , Hernia , Hernia, Inguinal , Herniorrhaphy , Hospitalization , Hypertrophy , Laparoscopy , Learning , Prostate , Prostatectomy , Prostatic Neoplasms , Pyrazines , Rectal Neoplasms , Recurrence , Urinary Bladder Neoplasms , Urinary RetentionABSTRACT
PURPOSE: Laparoscopic totally extraperitoneal herniorrhaphy (TEP) was developed as an alternative treatment of inguinal hernias to open hernia repair. This study evaluated 92 cases of laparoscopic surgery to determine the effectiveness and safety of laparoscopic TEP. METHODS: Laparoscopic TEP was performed on 92 patients with inguinal hernias from January 2008 to December 2010. Through a retrospective study of these patients, information om TEP repair was collected including the patients' characteristics, operation time, hospital stay, analgesic use and related complications. RESULTS: Laparoscopic herniorrhaphy were performed on a total of 92 patients (85 men and 7 women, age ranging from 16 to 83 years, with a mean of 56 years). The mean operation time for a unilateral inguinal hernia and bilateral inguinal hernia was 58.7 and 84.2 min, respectively. The mean postoperative hospital stay was 4.0 days (range, 2~9 days). Thirty nine patients were discharged without an analgesic injection, whereas 36 patients were injected with analgesic on the day of surgery. Of these 92 procedures, 10 complications were recorded; one granuloma complication, two patients with operation site discomfort, five with urinary retention issues, one patient with a scrotal seroma, and one patient with scrotal edema. CONCLUSION: TEP repairs have minimal morbidity and are more effective with less pain than the open procedure. TEP repair can be considered a favorable procedure for patients who request minimally invasive procedures for inguinal hernia repairs.
Subject(s)
Female , Humans , Male , Granuloma , Hernia , Hernia, Inguinal , Herniorrhaphy , Laparoscopy , Length of Stay , Pyrazines , Retrospective Studies , Seroma , Urinary RetentionABSTRACT
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.
Subject(s)
Humans , Analgesics , Cosmetics , Demography , Follow-Up Studies , Hernia , Hernia, Inguinal , Laparoscopy , Length of Stay , Pain, Postoperative , Prospective Studies , Pyrazines , Seroma , Urinary Retention , Wound InfectionABSTRACT
PURPOSE: The aims of this study were to evaluate the efficacy of laparoscopic totally extraperitoneal (TEP) repair of femoral hernia. METHODS: Eight patients who underwent laparoscopic TEP repair for femoral hernia between 2008 and 2010 were reviewed retrospectively. In total, 256 adult patients underwent inguinal or femoral hernia repair; TEP was performed in 224 patients. The preoperative diagnosis, clinical symptom, operative finding, postoperative complications, chronic pain, and recurrence were analyzed. RESULTS: The incidence of femoral hernia was 8 (3.1%) in the present study. The female to male ratio was 3:1 (6 females and 2 males). Seven patients were preoperatively misdiagnosed with inguinal hernia using ultrasonography. Computed tomography (CT) was performed in three patients, and femoral hernia was diagnosed in two patients. Two patients had synchronous femoral hernia with direct or indirect inguinal hernia. One patient has previously undergone ipsilateral inguinal hernia repair. In all patients, the hernia sac was irreducible by gas insufflation. Seven patients had lipoma-like soft tissue in hernia sac. Peritoneal tears developed in three patients. There was one postoperative complication: chronic discomfort due to seroma. There was no recurrence during median 6.5 months (range 2~26). CONCLUSION: Laparoscopic TEP repair is safe and effective therapeutic option for repair of femoral hernia. CT images are the most valuable type for the evaluation of the femoral hernia.