Laparoscopic totally extraperitoneal inguinal hernia repair: twenty-seven serious complications after 4565 consecutive operations.

OBJECTIVE: To identify and assess the complications of laparoscopic inguinal hernia treatment with totally extraperitoneal mesh placement (TEP). METHODS: We included patients who had undergone the TEP procedure in a consecutive series of 4565 laparoscopic hernia repairs between January 2001 and January 2011. Inclusion criteria were diagnosis with symptomatic inguinal hernia, including recurrence after inguinal hernia repair and previous surgery in the lower abdomen and pelvis. All patients were 18 years of age or above. Patients with incarcerated hernia in emergency were excluded from the study. RESULTS: A total of 4565 hernias were included in the study. In the group, there were 27 severe complications (0.6%): 12 bleedings (0.25%), two bladder lesions (0.04%), five intestinal obstructions (0.11%), four intestinal perforations (0.09%) one injury to the iliac vein (0.02%), one femoral nerve injury (0.02%), two lesions of vas deferens (0.04%) and two deaths (0.02%) (pulmonary embolism, peritonitis). CONCLUSION: The rate of complications with the TEP procedure is low. Laparoscopic hernia repair technique is reproducible and reliable. In our experience, there are contraindications to the TEP procedure. TEP technique must be meticulous to avoid intraoperative complications (bipolar diathermy). Complications can occur even after the surgeon has gained substantial experience.

Herniorrafia inguinal laparoscópica totalmente extraperitoneal: vinte e sete complicações graves após 4565 operações consecutivas / Laparoscopic totally extraperitoneal inguinal hernia repair: twenty-seven serious complications after 4565 consecutive operations

OBJETIVO: identificar e avaliar as complicações do tratamento da hérnia inguinal com a colocação de tela totalmente extraperitoneal. MÉTODOS: Foram incluídos, em uma série consecutiva de 4565 reparos de hérnia laparoscópica, pacientes que haviam sido submetidos ao procedimento TEP entre janeiro de 2001 e janeiro de 2011. Os critérios de inclusão foram: diagnóstico com hérnia inguinal sintomática, incluindo recorrência após correção de hérnia inguinal e cirurgia prévia em abdômen inferior e pelve. Todos os pacientes > 18 anos de idade. Pacientes com hérnia encarcerada na urgência foram excluídos do estudo. RESULTADOS: Um total de 4565 hérnias foram incluídas no estudo. Ocorreram 27 complicações graves (0,6%): 12 hemorragias (0,25%), duas lesões da bexiga (0,04%), cinco oclusões (0,11%), quatro perfurações intestinais (0,09%), uma lesão da veia ilíaca (0,02%), uma lesão do nervo femoral (0,02%), duas lesões dos vasos deferentes (0,04%) e dois óbitos (0,02%) (embolia pulmonar, peritonite). CONCLUSÃO: A taxa de complicações com o procedimento TEP é baixa. Correção de hérnia laparoscópica é uma técnica reprodutível e confiável. Em nossa experiência, existem contraindicações para o procedimento de TEP. A técnica TEP deve ser minuciosa para evitar complicações intraoperatórias (diatermia bipolar). As complicações podem ocorrer mesmo após o cirurgião ter adquirido experiência substancial.

OBJECTIVE: To identify and assess the complications of laparoscopic inguinal hernia treatment with totally extraperitoneal mesh placement (TEP). METHODS: We included patients who had undergone the TEP procedure in a consecutive series of 4565 laparoscopic hernia repairs between January 2001 and January 2011. Inclusion criteria were diagnosis with symptomatic inguinal hernia, including recurrence after inguinal hernia repair and previous surgery in the lower abdomen and pelvis. All patients were 18 years of age or above. Patients with incarcerated hernia in emergency were excluded from the study. RESULTS: A total of 4565 hernias were included in the study. In the group, there were 27 severe complications (0.6%): 12 bleedings (0.25%), two bladder lesions (0.04%), five intestinal obstructions (0.11%), four intestinal perforations (0.09%) one injury to the iliac vein (0.02%), one femoral nerve injury (0.02%), two lesions of vas deferens (0.04%) and two deaths (0.02%) (pulmonary embolism, peritonitis). CONCLUSION: The rate of complications with the TEP procedure is low. Laparoscopic hernia repair technique is reproducible and reliable. In our experience, there are contraindications to the TEP procedure. TEP technique must be meticulous to avoid intraoperative complications (bipolar diathermy). Complications can occur even after the surgeon has gained substantial experience.

[Endoscopic therapy of benign colonic post-operative strictures: report on 27 cases]. / Le traitement endoscopique des sténoses coliques bénignes post-opératoires. A propos de 27 cas.

UNLABELLED: Benign postoperative anastomotic strictures are frequent. OBJECTIVES: To evaluate the results of endoscopic dilatations and to propose an alternative treatment to surgery. METHODS: Between 1994 and 2001, 27 patients (16 female, 11 male, median 70 years old) with colonic anastomotic strictures were treated with pneumatic or mechanical dilatation. Eleven patients (40.7%) had been operated on for colon carcinoma, 2 for colorectal adenoma and 14 (51.8%) for complicated diverticular disease. A left colectomy was performed in 12 patients and a sigmoid colectomy in 15. Anastomoses were stapled in 25 cases. RESULTS: Twenty one patients were symptomatic (78%). The median time to diagnosis after surgery was 3 months (range: 21 days-4 years). Dilatation was possible in 26 cases (96.3%). The total number of dilatation sessions was 51 and the median number of sessions by patient was 2 (range: 1-4). Only one session was done in 11 patients (40.7%). There was one case of bowel perforation (1.9%) with the guide wire. In 21 cases (77.7%), the patients were no longer symptomatic and failure was observed in 5 cases. Surgery was necessary for 3 patients, with stenosis recurrence in 1. Three patients were treated with a self expanding metal stent. CONCLUSION: Endoscopic dilatation is a simple and efficient method. Therefore, it might be considered as the first line approach for benign anastomotic strictures. Self expanding metal stent could be an alternative to surgery, in case of failure.