A new approach in laparoscopic repair of inguinal and femoral hernias

The aim of this study to analyze results of a new method which eliminates complications associated with the classic mesh fixation areas and does not increase recurrence rates. This prospective study included a total of 70 patients applied with inguinal or femoral hernia repair with the laparoscopic TEP method. The patients were randomly separated into two groups as Group 1 applied with tack fixation and Group 2 applied with plug mesh and subcutaneous vicryl fixation. The groups were followed up and compared. The group applied with the newly-developed repair technique of plug mesh and vicryl fixation were observed to have a shorter length of stay in hospital, a lower requirement for postoperative analgesia, and reduced urinary retention and seroma rates. No difference was determined between the two groups in respect of operating time and return to normal activities. In the 24-month follow-up period, there was no significant difference in respect of hernia recurrence. The results of the study showed that the use of the newly-developed repair technique of plug mesh and vicryl fixation in laparoscopic TEP inguinal hernia repair increased the life quality after surgery. There are also cost advantages. This is a technique that can be selected for suitable patients.

PDF

___

Dulucq JL. Treatment of inguinal hernia by insertion of a subperitoneal patch under pre-peritoneoscopy. Chirurgie. 1992;118:83-5.

Büyükaşık K. A new method for the video laparoscopic repair of femoroinguinal hernias (Sakman Procedure). Thesis, Istanbul, 1996.

Chowbey PK, Bandyopadhyay SK, Sharma A, et al. Recurrent hernia following endoscopic total extraperitoneal repair. J Laparoendosc Adv Surg Tech A. 2003;13:21-5.

Lau H, Patil NG. Acut pain fallowing endoscopic totally extraperitoneal (TEP) inguinal hernioplasty: multivariate analysis of predictive factors. Surg Endosc. 2004;18:92-6.

Schwab R, Schumacher O, Junge K. et al. Biomechanical analyses of mesh fixation in TAPP and TEP hernia repair. Surg Endosc. 2008;22:731-8.

Deans GT, Wilson MS, Royston CM, et al. Recurrent inguinal hernia after laparoscopic repair: possible cause and prevention. Br J Surg. 1995;82:539-41.

Beattie GC, Rumar S, Nixon SJ. Laparoscopic total extraperitoneal hernia repair: mesh fixation is unnecessary. J Laparoendosc Adv Surg. 2000;10:71-3.

Poobalan AS, Bruce J, Smith WC, et al. A review of chronic pain after inguinal herniorrhaphy. Clin J Pain. 2003;19:48-54.

Kaul A, Hutfless S, Le H, et al. Staple versus fibrin gluefixation in laparoscopic total extraperitoneal repair of inguinal hernia: a systematic review and meta-analysis. Surg Endosc. 2012;26:126978.

Schwab R, Willms A, Kroger A, et al. Less chronic pain following mesh fixation using a fibrin sealant in TEP inguinal hernia repair. Hernia. 2006;10:272-7.

Khajanchee YS, Urbach DR, Swanstrom LL, et al. Outcomes of laparoscopic herniorrhaphy without fixation of mesh to the abdominal wall. Surg Endosc. 2001;15:1102-7. 1

Li JW, Zheng MH, Li HQ, et al. A randomized controlled clinical trial comparing stapling with non-stapling of mesh in laparoscopic total extraperitoneal inguinal hernioplasty. Chin J Gen Surg. 2007;22:4402.

Dehal A, Woodward B, Johna S, et al. Bilateral laparoscopic totally extraperitoneal repair without mesh fixation. JSLS. 2014;18:e2014.00297.

Christoffersen MW, Brandt E, Helgstrand F, et al. Recurrence rate after absorbable tack fixation of mesh in laparoscopic incisional hernia repair. Br J Surg. 2015;102:541-7.

Schwab R, Schumacher O, Junge K, et al. Biomechanical analyses of mesh fixation in TAPP and TEP hernia repair. Surg Endosc. 2008;22:731-8.

Lau H, Patil NG. Selective non-stapling of mesh during unilateral endoscopic total extraperitoneal inguinal hernioplasty: a casecontrol study. Arch Surg. 2003;138:1352-5.

Taylor C, Layani L, Liew V, et al. Laparoscopic inguinal hernia repair without mesh fixation, early results of a large randomized clinical trial. Surg Endosc. 2008;22:757-62.

Koch CA, Grinberg GG, Farley DR. Incidence and risk factors for urinary retention after endoscopic hernia repair. Am J Surg. 2006;191:381-5.

Ismail M, Garg P. Laparoscopic inguinal total extraperitoneal hernia repair under spinal anesthesia without mesh fixation in 1220 hernia repairs. Hernia. 2008;13:115-9.

Mulroy MF. Hernia surgery, anesthetic technique, and urinary retention-apples, oranges, and kumquats? Reg Anesth Pain Med. 2002;27:587-9.

Lau H. Fibrin sealant versus mechanical stapling for mesh fixation during endoscopic extraperitoneal inguinal hernioplasty: a randomized prospective trial. Ann Surg. 2005;242:670-5.

Ferzli GS, Frezza EE, Pecoraro AM Jr, et al. Prospective randomized study of stapled versus unstapled mesh in a laparoscopic preperitoneal inguinal hernia repair. J Am Coll Surg. 1999;188:461-5.