Totally extraperitoneal laparoscopic inguinal hernia repair is a safe option in patients with previous lower abdominal surgery.
ABSTRACT History of inguinal hernia repair changed over the decades from repair by tissue approximation to the insertion of synthetic mesh and the introduction of laparoscopic repair. Despite accounting for 15-20% of hernia operations worldwide, many surgeons considered previous lower abdominal surgery as a contraindication to performing totally extraperitoneal (TEP) repair.
The aim of this study was to assess the feasibility of TEP in primary and recurrent inguinal hernias in patients with previous lower abdominal surgery.
This study was a retrospective review of patients who underwent TEP inguinal hernia repair from January 2001 to July 2005. Variables studied included patient demographics, type of hernia, type of previous surgery, conversion to open repair, postoperative complications, and overnight admission.
One hundred eight patients (107 males, 1 female), with a median age of 55 years (range 87-24), underwent TEP repair. Ninety-four patients had primary inguinal hernias, and 13 patients had recurrent inguinal hernias. Seventeen patients had a previous lower abdominal surgery (13 primary and 4 recurrent inguinal hernias). There was 1 conversion to open repair and 1 case of postoperative bleeding that required an exploration-both in the group with no previous surgery. Postoperative complications were minimal. All cases were performed as day cases; however, patients with recurrent hernia stayed longer in the hospital than those with primary hernia (P = 0.006).
TEP repair is feasible in patients with previous lower abdominal surgery. TEP was planned as a day-case procedure; however, patients with recurrent hernias needed a planned admission, as an overnight stay was required.
- Journal of The Korean Surgical Society - J KOREAN SURG SOC. 01/2010; 78(6).
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ABSTRACT: The laparoscopic approach to repair of inguinal hernia has proven advantages over open repair. Repair of more technically challenging hernias, such as patients previously receiving prostatectomy, has been less studied and may not have these advantages. We aimed to compare safety, feasibility, and clinical outcomes for repairs in patients who previously underwent prostatectomy to control subjects. We undertook a case-control study using a prospectively collected database. From 2004, all patients were routinely offered totally extraperitoneal laparoscopic repair. All patients who had a history of previous prostatectomy were identified and compared to a matched control group. Both operative and follow-up data were analyzed. Of 987 patients undergoing surgery during this time period, 52 prostatectomy patients were identified (44 % open, 44 % robotic, 3 % laparoscopic) and matched to 102 control subjects. Accounting for bilateral repairs, 203 hernia repairs had been performed. Patients were well matched for age and American Society of Anesthesiologists score. Operative time was longer for prostatectomy patients (mean, 70 vs. 52 min, p < 0.0001); however, this reduced over time when comparing the first and second half prostatectomy patients (77 vs. 63 min, p = 0.144). Overall, there were no intraoperative or major postoperative complications and only one conversion (prostatectomy group). No significant differences were found for rates of minor postoperative complications, length of stay, or recurrence (n = 1, control group). No difference was observed for chronic pain, and all patients in each group reported satisfaction with surgery at contemporary follow-up. In experienced hands, totally extraperitoneal inguinal hernia repair for patients previously having undergone prostatectomy is safe and has equivalent outcomes to patients not having undergone prostatectomy, and is an option to open repair. Understandably, slightly longer operative times may be justified, given the benefits of early discharge and less postoperative pain after laparoscopic surgery.Surgical Endoscopy 07/2013; · 3.43 Impact Factor
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ABSTRACT: Laparoscopic total extraperitoneal (TEP) repair of inguinal hernia is technically challenging enough to build high barrier to entry. The purpose of this study was to identify clinical factors influencing technical difficulty with laparoscopic TEP according to learning period.Annals of surgical treatment and research. 10/2014; 87(4):203-8.