Feasibility and safety of total extraperitoneal inguinal hernia repair after previous lower abdominal surgery: a case–control study

Abstract Aim Aim of this study is to compare long term results of efficacy, recurrence and quality of life in patients submitted to TAPP for inguinal hernia repair with standard Heavyweight or Selfgripping mesh. Material and Methods A prospective case control study was conducted at single third referral center. The study included adult patients submitted to TAPP, of both sex, with primary and recurrent, unilateral and bilateral inguinal hernia. Patients received non-fixated standard heavyweight meshes (HW) or PROGRIP self gripping mesh (PG), their data were entered in EuraHS platform and the EuraHS Quality of life (QOL) questionnaire was administered before and 1 year after surgery. Primary outcome of the study is to compare long term QOL before and after surgery in HW vs PG group. Secondary outcome is perioperative morbidity and 12 months recurrence assessed with PINQ questionnaire. Results Between 2016 and 2020, 100 patients of both sexes (10 female) were enrolled, 50 in HW group and 50 in PG group. The two groups were comparable preoperatively. After 12 months no cases of CPIP were observed and there wasn’t differences in QOL reported by patients, although in both groups there was an improvement of pain, movement limitations and esthetical discomfort after surgery. None recurrence and overall only 4 cases of complications (1 hematoma and 1 seroma for each group) were registered. Conclusions Selfgripping Mesh for laparoscopic hernia repair has produced results equal to standard of care meshes in term of recurrence rate, early morbidity and postoperative quality of life of patients.

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Performing total extraperitoneal inguinal hernia repair in patients with previous abdominal surgery is safe: an analysis of 1591 patients

British Journal of Surgery ◽

10.1093/bjs/znab202.037 ◽

2021 ◽

Vol 108 (Supplement_4) ◽

Author(s):

H Merker ◽

J Slieker ◽

S Soppe ◽

A Keerl ◽

A Nocito

Keyword(s):

Inguinal Hernia ◽

Abdominal Surgery ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Odds Ratio ◽

Univariate Analysis ◽

Significant Risk ◽

Increased Risk ◽

Total Extraperitoneal ◽

Operation Duration

Abstract Objective The safety of endoscopic total extraperitoneal inguinal hernia repair (TEP) in patients who previously underwent open lower abdominal surgery has been discussed for many years, since operative difficulties can be expected due to adhesions and scarring. Some research has been done in this area, most of which ask for further studies to be conducted. The aim of this study was to assess the safety and feasibility of TEP in patients with previous lower abdominal surgery (PLAS). Methods We retrospectively analysed all patients who underwent a TEP inguinal hernia repair at our institution between July 2012 and May 2018. Previous lower abdominal surgery (PLAS) was defined as any previous open surgery with scarring below the umbilicus. In case of scars outside the midline, these were defined as PLAS when on the same side as the operated inguinal hernia. A univariate analysis as well as logistic regression were performed to identify outcomes of surgery between patients with- and without PLAS. Results In total 1591 patients were included in the study. 274 patients had PLAS, corresponding to 17.2%. Comparing to patients without PLAS, the group with PLAS had a significant higher risk of increased operation duration (odds ratio 1.07, p-value 0.004), but no increased risk of conversion, or intra- or postoperative complications. The highest significant risk of increasing operation duration was found after aortoiliac surgery (OR 2.08), bladder surgery (OR 1.71) or prostate surgery (odds ratio 1.22). Conclusion Performing TEP inguinal hernia repair after lower abdominal surgery slightly increases the operation duration, however there is no negative effect on the length of stay and the complication- or conversion rate. Therefore, we consider TEP to be a feasible and safe operation technique also for patients who previously underwent open lower abdominal surgery.

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