P114 ROBOTIC INGUINAL HERNIA REPAIR (RTAPP): ANATOMY LESSONS AND RESULTS OF A CASUISTIC OF 302 OPERATED HERNIAS

Abstract Aim The purpose of this study is to apply the resources of robotics to inguinal hernia repair (r-TAPP) and to investigate where specific optimizations to the surgical technique of can be achieved. Material and Methods The results of 302 consecutive r-TAPP surgeries performed over an 18-month period are presented. It is a cohort study without a control group. The study was approved by the ethics committee (Ref. No. 2019-02046). Decisions on interventions (suturing of the transverse fascia or fibrin glue sealing of the inguinal canal) and mesh size were made intraoperatively. Patients were followed up six weeks postoperatively. Results In every fourth patient, a femoral, obturator, or Spieghel hernia was diagnosed in addition to symptomatic inguinal hernia. Mesh fixation with absorbable suture at 4 points was matured. The operative time averaged 71 minutes for unilateral, 103 minutes for bilateral and 95 minutes for unilateral recurrent hernias. 48% of procedures were performed by residents. Seroma incidence decreased from 15.0% in the first period to 5.1% in the third study period. None of the patients experienced pain symptoms due to nerve lesion. The study provided new clarity about the blood supply patterns of the lipoma, the course of the genital branch and the constitution iliac fascia. Conclusions Suturing of the transversal fascia, fibrin glue sealing of the inguinal canal, and suture fixation of the mesh are steps who must be validated in future studies. Robotics provides optimal conditions for residents training, without learning curve on the patient and with predictable OR times. Postoperative seroma formation and complication rate of r-TAPP are low.

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Review of 1000 fibrin glue mesh fixation during endoscopic totally extraperitoneal (TEP) inguinal hernia repair

Surgical Endoscopy ◽

10.1007/s00464-016-4791-3 ◽

2016 ◽

Vol 30 (10) ◽

pp. 4544-4552 ◽

Cited By ~ 16

Author(s):

Christophe R. Berney ◽

Joseph Descallar

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Fibrin Glue ◽

Mesh Fixation ◽

Totally Extraperitoneal

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Fibrin glue versus staple mesh fixation in single-port laparoscopic totally extraperitoneal inguinal hernia repair: A propensity score-matched analysis

International Journal of Surgery ◽

10.1016/j.ijsu.2018.01.029 ◽

2018 ◽

Vol 53 ◽

pp. 32-37 ◽

Cited By ~ 1

Author(s):

Byung Jo Choi ◽

Won Jun Jeong ◽

Sang Chul Lee

Keyword(s):

Inguinal Hernia ◽

Propensity Score ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Fibrin Glue ◽

Single Port ◽

Mesh Fixation ◽

Totally Extraperitoneal

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Fibrin Glue Mesh Fixation (GMF) Vs Sutures Mesh Fixation (SMF) In Human Open Inguinal Hernia Repair (OIHR): Surgically and Histologically

International Journal of Surgery and Research ◽

10.19070/2379-156x-1700016 ◽

2017 ◽

pp. 75-81

Author(s):

Ghonimi WAM ◽

◽

Elhorbity MA ◽

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Fibrin Glue ◽

Mesh Fixation ◽

Open Inguinal Hernia Repair

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A comparative study of postoperative chronic pain after tension free inguinal hernia repair using absorbable versus non absorbable sutures for mesh fixation

International Surgery Journal ◽

10.18203/2349-2902.isj20181114 ◽

2018 ◽

Vol 5 (4) ◽

pp. 1378 ◽

Cited By ~ 1

Author(s):

Laxmi Narayan Meena ◽

Somendra Bansal ◽

Pradeep Verma ◽

Rohit Rai

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Groin Pain ◽

Mesh Fixation ◽

Absorbable Suture ◽

Tension Free ◽

Vas Score ◽

Absorbable Sutures ◽

Common Diagnosis

Background: Inguinal hernia is a one of common diagnosis which is frequently encountered in routine clinical practice. The Lichtenstein technique (tension free mesh repair) is currently the gold standard in open inguinal hernia repair. Currently chronic groin pain (Inguinodynia) is one of the common complications after hernia repair and it may affect quality of life and it has been reported in 16% to 62% of the patients.Methods: This prospective, randomized study was conducted in the department of general surgery in S.M.S. Medical College and attached group of hospitals, Jaipur from May 2014 to December 2015. All patients of 18-80 years old, who were admitted for elective inguinal hernia repair, were included for the study. Patients with bilateral, recurrent, irreducible or incarcerated hernia, pregnant patients and patients with co morbid conditions, were excluded from the study.Results: Mean age was 46.5 years in absorbable group and 45.4 years in non absorbable group. Male to female ratio was 142:13 in absorbable group and 143:12 in non absorbable group. Post operative pain was measured by VAS score. Mean postoperative pain (VAS score) was lower in absorbable sutures group as compared to non absorbable group at 3 months (0.92±0.879 vs. 1.23±1.2; p=0.013) and at 6 months (0.48±0.57 vs. 0.77±0.65; p≤0.001), which was significant.Conclusions: Patients with absorbable suture for mesh fixation has less groin pain as compared to non-absorbable suture in hernia repair during 6 months follow up period.

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P080 ROUTINE ELECTIVE ILIOHYPOGASTRIC NEURECTOMY IN LICHTENSTEIN INGUINAL HERNIA REPAIR

British Journal of Surgery ◽

10.1093/bjs/znab395.075 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Kryspin Mitura

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Groin Hernia ◽

Mesh Fixation ◽

Synthetic Mesh ◽

Control Group ◽

Effective Technique ◽

Open Inguinal Hernia Repair

Abstract Aim Chronic postherniorraphy pain occurs in 8-25% of patients undergoing groin hernioplasty with mesh insertion. The most common cause for inguinodynia is neuropathy resulting from nerve damage or entrapment during mesh fixation. With wide mesh insertion there is often a conflict between upper prosthesis margin and an iliohypogastric nerve. The aim of this study is to present a routine elective iliohypogastric neurectomy in Lichtenstein groin hernia repair for prevention of chronic inguinodynia. Material and Methods Between 2018 and 2020, 398 patients were admitted for open inguinal hernia repair. 218 patients underwent a Lichtenstein repair with transection of iliohypogastric nerve before implantation of 10x14 polypropylene mesh (IH group). In the control group of 180 patients all nerves were spared (C group). Follow-up was conducted on 1 POD,1 month, and 1 year after surgery. Results 1 month after a surgery a pain was reported in 24 (11%) patients in IH group (2.9% severe; 8.1% moderate; 89% no pain), and 48 (26.7%) patients in C group (3.9% severe; 22.8% moderate; 73.3% no pain). 1 year after a surgery a persistent pain was reported in 1 (0.4%) patient in IH group, and in 5 (2.8%) patients in C group. An incidence of inguinodynia was significantly lower after iliohypogastric neurectomy (0.5% vs. 2.8%; p < 0.001). Conclusions Routine neurectomy of iliohypogastric nerve appears to be an effective technique in chronic inguinodynia after open mech repair for inguinal hernias. Iliohypogastric nerve resection allows to place a flat synthetic mesh with wide coverage of myopectineal orifice with no need for additional mesh trimming.

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Morphological testicular changes following the experimental inguinal hernia repair modeling

Research n Practical Medicine Journal ◽

10.17709/2410-1893-2021-8-3-6 ◽

2021 ◽

Vol 8 (3) ◽

pp. 62-69

Author(s):

N. G. Kulchenko

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Polypropylene Mesh ◽

Inguinal Canal ◽

Morphological Changes ◽

Reproductive Age ◽

Control Group ◽

Tension Free ◽

Spermatogenic Epithelium

Purpose of the study. To evaluate morphological changes in the testes in experimental animals after tension-free inguinal hernia repair modeling.Materials and methods. The study included male rabbits, aged 120 days, weighing 3.8 ± 0.9 kg. All rabbits were divided into two groups depending on the type of operation: in the first group (n = 10) of animals, we made a model of tension-free inguinal hernia repair and used a polypropylene mesh; in the second group (n = 10) of animals, we left the structures of the inguinal canal intact. Morphological assessment of spermatogenesis was performed after 40 days. All morphometric measurements were carried out on strictly cross-sections of the convoluted seminal tubules.Results. In rabbits of group 1, the volume of the testicle was significantly three times less than in animals of group 2 (p < 0.05). In the animals of the first group, a significant deterioration in spermatogenesis was observed (p < 0.05). Histological examination of sections of the testes of these animals showed that hypoplasia of the spermatogenic epithelium was present in the convoluted seminal tubules, in 1/8 of the tubules there was subtotal aplasia of the spermatogenic epithelium, Sertoli-Cell-Only Syndrome was detected only in 2 %. Atrophy of the convoluted seminal tubules was not recorded at this period of observation. In the animals of the control group, almost 90 % of cases of spermatogenesis disorders were not detected.Conclusions. This experimental study on rabbits showed that after using a polypropylene mesh for inguinal canal plastic, inhibition of germ cell maturation occurs after 1.5 months. Therefore, in men of reproductive age, it is necessary to use polypropylene mesh implants with caution in terms of performing inguinal hernia repair.

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