Feasibility of laparoscopic inguinal hernia repair (TEP) in rural centre in India

Background: Inguinal hernia repair is one of the most frequently performed operations in general surgery worldwide. Routinely used gold standard Lichtenstein technique gives a long scar and more post-operative pain. TEP has demonstrated favourable short-term results, with regards to reduced postoperative stay, pain and earlier return to physical activity in comparison with open mesh repairs.Methods: This study was prospective observational study in which 75 patients were included for TEP repair and followed for the outcome measured as the time taken for operation, incidence of intra operative and post-operative complications, severity of pain at post-operative day 1, 1 week, 1 month and 6 months after operation, return to work and cost effectiveness of inguinal hernia repair.Results: We have enrolled the 75 patients from 16 to 80 years out of which 34 (45.3%) patients were from age group 50 to 70 years. 47 (62.7%) patients operated on right side and 58 (77.4%) were operated for indirect hernia. Mean time taken for TEP was 81.5 minutes with minimum of 45 minutes and maximum of 135 minutes. There was single most complications of Pneumoperitoneum in 24 (32.0%) which was benign and managed conservatively. Other complications include bleeding in 4 (5.3%) and vas injury in one (1.3%). the mean duration of time taken for return to work was 11 days. The mean cost of TEP was Rs. 5932 with minimum of Rs. 4327 and maximum of Rs. 7742.Conclusions: The laparoscopic (TEP) repair is well established surgery for primary hernia repair and the other open tension free Lichtenstein technique is still regarded as a gold standard for inguinal hernia repair. The laparoscopic hernia surgery attempting similar claims underwent controversies with conflicting results. Laparoscopic (TEP) inguinal hernia repair gives greater patient’s satisfaction and better cosmetic results than open (Lichtenstein) repair.

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Outcomes of an innovative training course in laparoscopic hernia repair

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2017.0094 ◽

2017 ◽

Vol 99 (8) ◽

pp. 614-616 ◽

Cited By ~ 1

Author(s):

D Light ◽

S Bawa ◽

P Gallagher ◽

L Horgan

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Ventral Hernia ◽

Inguinal Hernia Repair ◽

Ventral Hernia Repair ◽

Operative Time ◽

Laparoscopic Inguinal Hernia Repair ◽

Laparoscopic Ventral Hernia Repair ◽

Hernia Surgery ◽

The Mean

Introduction The Ethicon™ laparoscopic inguinal groin hernia training (LIGHT) course is an educational course based on three days of teaching on laparoscopic hernia surgery. The first day involves didactic lectures with tutorials. The second day involves practical cadaveric procedures in laparoscopic hernia surgery. The third day involves direct supervision by a consultant surgeon during laparoscopic hernia surgery on a real patient. We reviewed our outcomes for procedures performed on real patients on the final day of the course for early complications and outcomes. Methods A retrospective study was undertaken of patients who had laparoscopic hernia surgery as part of the LIGHT course from 2013 to 2015. A matched control cohort of patients who had elective laparoscopic hernia surgery over the study period was identified. These patients had their surgery performed by the same consultant general surgeons involved in delivering the course. All patients were followed up at 6 weeks postoperatively. Results A total of 60 patients had a laparoscopic inguinal hernia repair and 23 patients had a laparoscopic ventral hernia repair during the course. The mean operative time for laparoscopic inguinal hernia repair was 48 minutes for trainees (range 22–90 minutes) and 35 minutes for consultant surgeons (range 18–80 minutes). There were no intraoperative injuries or returns to theatre in either group. All the patients operated on during the course were successfully performed as daycase procedures. The mean operative time for laparoscopic ventral hernia repair was 64 minutes for trainees (range 40–120 minutes) and 51 minutes for consultant surgeons (range 30–130 minutes). Conclusions The outcomes of patients operated on during the LIGHT course are comparable to procedures performed by a consultant. Supervised operating by trainees is a safe and effective educational model in hernia surgery.

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Early outcomes of laparoscopy for totally extra - peritoneal (TEP) inguinal hernia repair at E Hospital

Vietnam Journal of Endolaparoscopic Surgery ◽

10.51199/vjsel.2019.2.3 ◽

2019 ◽

Vol 9 (2) ◽

Author(s):

Đức Anh Lương ◽

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Advanced Technique ◽

Mesh Placement ◽

Tep Repair ◽

Early Results ◽

Technical Issues ◽

Alternative Choice ◽

Laparoscopic Tep

Tóm tắt Đặt vấn đề: Phẫu thuật nội soi đi đường ngoài phúc mạc hoàn toàn đặt lưới để điều trị bệnh thoát vị bẹn (TVB) ở người lớn là một tiến bộ kỹ thuật đang được phát triển và áp dụng bổ sung cho các phương pháp khác, nhưng đây lại là phương pháp có nhiều thách thức về kỹ thuật nhất với các phẫu thuật viên. Tại Bệnh viện E từ tháng 5/2017 đến tháng 5/2019 có 35 ca được mổ theo phương pháp này. Mục tiêu nghiên cứu nhằm đánh giá kết quả sớm, một số kinh nghiệm về chỉ định và kỹ thuật mổ. Phương pháp nghiên cứu: Thiết kế nghiên cứu can thiệp, một nhóm, dạng quan sát mô tả tiến cứu, đánh giá kết quả trước và sau can thiệp. Kết quả: 35 bệnh nhân (BN) TVB gồm 2 nữ, 33 nam; tuổi TB 66,2±10,65 (41- 91); TVB 1 bên: 33 (94,3%), 2 bên: 2 (5,7%); TVB trực tiếp: 13 (37,1%), gián tiếp: 22 (62,9%); một ca có tiền sử mổ Bassini hai lần cùng bên và tái phát được mổ thành công. Hai ca thủng phúc mạc trong khi phẫu tích, khắc phục không phải chuyển TAPP. Thời gian mổ: 121,1±33,20 phút (90-190). Kết luận: Phương pháp khả thi an toàn thời gian nằm viện giảm, thẩm mỹ và ít đau, tuy nhiên có nhiều điểm cần lưu ý trong kỹ thuật cần nghiên cứu tiếp tục liên quan đến kết quả mổ như nhận định giải phẫu, phẫu tích, xử lý thủng khi thủng phúc mạc, cố định chắc chắn vật liệu vào khoang để che phủ lỗ thoát vị... Abstract Introduction: Laparoscopic totaly extraperitoneal inguinal hernia repair with placement of a mesh outside the peritoneum to repair inguinal hernia in adult patients is an advanced technique has been developing as alternative choice for surgeons. However, this method has is challenging in technical issues for surgeons. Over a 24-month period (May 2017 through May 2019), a total of 35 laparoscopic TEP inguinal hernia repairs were carried out. This paper aimed to evaluate the early results and discuss some important technical issues as well. Material and Methods: A prospective observational study, one group, evaluating results before and after intervention. Results: 35 patients including 2 females and 33 males with mean age of 66,2±10,65 years old (41- 91); unilateral inguinal hernia (IH): 33 patients (94,4%), bilateral IH: 2 patients (5,7%); direct IH: 13 patients (37,1%), indirect IH: 22 (62,9%); One patient underwent two times previously by Bassini procedure due to recurrence. Per-operative adverse events including: peritoneum laceration during dissection in 2 cases, overcome by repair peritoneum damaged without conversion into TAPP. Mean operative time: 121,1±33,20 min (90-190). Conclusion: Laparoscopic TEP IH repair with prolene mesh placement is a suitable treatment option for selected inguinal hernia patients. However, some technical issues should be considered such as accuracy recognization of endoscopic anatomy landmarks during dissecting inguinal canal elements and management of incident happened management for example peritoneum being lacerated, clearing the pre- peritoneal space for laying mesh, substantial fine fixation of mesh... may cause the outcomes. Keywords: Laparoscopy, Inguinal hernia, TEP repair.

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Laparoscopic total extraperitoneal (tep) repair of direct inguinal hernia using nonfixation of three-dimensional mesh: Long term follow up

Vietnam Journal of Endolaparoscopic Surgery ◽

10.51199/vjsel.2019.1.7 ◽

2019 ◽

Vol 9 (1) ◽

Author(s):

Đình Tuấn Dũng Phan ◽

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Three Dimensional ◽

Mesh Migration ◽

Direct Inguinal Hernia ◽

Tep Repair ◽

Total Extraperitoneal ◽

Laparoscopic Tep

Tóm tắt Đặt vấn đề: Đến nay, phẫu thuật nội soi trong điều trị bệnh lý thoát vị bẹn được thực hiện ngày càng nhiều trên lâm sàng, trong đó phẫu thuật nội soi hoàn toàn ngoài phúc mạc đã được sử dụng rộng rãi cùng một tấm lưới nhân tạo được cố định vào thành bụng trước. Tuy nhiên, sự cố định này là một trong những nguyên nhân chủ yếu gây ra tình trạng đau sau mổ và ngược lại sự di chuyển của tấm lưới nhân tạo phẳng chính là nguyên nhân gây ra tình trạng thoát vị tái phát. Việc sử dụng tấm lưới nhân tạo 3D (3DMAX Mesh/Bard-Davol) có thể tránh được những vấn đề này. Mục tiêu của đề tài nhằm đánh giá kết quả lâu dài của phương pháp phẫu thuật đặt tấm nhân tạo 3D ngoài phúc mạc qua ngã nội soi trong điều trị bệnh lý thoát vị bẹn trực tiếp. Phương pháp nghiên cứu: Phương pháp nghiên cứu mô tả tiến cứu được thực hiện trên các người bệnh được chẩn đoán thoát vị bẹn trực tiếp và được điều trị phẫu thuật nội soi hoàn toàn ngoài phúc mạc (TEP) đặt tấm nhân tạo 3D (3D-Max - Davol) từ tháng 6 năm 2010 đến tháng 12 năm 2018. Nghiên cứu đánh giá về các đặc điểm chung, đặc điểm phẫu thuật, biến chứng, thời gian nằm viện và đánh giá tái khám sau phẫu thuật sau 36 tháng. Kết quả: Có 62 người bệnh (tổng số 67 trường hợp thoát vị trực tiếp) đã được phẫu thuật bằng phương pháp đặt tấm nhân tạo 3D ngoài phúc mạc bằng nội soi. Độ tuổi trung bình 54,7 ± 13,1 tuổi (nhỏ nhất 41 tuổi, lớn nhất 81 tuổi). 91,9% là thoát vị bẹn một bên. Đặc điểm phẫu thuật: thủng phúc mạc trong quá trình phẫu thuật chiếm tỷ lệ 4,5%, không có trường hợp nào tổn thương các mạch máu lớn trong phẫu thuật. Thời gian phẫu thuật trung bình là 47,2±11,9 phút (35-95 phút) đối với thoát vị bẹn một bên và 81,4±18,9 phút (65-120 phút) đối với thoát vị bẹn hai bên. Tái khám sau mổ: 3/67 (4,5%) trường hợp còn cảm giác đau khi tái khám vào tháng thứ 3, không có trường hợp tụ dịch ở vết mổ, không có trường hợp tái phát nào được ghi nhận lúc tái khám vào ở vết mổ, không có trường hợp tái phát nào được ghi nhận lúc tái khám vào tháng thứ 36. Kết luận: Phẫu thuật nội soi hoàn toàn ngoài phúc mạc với tấm nhân tạo 3D trong điều trị thoát vị bẹn trực tiếp có tính an toàn và hiệu quả cao. Kỹ thuật này có thể được áp dụng rộng rãi và nên được xem như là tiêu chuẩn vàng trong điều trị bệnh lý thoát vị bẹn. Abstract Introduction: Laparoscopic inguinal hernia repair is frequently performed using the mechanical fixation of a flat polypropylene mesh. This procedure is associated with pain issue and mesh migration that may occur without fixation of flat prothesis. An anatomically contoured mesh 3D-Max (3DMAX Mesh/Bard-Davol, France) using no fixation would prevent these problems. The objective of this study is to evaluate the effectiveness and safety of laparoscopic totally extraperitoneal (TEP) for inguinal hernia repair with nonfixation of three-dimensional mesh. Material and Methods: A retrospective analysis of patients, admitted for direct inguinal hernia and operated by laparoscopic TEP with nonfixation of 3-D mesh, performed between June 2010 and December 2018. Data were collected regarding general characteristics, complications, length of hospital stay and the recurrence rates. Results: 62 patients with 67 direct hernias underwent laparoscopic (TEP) to repair hernia with an average age of 54.7±13,1 years (range 41 – 81 years); peritoneal injury was noticed during dissection in 4.5%, there was no injury of the inferior epigastric vessels during dissection. Average operative time of unilateral hernia was 47.2±11.9 minutes (range 35 – 95 minutes). All patients in this series were followed, pain in 4.5% at 3 months after operation. There were no recurrences at 36 months postoperative follow up. Conclusion: The laparoscopic (TEP) repair of inguinal hernia is safe and effective. It is considered as the gold standard technique in treatment of direct hernia. Keyword: Inguinal hernia – Laparoscopic TEP, hernioplasty – laparoscopy.

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LAPAROSCOPIC TOTAL EXTRAPERITONEAL (TEP) REPAIR OF INGUINAL HERNIA: A PROSPECTIVE CONTROLLED STUDY

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2012.3.2 ◽

2012 ◽

pp. 9-14

Author(s):

Dinh Tuan Dung Phan ◽

Nhu Hiep Pham ◽

Loc Le

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Groin Hernia ◽

Controlled Study ◽

Complication Rates ◽

Tep Repair ◽

Totally Extraperitoneal ◽

Inguinal Hernias ◽

Laparoscopic Tep

Objectives: Inguinal hernia is the most common hernia and inguinal hernia repair is the most frequently performed operation in gerenal surgery. Hernioplasty by laparoscopy was gradually the standard method for inguinal hernia repair all over the world. The objective of this study is to demonstrate the effectness and safeness of laparoscopic totally extraperitoneal (TEP) hernia repair. Materials and methods: A prospective analysis of patients, admitted for groin hernia and operated by laparoscopic TEP hernia repair, performed between June 2010 and December 2011. Data were collected regarding general characteristics, complication rates, length of hospital stay and the recurrence rate postoperative of this laparoscopic method. Results: 35 patients underwent laparoscopic totally extraperitoneal (TEP) hernia repair with an average age of 51.3±13.8 years (range 31 – 72 years); 5.7% of the inguinal hernias were operated bilaterally, peritoneal laceration was noticed during dissection in 14.3%, there was no injury of the inferior epigastric vessels during dissection. Unilateral hernia had an operative time of 66.52 ± 17.4 minutes (range 45 – 115 minutes) and bilateral hernia took 107.5 minutes (range 95 – 120 minutes). All of these patients in the study were controlled, 5.7% had seroma at the time 3 months postoperative, there were no recurrences during follow-up ranging from 3 – 18 months (average 9.6 months). Conclusions: The laparoscopic (TEP) repair of inguinal hernia is safe and effective. That laparoscopy method should be the gold standard technique in treatment for the repair of inguinal hernias. Keywords: groin hernia – TEP hernioplasty - laparoscopy

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STUDY OF PATTERNS OF PRESENTATION AND MANAGEMENT OF COMPLICATED INGUINAL HERNIAS

10.36106/ijsr/4029417 ◽

2020 ◽

pp. 1-2

Author(s):

Sarita Durge ◽

Mayur Bandawar

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Surgical Intervention ◽

Age Distribution ◽

Emergency Setting ◽

Indirect Inguinal Hernia ◽

Hernia Surgery ◽

Inguinal Hernia Surgery ◽

The Mean

Background There are a lot of advancement in techniques of elective inguinal hernia surgery, but progress for management of complicated inguinal hernia repair in emergency, fall behind. The aim of study was to know age distribution, pattern of presentation, to evaluate the outcome of various types of surgical procedure done for complicated inguinal hernia and their post-operative complications. Methods and Materials This retrospective study included 62 patients suffering from complicated inguinal hernia,and who underwent emergency surgery, from Jan-2016to Dec-2019. Results The mean of age of sampled patients was 53.88 + 14.23 years, with increased incidence in males.Right sided, indirect inguinal hernia was frequently involved.Commonest postoperative complication was wound infection.Tension free repair Lichenstein’s technique (Hernioplasty) was done in maximum cases. Conclusion Mesh repair (hernioplasty) is acceptable and safe option for inguinal hernia repair in emergency setting. Early hospitalization and timely surgical intervention are associated with better outcome.

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Airway management with I-gelTM for ambulatory laparoscopic inguinal hernia repair in children; a retrospective review of 230 cases

Anaesthesia, Pain & Intensive Care ◽

10.35975/apic.v24i5.1358 ◽

2020 ◽

Vol 24 (5) ◽

Author(s):

Carla Hipólito ◽

Vicente Vieira ◽

Virginia Antunes ◽

Petra Alves ◽

Adriana Rodrigues ◽

...

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Airway Management ◽

Inguinal Hernia Repair ◽

Neuromuscular Blockade ◽

Retrospective Review ◽

Laparoscopic Inguinal Hernia Repair ◽

Laparoscopic Inguinal Hernia ◽

Increased Risk ◽

The Mean

Background: Inguinal hernia is one of the most common conditions presented for surgical repair in children and laparoscopic approaches are increasingly performed. Previous studies have shown safety and efficacy in the use of supraglottic devices (SGD) as an alternative to tracheal intubation, which fits particularly well with outpatient anesthesia. Methodology: we conduct a retrospective observational study, collecting data from the electronic anesthetic form, from all patients aged 0 to 17 y who underwent ambulatory laparoscopic percutaneous internal ring suturing between February 2015 and August 2019, if I-gelTM was used to airway management. Results: We found 230 patients meeting the inclusion criteria. The mean age was 5.2 y old, mean weight 20.1 kg. All patients were ASA I (n=203) or ASA II (n=27). The mean surgery duration was 38 minutes. We found 4 respiratory adverse events, three bronchospasms, and one laryngospasm, managed in the operating room. Ninety percent of the surgeries were performed without neuromuscular blockade. Conclusion: I-gelTM was a safe, effective, and convenient alternative to airway management to laparoscopic inguinal hernia repair in the ambulatory setting. According to available literature, our practice did not represent an increased risk for the studied respiratory events. SGD obviates the need for neuromuscular blockade. Key words: I-gel; Supraglottic devices; Laparoscopy; Inguinal hernia repair; Pediatrics; Anesthesia, ambulatory Citation: Hipólito C, Vieira V, Antunes V, Alves P, Rodrigues A, Santos MJ. Airway management with I-gelTM for ambulatory laparoscopic inguinal hernia repair in children; a retrospective review of 230 cases. Anaesth. pain intensive care 2020;24(5): Received: 18 February 2020, Reviewed: 5 August, 6 September 2020, Accepted: 11 September 2020

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