Prospective comparative study of laparoscopic totally extraperitoneal versus Lichtenstein’s tension free open meshplasty for management of inguinal hernia

Background: Since the advent of minimal access surgery, its application has been widespread starting from appendectomy to complex intestinal surgeries carried out laparoscopically. But hernia surgery is a major debatable section, to compare it with the commonly performed gold standard Lichtenstein repair. First laparoscopic transabdominal preperitoneal and then totally extra peritoneal (TEP) repair came into existence. In today’s era of extended TEP repair laparoscopic TEP repair has emerged to be gold standard.Methods: This is a prospective cohort study including 40 cases of Lichtenstein open meshplasty, against minimally invasive laparoscopic TEP procedure were compared. Patients operated in our department between January 2010 and September 2010 were included after consent and assessment. Procedures were carried out according to standard guidelines, and results compared for technical details, cosmesis, intra or post-operative complications, analgesia requirement, hospital stay, recovery and follow up and all results were analyzed.Results: Operative time was less by 2 minutes, hospital stay less by 1 day, return to work earlier by nearly 20 days for strenuous work, analgesia requirement less for laparoscopic extra peritoneal repair.Conclusions: Study showed that if the period of learning curve has been eliminated than an experienced surgeon performs laparoscopic procedure with better patient satisfaction, less hospital stay, faster recovery and earlier return to work with less operative time, analgesic consumption, and complication.

Download Full-text

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

International Surgery Journal ◽

10.18203/2349-2902.isj20172793 ◽

2017 ◽

Vol 4 (7) ◽

pp. 2336

Author(s):

Prashant Sawarkar ◽

Ranjana Zade ◽

Suchine Dhamanaskar ◽

Bhupendra Gathe ◽

Pradip Sawardekar ◽

...

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Return To Work ◽

Inguinal Hernia Repair ◽

Gold Standard ◽

Lichtenstein Technique ◽

Hernia Surgery ◽

Tep Repair ◽

The Mean ◽

Laparoscopic Tep

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.

Download Full-text

Pre-peritonial Repair for Recurrent Inguinal Hernia after Tension free Hernioplasty

Medical Journal of Pokhara Academy of Health Sciences ◽

10.3126/mjpahs.v2i3.26106 ◽

2019 ◽

Vol 2 (3) ◽

pp. 126-129

Author(s):

Suresh Raj Poudel ◽

Narendra Vikram Gurung ◽

Dhruba Bahadur Adhikari ◽

Arjun Acharya ◽

Santosh Shrestha ◽

...

Keyword(s):

Inguinal Hernia ◽

Return To Work ◽

Hospital Stay ◽

Operative Time ◽

Operating Time ◽

Recurrent Hernia ◽

Recurrent Inguinal Hernia ◽

Tension Free ◽

Lichtenstein Hernioplasty ◽

Stay Time

Background: Inguinal herniorrhaphy is a common general surgical operation. The repair of recurrent hernia is difficult surgery due to obscured and distorted anatomy and risk of further recurrence. The aim of this study is to determine the outcome in terms of operative time, hospital stay, return to work, complications and recurrence of open pre-peritoneal repair for recurrent inguinal hernias after Lichtenstein tension-free hernioplasty. Materials and Method: It is a prospective observational study conducted at Western Regional Hospital, Pokhara from 2013 to 2016. A total of eight patients including referred from other centers were included. Pre-peritoneal repair was performed on recurrent hernias after Lichtenstein tension-free hernioplasty. Age, sex, operating time, hospital stay, time to return work, postoperative complications and recurrence of patients were noted. Statistical analysis was done using SPSS- 21. Patients were called for follow up in 2 weeks, 3 months and 12 months time. Results: Out of eight patients, seven were male, one was female with mean age of 59.5 years. Recurrence was common on direct inguinal hernia (six patients) who had previous Lichtenstein hernioplasty. Mean operative time was 43.13 minutes (35 to 50 minutes), mean hospital stay was 2.5 days (2 to 4 days) and mean time to return to work was 8.12 days (7 to 10 days). There was hematoma formation in one patient. Conclusion: Pre-peritoneal mesh repair is easy, safe, with less operative time, short hospital stay, low recurrence and complication rate for recurrent inguinal hernia after Lichtenstein hernioplasty.

Download Full-text

Laparoscopic cholecystectomy in Jordan

Eastern Mediterranean Health Journal ◽

10.26719/2001.7.4-5.838 ◽

2001 ◽

Vol 7 (4-5) ◽

pp. 838-840

Author(s):

A. Al Raymoony

Keyword(s):

Laparoscopic Cholecystectomy ◽

Postoperative Pain ◽

Return To Work ◽

Hospital Stay ◽

Operative Time ◽

Safe Procedure ◽

Short Hospital Stay ◽

Early Return ◽

The Mean ◽

Mean Time

This study was conducted on 100 patients with symptomatic gallbladder stones, aged 22-81 years with a mean of 51.5 years, who underwent cholecystectomy in Zarqa city, Jordan between July 1998 and July 1999. The success rate was 87% and the procedure was completed using the conventional method in 13 patients. The mean operative time was 60 minutes, complication rate was 5% and there were no deaths. The mean hospital stay was 1 day and mean time to return to work was 10 days. This study showed that laparoscopic cholecystectomy is a safe procedure with reasonable operative time, less postoperative pain, a short hospital stay, early return to work, and a low morbidity and mortality rate.

Download Full-text

Laparoscopic Versusopen Appendectomy - Which One Is Better?

Journal of Surgical Sciences ◽

10.3329/jss.v17i1.43697 ◽

2019 ◽

Vol 17 (1) ◽

pp. 7-13

Author(s):

Md Atiar Rahman ◽

Md Shahadot Hossain Sheikh ◽

Md Ibrahim Siddique ◽

Md Shahidul Islam ◽

AKM Ahsan Ullah ◽

...

Keyword(s):

Hospital Stay ◽

Operative Time ◽

Operative Procedure ◽

Open Appendectomy ◽

Length Of Hospital Stay ◽

Laparoscopic Group ◽

Patient Characteristics ◽

Laparoscopic Technique ◽

Analgesia Requirement ◽

Initial Procedure

Objective: Appendectomy, being the most common surgical procedure performed in general surgery, is still being performed by both open and laparoscopic methods due to a lack of consensus as to which is the most appropriate method. Because further trials are necessary and few such studies have been performed in developing countries, we decided to evaluate the outcomes of the 2 procedures to share our experience with others. Methods: Prospectively collected data from 618 consecutive patients with appendicitis were studied. These comprised of 340 patients who underwent conventional open appendectomy and 260 patients treated laparoscoplcally&18 were excluded because of protocol violations. The two groups were compared with respect to operative time, length of hospital stay, postoperative pain, return to normal work, complication rate and cost. Results: There were no statistical differences regarding patient characteristics between the two groups. Conversion to laparotomy was necessary in 5 patients (1.88%). Laparoscopic appendectomy was associated with a shorter hospital stay (1.5 d vs 2.5 d), lower incidence of wound infection (3.07% vs 8.29%,) &less analgesia requirement. The operative time was more (45.6 vs 24.5 min) and the cost of treatment was higher in the laparoscopic group. Conclusion: The laparoscopic technique is a safe and clinically beneficial operative procedure. It provides certain advantages over open appendectomy, ·including short hospital stay, decreased requirement .of postoperative analgesia, early food tolerance, and earlier return to normal activities, Where feasible, laparoscopy should be undertaken as the initial procedure of choice for most cases of appendicitis. Journal of Surgical Sciences (2013) Vol. 17 (1) : 7-13

Download Full-text

A comparative study to evaluate milligan morgan hemorrhoidectomy versus pile suture method in management of haemorrhoids

International Surgery Journal ◽

10.18203/2349-2902.isj20210381 ◽

2021 ◽

Vol 8 (2) ◽

pp. 664

Author(s):

Aditya . ◽

Kuldeep Raj ◽

P. N. Agarwal ◽

Md Abu Nasar

Keyword(s):

Return To Work ◽

Hospital Stay ◽

Operative Time ◽

Suture Technique ◽

Pain Scores ◽

Early Return ◽

Suture Group ◽

Group A ◽

The Mean ◽

Group B

Background: A pile suture technique was described originally by the Farag in 1978 was better in terms of post- operative pain, bleeding, hospital stay and early return to work which are the distressing effects of conventional Milligan Morgan Hemorrhoidectomy which is well accepted surgical procedure for haemorrhoids. This study is designed to compare the pile suture and Milligan Morgan Hemorrhoidectomy.Methods: After fulfilling the criteria, 60 patients were randomly allocated to the group A (Pile Suture [PS] n -30) and group B (Milligan Morgan Hemorrhoidectomy [MM] n – 30). The techniques were evaluated with respect to the operative time, pain scores, bleeding, hospital stay, return to work, and recurrence.Results: The mean age of patients was 44.33 years and 42.77 years in the pile suture group and MM group respectively. Grade III or IV hemorrhoids were more common in men (i.e., 80% and 60% in the pile suture and MM group, respectively). The mean operative time was shorter in the PS 20.10 minutes versus 51.47 minutes in the MM group (P .001). The bleeding and pain scores were less in the PS. Mean hospital stay was 4 days and 6.6 days in the PS and MM group, respectively. The patients in the pile suture group returned to their routine activities earlier (i.e., within 7.33 days) as compared with 16.87 days in the MM group.Conclusions: Therefore, pile suture method can be considered as less traumatic for the patients and method can be recommended as a safer alternative to Milligan Morgan haemorrhoidectomy.

Download Full-text

Single incision laparoscopic appendicectomy versus conventional laparoscopic appendicectomy- a prospective study

International Surgery Journal ◽

10.18203/2349-2902.isj20171602 ◽

2017 ◽

Vol 4 (5) ◽

pp. 1588

Author(s):

Rohit Kumar ◽

Rajan Vaithianathan ◽

Vinoth Sundaresan

Keyword(s):

Prospective Study ◽

Hospital Stay ◽

Operative Time ◽

Single Incision ◽

Laparoscopic Appendicectomy ◽

Conventional Laparoscopic ◽

Pain Duration ◽

Prospective Comparative Study ◽

Almost All ◽

A Prospective Study

Background: The advent of Single incision laparoscopic appendicectomy (SILA) has encouraged surgeons to compare its benefits over conventional laparoscopic appendicectomy (CLA). We conducted a prospective study comparing SILA with CLA, evaluating parameters like operative time and complications, post-operative pain, duration of stay and the cosmetic outcome.Methods: A prospective, comparative study of 94 consecutive patients was conducted at our institution between December 2014 and May 2016. The data regarding the various parameters were documented in both groups of patients.Results: Among the 94 patients, 30 underwent SILA and 64 underwent CLA. We found statistically significant outcomes for SILA over CLA in variables such as operative time (p=0.0018), duration of hospital stay (p≤0.0001) and cosmetic outcome (p≤0.0001). Almost all patients in the SILA category showed no evidence of a scar after a three month follow up.Conclusions: SILA was found to have a better outcome than CLA with regard to operative time, hospital stay and cosmesis. We conclude that this technique of SILA can be a better alternative to CLA.

Download Full-text

Outcome comparison study between laparoscopic appendisectomy and conventional open appendisectomy

International Surgery Journal ◽

10.18203/2349-2902.isj20191471 ◽

2019 ◽

Vol 6 (5) ◽

pp. 1520

Author(s):

Mimamaychet B. Sangma ◽

Selvakumaran Selvaraju ◽

Pratheeba Natarajan ◽

Fremingston Marak ◽

Simon David Dasiah

Keyword(s):

Return To Work ◽

Hospital Stay ◽

Operative Time ◽

Meta Analysis ◽

Operation Time ◽

Significant Finding ◽

Medical College ◽

Early Return ◽

Outcome Comparison ◽

Gandhi Medical College

Background: Open appendisectomy (OA) had been the procedure of choice for acute appendisectomy for a century since Mc Burney introduced in 1884. Laprascopic appendisectomy (LA) didn’t gain popularity and many studies had been conducted to see the superiority of one over the other. Recent meta-analysis studies, found overall benefits in favour of LA. So, we have done comparative study with the aim to compare the benefits of LA over OA.Methods: Total of 90 appendisectomies was done, 45 each in OA and LA group and compared over a period of 1-year from October 2016 to October 2017 in Indira Gandhi Medical College and RI, Pondicherry. Outcome parameters were compared between the 2-groups in relation to operative time, analgesia used, length of post-operative hospital stay, return to work, resumption of a regular diet, post-operative scar and post-operative complications.Results: Mean age of LA was 35 years, OA was 30 years. Male preponderance observed in OA (67%), female in LA (60%). Post-operative short hospital stay was 3-days in LA, 5-days in OA. Early return to work was 9-days in LA, 15-days in OA. Operative time was significantly shorter in LA which was 30-minutes and 40-minutes in OA. In laprascopic group, no complications was observed, in open group we had two post-operative infections.Conclusions: LA is an effective and safe option and the procedure of choice for most patients regardless of age, sex and BMI, with a statistically significant finding in regards to operation time in LA compared to conventional OA group.

Download Full-text

A Single Surgeon’s Experience of Total Extra Peritoneal Repair Vs Transabdominal Preperitoneal Repair- A Prospective Cohort Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2020/47056.14406 ◽

2021 ◽

Author(s):

Tharun Ganapathy Chitrambalam ◽

Koshy Mathew Panicker ◽

Jeyakumar Sundaraj ◽

Sidhu Rajasekhar ◽

Pradeep Joshua Christopher

Keyword(s):

Inguinal Hernia ◽

Postoperative Pain ◽

Hospital Stay ◽

Pain Score ◽

Operative Time ◽

P Value ◽

Tep Repair ◽

Duration Of Hospital Stay ◽

Tapp Repair ◽

The Mean

Introduction: Hernia surgery has evolved over a period of 2500 years from the Bassini-Shouldice era to conventional Lichenstein’s meshplasty to the laparoscopic era. Since, inception of the laparoscopic approach 25 years ago, there were several advancements in the techniques of inguinal hernia repairs. The two most commonly practiced laparoscopic approaches are the Total Extra Peritoneal (TEP) and Transabdominal Preperitoneal (TAPP) repair. Aim: To compare the outcomes for TEP and TAPP approaches in laparoscopic inguinal hernia surgery in terms of operative time consumed, postoperative pain, duration of hospital stay, complications and recurrence rate when performed by a single surgeon. Materials and Methods: A prospective interventional cohort study was carried out among 70 patients with uncomplicated inguinal hernia. Patients were divided equally into two groups of 35 patients and underwent TAPP and TEP repairs depending on group randomisation. All surgeries were performed by the same surgeon. Factors including operative time, postoperative pain, duration of hospital stay, complications and recurrence were documented and compared for both the groups. The statistical analysis was done using Statistical Package for the Social Sciences (SPSS) software version 21. Unpaired t-test was used to compare the mean between the two groups. The p-value of <0.05 was considered to be statistically significant. Results: The mean operative time measured in minutes for TEP repair was 31.03 minutes and TAPP repair was 42.26 showing a difference of 11.23 minutes which was statistically significant (p-0.001). The mean Standard Deviation (SD) pain score at 24 hours for TEP repair was 2.43 (1.195) and TAPP repair was 3.43 (0.917). The mean (SD) pain score at 48 hours for TEP repair was 1.31 (1.051) and TAPP repair was 2.20 (0.901). The mean (SD) pain score at one week for TEP repair was 0.37 (0.690) and TAPP repair was 0.91 (0.781). The mean (SD) duration of hospital stay in TEP repair was 2.60 days (0.553) when compared to 3.49 days (0.658) in TAPP repair. All the results were statistically significant with a p-value of 0.001. Conclusion: TEP repair had superior outcomes in terms of reduction in operative time, less postoperative pain and shorter hospital stay than TAPP repair.

Download Full-text

A prospective comparative study of ureterorenoscopy with and without DJ stenting for the management of ureteric stones

International Surgery Journal ◽

10.18203/2349-2902.isj20214753 ◽

2021 ◽

Vol 8 (12) ◽

pp. 3606

Author(s):

Dinesh Prasad ◽

Yogesh Satani ◽

Shivam Singh ◽

Darpen Gajera

Keyword(s):

Comparative Study ◽

Hospital Stay ◽

Operative Time ◽

Ureteral Stones ◽

Safe Alternative ◽

Stone Free Rate ◽

Group A ◽

Prospective Comparative Study ◽

Group B ◽

Free Rate

Background: Urolithiasis is the most common urological disease. Surgical treatment of ureteral stones consists of four minimally invasive modalities including ESWL, URS, PCNL, and laparoscopic or robotic-assisted stone surgery. URS and ESWL are the most widely used techniques. However, the use of ureteral stents for the treatment of ureteral stones is still controversial. Herein, we did a comparative study of URS with and without DJ stenting for the management of ureteric stones. Objectives of current study were to compare prevalence of post-operative complications in patients undergoing ureterorenoscopy without ureteral stenting as compared to patients undergoing stenting procedure, to study the frequency of morbidity in patients during post -operative period in both ‘stent’ and ‘no stent’ groups. Stone free-rate, operative time, complications, hospital stay and need for re-treatment in both groups will be determined.Methods: 50 patients with ureteric stones admitted in our hospital-SMIMER fulfilling our inclusion and exclusion criteria were randomly divided in two groups- patients in group A (25) underwent URS without DJ stenting and group B (25) underwent URS with DJ stenting.Results: URS without DJ stenting had less operative time, less postoperative complications like pain, requirement of analgesia, hematuria, UTI, dysuria, fever, less readmission rate and less hospital stay, similar stone free rate compared to URS with DJ stenting but it requires higher surgical endoscopy skills with urological expertise.Conclusions: Thus, after adequate training, URS without DJ stenting can be recommended as a safe alternative procedure than URS with DJ stenting for management of ureteric stones.

Download Full-text

To compare advantage of non-fixation versus fixation of mesh in Laparoscopic totally Extra Peritoneal (TEP) repair of inguinal hernias

Asian Journal of Medical Sciences ◽

10.3126/ajms.v9i4.19621 ◽

2018 ◽

Vol 9 (4) ◽

pp. 35-40

Author(s):

Ambar Gangopadhyay ◽

Bikash Chandra Ghosh

Keyword(s):

Hospital Stay ◽

Postoperative Complication ◽

Operative Time ◽

Mesh Fixation ◽

Chronic Groin Pain ◽

Tep Repair ◽

Medical College ◽

Inguinal Hernias ◽

Average Pain ◽

Background Mesh

Background: Mesh fixation during laparoscopic totally extra peritoneal repair is thought to be necessary to prevent recurrence of infections and post-operative complications. However, mesh fixation might increase the postoperative complications and chronic pain. This study was to describe the experience of a single surgeon at R.G. Kar Medical College and Hospital performing this operation. This study evaluates the outcomes of laparoscopic hernioplasty performed with and without mesh fixation at our institution.Aims and Objective: To compare advantage of non-fixation versus fixation of mesh in laparoscopic Totally Extra peritoneal (TEP) repair of inguinal hernias. This study was conducted for analysis of outcome with respect to pain, operative time, intra and postoperative complication, days of hospital stay, recurrence regarding the procedure between fixation and non-fixation of mesh in totally extra peritoneal repair of inguinal hernia.Materials and Methods: The study was conducted in the Department of Surgery, R.G.Kar Medical College and Hospital from January 2011 to April 2012. All patients admitted in General surgical unit presenting with uncomplicated unilateral inguinal hernias were included. A total of 60 patients were included in the study, of which 30 patients underwent TEP repair without fixation of mesh and for remaining 30 patients the mesh was fixed using metallic tacks.Results: Difference in average pain score at 24 hrs, 72 hrs, 1 month and 6 months was significant statistically (p =0.003, p = 0.003, p< 0.001 and p=0.001 respectively) when compared in both groups. There was no recurrence in the study period in either of the groups. The duration of operative time and days of hospital stay was higher in fixation group and was statistically significant.Conclusion: Mesh fixation appears to be disadvantageous in TEP repair of inguinal hernias compared to non- fixation of mesh as it is associated with higher operative time, higher postoperative complication and an increased likelihood of developing chronic groin pain. The omission of mesh fixation did not increase the risk of early hernia recurrence.Asian Journal of Medical Sciences Vol.9(4) 2018 35-40

Download Full-text