scholarly journals Prevention and recovery for peritoneal injury during totally extraperitoneal inguinal hernia repair: A single-center retrospective cohort study

2020 ◽  
Author(s):  
Ryohei Nishiguchi ◽  
Shigehiro Kojima ◽  
Shinichi Asaka ◽  
Hiroyuki Maeda ◽  
Takebumi Usui ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Operative Time ◽  
Preperitoneal Space ◽  
Phase 3 ◽  
Hernia Sac ◽  
Recovery Method ◽  
Large Group ◽  
Totally Extraperitoneal ◽  
Medial Side ◽  
Sharp Dissection

Abstract Background During totally extraperitoneal (TEP) repair, peritoneal injury (PI) may result in technical difficulty due to the imparied working space inside the preperitoneal space. We aimed to clarify the factors causing PIs by focusing on the size of the hernia and to provide the prevention and recovery method for PI.Methods A total of 71 inguinal hernia with unilateral TEP repairs were classified by the size of hernia; Small group (<1cm, n=16) and Large group (≧1cm, n=55). Patient characteristics and surgical outcomes were analyzed retrospectively. TEP procedure was broke down into five phases (e.g. Phase 3 was a period from starting the dissection to transection of hernia sac) in the PI cases of the Large group (n=21). Common site of PI, maneuver and recovery method were further analyzed.Results Operative time (P<0.0001) and PI rate (P=0.015) were higher in the Large group. PI cases in the Large group showed a higher PI rate in Phase 3 (P=0.036) and PI mostly occurred by a sharp dissection of the medial side of hernia sac with using an ultrasonically activated device. In terms of recovery methods, pre-tied suture loop ligation and endoscopic suturing tended to be faster than doing nothing and conversion to TAPP but showed no significance (P=0.059).Conclusions Hernia size and a sharp dissection during the medial side of the hernia sac may be important factors causing PIs. A careful dissection combined with an appropriate blunt dissection is required for the prevention of PI because of the strong adhesion at the medial side and thin peritoneum in most cases of large hernia sacs. In cases of PI, extension of operative time could be prevented by ligation or suturing of the peritoneal defect.

scholarly journals Usefulness of a Long Forceps Technique in Single-Incision Laparoscopic Surgery for Totally Extraperitoneal Repair of Inguinal Hernia

2017 ◽  
Vol 102 (3-4) ◽  
pp. 115-118
Author(s):  
Yutaka Tokairin ◽  
Yasuaki Nakajima ◽  
Kenro Kawada ◽  
Akihiro Hoshino ◽  
Kagami Nagai ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Laparoscopic Surgery ◽  
Single Incision ◽  
Preperitoneal Space ◽  
Single Incision Laparoscopic Surgery ◽  
Hernia Sac ◽  
Co2 Gas ◽  
Umbilical Incision ◽  
Totally Extraperitoneal ◽  
Totally Extraperitoneal Repair

Collisions between the laparoscope and the forceps remain a specific problem for single-incision laparoscopic surgery (SILS). We considered that the use of a long forceps would resolve this problem and use the long forceps in SILS for totally extraperitoneal repair (TEP). SILS for TEP (S-TEP) was performed to treat 34 inguinal hernias in 27 patients from November 2013 to February 2015. Among them, unilateral inguinal hernia repair was performed in 5 patients (median age: 71 years; range: 40–88 years) using a laparosonic coagulating shears (LCS) device and a straight long (43 cm) forceps. A 1-cm umbilical incision was made, a 5-mm flexible laparoscope was moved into the peritoneal cavity, and the type of inguinal hernia was diagnosed. Next, preperitoneal space was made using a finger or gauze. The single-port device was applied at preperitoneal space and insufflation was initiated with CO2 gas. The preperitoneal space was more easily created using a long straight forceps rather than standard ones. The hernia sac was then freed from the spermatic cord and a mesh was rolled, inserted, and deployed. Absorbable spiral tackers were used for fixation over the Cooper's ligament, lateral to the inferior epigastric vessels. The use of a long forceps was considered to be associated with reduction of the difficulty for dissection in S-TEP. We considered the use of a long forceps to be useful to the S-TEP operation.

scholarly journals Two Ports Laparoscopic Inguinal Hernia Repair in Children

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Medhat M. Ibrahim
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Operative Time ◽  
Laparoscopic Hernia Repair ◽  
Recurrent Hernia ◽  
Bilateral Hernia ◽  
Hernia Sac ◽  
Treatment Techniques ◽  
The Mean ◽  
Open Hernia Repair

Introduction. Several laparoscopic treatment techniques were designed for improving the outcome over the last decade. The various techniques differ in their approach to the inguinal internal ring, suturing and knotting techniques, number of ports used in the procedures, and mode of dissection of the hernia sac.Patients and Surgical Technique. 90 children were subjected to surgery and they undergone two-port laparoscopic repair of inguinal hernia in children. Technique feasibility in relation to other modalities of repair was the aim of this work. 90 children including 75 males and 15 females underwent surgery. Hernia in 55 cases was right-sided and in 15 left-sided. Two patients had recurrent hernia following open hernia repair. 70 (77.7%) cases were suffering unilateral hernia and 20 (22.2%) patients had bilateral hernia. Out of the 20 cases 5 cases were diagnosed by laparoscope (25%). The patients’ median age was 18 months. The mean operative time for unilateral repairs was 15 to 20 minutes and bilateral was 21 to 30 minutes. There was no conversion. The complications were as follows: one case was recurrent right inguinal hernia and the second was stitch sinus.Discussion. The results confirm the safety and efficacy of two ports laparoscopic hernia repair in congenital inguinal hernia in relation to other modalities of treatment.

The Comparison of Balloon and Camera Dissection of the Preperitoneal Space in Totally Extraperitoneal Repair Hernia Repair. Our Initial Experience!

2021 ◽  
pp. 155335062199929
Author(s):  
Selim Birol ◽  
Hasan V. Ofluoglu
Keyword(s):  
Hernia Repair ◽  
Operating Time ◽  
Operation Time ◽  
Preperitoneal Space ◽  
Post Discharge ◽  
Hernia Sac ◽  
Totally Extraperitoneal ◽  
Working Space ◽  
Severity Scores ◽  
Totally Extraperitoneal Repair

Purpose. To perform totally extraperitoneal repair of a hernia, it is essential to create a working space for the placement of instruments. In this study, we aimed to compare balloon dissection (BD) and camera or telescopic dissection (CD) with respect to the surgical outcomes, without considering the cost-effectiveness. Methods. Forty consecutive, healthy, unilateral inguinal hernia patients who underwent Totally Extraperitoneal Repair hernia repair were randomized into 2 groups according to whether they received BD or CD. The perioperative demographic characteristics were recorded. All the operations were video recorded from the beginning to the end of each procedure. The virtually constructed periods of the procedures were evaluated by another surgeon who watched each video. The time spent for each period, the severity score assigned by the surgeon, the total operation time, the peritoneal laceration rate, the presence of early and late postoperative pain, the number of postoperative visits, the total analgesic requirements, and the complications were recorded. Results. The demographic properties of the patients, the perioperative and postoperative complications, and the severity scores in the BD and CD groups were statistically similar. The total operating time and the time from the dissection of the peritoneum to the reduction of the hernia sac were significantly longer in the CD group. Post-discharge analgesic consumption, Visual Analog Scale scores, and the number of visits were similar between the groups. Conclusions. The dissection of the working space in the preperitoneal area can be achieved using camera dissection without the risk of common complications associated with balloon dissection, particularly balloon rupture.

scholarly journals Two mesh technique in lieu of single mesh in giant prosthetic reinforcement of the visceral sac for bilateral inguinal hernias

2017 ◽  
Vol 4 (8) ◽  
pp. 2736
Author(s):  
Bhavinder K. Arora ◽  
Rachit Arora ◽  
Akshit Arora
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Operative Time ◽  
Posterior Wall ◽  
Polyglycolic Acid ◽  
Bilateral Inguinal Hernia ◽  
Hernia Sac ◽  
Tension Free ◽  
Direct Hernia

Background: Posterior wall strengthening is the essential aim of Bilateral Inguinal hernia repair. The two methods for it are tissue repair and tension free repair. Tension free repair have become the gold standard. The preperitoneal repair for Bilateral Inguinal hernia is performed by wrapping the lower part of the parietal peritoneum with a large chevron shape polypropylene mesh.Methods: This study presents a modification of stoppas repair using a polypropylene mesh of size 15×9 cm to cover the myopectineal ostium of fruchaud on each side. The direct hernia sac was inverted with a purse string suture. Indirect hernia was opened and margins approximated with a 2-0 polyglycolic acid suture. No drainage was used.Results: Post-operative period was uneventful in all the patients. This new technique uses less post-operative time and the cost of surgery is reduced. There was one post-operative recurrence on one side only on follow up at one week, three weeks and three months.Conclusions: The use of two small size mesh covering both Fruchaud’s myopectineal orifices for bilateral inguinal hernia repair instead of a large size mesh is a promising technique. It saves the operative time and shortens the hospitalization time.

scholarly journals 40 cases of Single-incision laparoscopic surgery to totally extraperitoneal herniorrhaphy via umbilical incision under posterior rectus abdominis sheath

2019 ◽  
Author(s):  
Xiaojun Wang ◽  
Yizhong Zhang ◽  
Changlei Qi ◽  
Encheng Zhou ◽  
Haiqiang Zhang ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Operative Time ◽  
Single Incision ◽  
Single Port ◽  
Rectus Abdominis ◽  
Preperitoneal Space ◽  
Single Incision Laparoscopic Surgery ◽  
Umbilical Incision ◽  
Totally Extraperitoneal ◽  
Port Device

Abstract Background Since 2008, the first case of Single-incision laparoscopic surgery totally extraperitoneal (SILS-TEP) was reported, there was more than 10 years history on SILS-TEP. Because of difficult to operation, SILS-TEP is popularized slowly. This study investigate the safety and feasibility of SILS-TEP under posterior rectus abdominis sheath. Methods A single 2.5cm long cured incision was made along the lower umbilical border. A 5.0cm size preperitoneal space was created by electrotome or blunt dissection under the posterior sheath and the linea alba. The silica gel sealing sleeve of Iconport single port device was crammthed under the posterior rectus abdominis sheath, then the preperitoneal space was broadened toward lower abdomen in condition of CO2 gas inflation. Conventional laparoscopic instruments were used to complete the operation according to the operation procedure of laparoscopic total extraperitoneal herniorrhaphy. Results SILS-TEP hernia repair was successfully completed in 39 patients. One need an additional ports to complete totally extraperitoneal hernioplasty. Mean operative time was 73.8 minutes (range, 45 to 130 minutes) and 55.2 minutes (range, 34 to 95 minutes) in unilateral indirect hernia and in unilateral direct or femoral hernia, respectively . Mean operative time was 92.3 minutes (range, 65 to 150 minutes) in bilateral hernia. 3 seroma and 5 chronic pain were seen during the 1-6 months follow-up periods, all were treated conservatively. No other major complications. Mean post-operative hospital stay was 2.6 days. Conclusion The operation of SILS-TEP via umbilical incision under posterior rectus abdominis sheath is safe and feasible. The Iconport single-port device has potential advantages in SILS-TEP surgery. Trial registration: The study was registered with the Chinese Clinical Trial Registry (ChiCTR)(www.chictr.org.cn).Registration number:ChiCTR1900023056. Registration date: May 9, 2019.Retrospectively registered.

scholarly journals Incarcerated femoral hernia treated with elective totally extraperitoneal repair: a case report

2020 ◽  
Vol 2020 (6) ◽  
Author(s):  
Shigeo Ninomiya ◽  
Syunsuke Fujita ◽  
Tadashi Ogawa ◽  
Yoshitake Ueda ◽  
Norio Shiraishi ◽  
...  
Keyword(s):  
Femoral Hernia ◽  
Elective Surgery ◽  
Lower Abdominal Pain ◽  
Greater Omentum ◽  
Preperitoneal Space ◽  
Hernia Sac ◽  
Totally Extraperitoneal ◽  
The Right ◽  
Totally Extraperitoneal Repair ◽  
Incarcerated Groin Hernia

Abstract Incarcerated groin hernia is a common surgical emergency. However, reports of incarcerated femoral hernia treated with elective totally extraperitoneal repair are extremely rare. A 62-year-old woman visited our hospital with lower abdominal pain and bulging from a right groin lesion. The patient was diagnosed as having right incarcerated femoral hernia containing greater omentum by computed tomography. As there were no clear findings of intestinal obstruction and peritonitis, elective surgery was performed. Intraoperatively, the hernia sac had herniated into the right femoral canal. We could release the hernia sac using laparoscopic forceps. After reduction of the hernia sac, polypropylene mesh was placed in the preperitoneal space and fixed to Cooper’s ligament. The patient’s postoperative course was uneventful, and she was discharged 3 days after surgery. We consider elective totally extraperitoneal repair for incarcerated femoral hernia to be an effective procedure for selected patients who have been diagnosed accurately.

Lichtenstein Versus Desarda’s Technique of Hernia Repair

2020 ◽  
Vol 22 (2) ◽  
pp. 99-103
Author(s):  
Md Fardhus ◽  
AMSM Sharfuzzaman ◽  
Md Nayeem Dewan ◽  
Md Abul Hossain ◽  
Ahmed Sami Al Hasan ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Mesh Repair ◽  
Operative Time ◽  
Seroma Formation ◽  
Age Group ◽  
Serous Fluid ◽  
Medical College ◽  
Randomized Control ◽  
And Gender

Aim: To compare Desarda’s versus Lichtenstein’s mesh repair in patients with unilateral, primary, reducible inguinal hernia in terms of mean operative time and seroma formation Methods: This randomized control trial conducted at Department of Surgery, Patuakhali Medical College & Hospital, Patuakhali. Eighty patients with unilateral, primary, reducible inguinal hernia were randomly distributed into two groups to undergo hernia repair i.e. Lichtenstein (L) and Desarda’s (D). Outcome was measured in terms of mean operative time and seroma formation. Seroma formation was defined as presence of enclosed cavity containing serous fluid determined by ultrasonography at 30th post-operative day. Results: Thirty three patients (41.25%) were above 50 years of age, whereas remaining 47 patients (58.75%) were below 50 years of age. Five patients (6.25%) were female and 75 patients(93.75%) were male. Seroma formation was 5% in Desarda’s group while 7.5% in Lichtenstein group (P> 0.05). Similarly difference in mean operative time was statistically non-significant. Seroma formation was common in older age group. There was no effect of smoking, obesity, operative time and gender on seroma formation. Conclusion: It is concluded that there is no difference in frequency of seroma formation and mean operative time in Desarda’s or Lichtenstein’s technique of hernia repair. Journal of Surgical Sciences (2018) Vol. 22 (2) : 99-103

LAPAROSCOPIC TRANS-ABDOMINAL PRE-PERITONEAL (TAPP) REPAIR FOR TREATMENT INGUINAL HERNIA DISEASE

2018 ◽  
Vol 8 (4) ◽  
pp. 76-80
Author(s):  
Thao Nguyen Minh ◽  
Vu Pham Anh ◽  
Tri Nguyen Huu ◽  
Phu Nguyen Doan Van ◽  
Phuc Nguyen Thanh ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Operative Time ◽  
Bilateral Hernia ◽  
Repair Method ◽  
Tapp Repair ◽  
Post Operation ◽  
Average Operative Time ◽  
The Mean

Background: Inguinal hernia is one of the commonest surgical diseases and there are many different techniques applied. The laparoscopic trans-abdominal pre-peritoneal (TAPP) repair allows a better view of the inguinal anatomy, evaluation of opposite side and resolve combined peritoneal diseases as well. Patient and method: The study included 60 cases with inguinal hernia that have been treated by laparoscopic transabdominal pre-peritoneal (TAPP) repair. Method: Description, prospective follow-up. Result: The mean age was 58±18.2. 96.7% were males. The average operative time was 45.6±15.1 minutes for one side hernia, 73±25.2 minutes for bilateral hernia. 02 cases have been post-operation inguinal seroma complication (3.3%), 02 cases with hydrocele (3.3%), 01 case with abdominal seroma (1.7%). 04 cases (6.7%) opposite inguinal hernia were detected and 05 cases (8.3%) with combined diseases were resolved. Duration of post-operative stay was 3.9±1.1 days. Conclusion: TAPP is a safe and feasible procedure, allows evaluation of opposite side and resolve combined peritoneal diseases.

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