Totally extraperitoneal inguinal hernia repair versus Lichtenstein repair: a one-year follow-up study

The inguinal hernia has an incidence of 27 — 43 % in males. Surgical repair is the most accepted treatment to prevent the development of complications. Laparoscopic inguinal hernia repair has become popular worldwide and includes the use of a laparoscopic technique for mesh placement behind the defect. Objective — to assess whether totally extraperitoneal (TEP) inguinal hernia repair shows benefits over Lichtenstein repair in intraoperative and one‑year follow‑up postoperative outcomes for male patients with primary unilateral inguinal hernia. Materials and methods. 53 males were randomly allocated to two groups. Group 1 included 27 patients who underwent totally extraperitoneal hernia repair using self‑gripping lightweight mesh, and group 2 included 26 patients who were treated surgically with Lichtenstein repair using lightweight mesh. Results. Both groups were comparable in mean age, type of hernia, body mass index and patient’s distribution according to the European hernia society classification. TEP repair takes on average a little less time as compared to Lichtenstein repair, and this difference is not statistically significant. The mean of visual analogue scale for pain scoring in the first 24 hours after surgery as well as in the next 24 hours is statistically significantly smaller in group 1 compared to group 2. The mean time taken to return to work was 2.15 times longer in group 2 than in group 1, and the difference was statistically significant. Conclusions. Totally extraperitoneal hernia repair shows potential benefits over Lichtenstein repair for primary unilateral inguinal hernias as it causes less pain in the postoperative period and ensures early return to work.

Endovideogernioplasty in patients with inguinal hernias: advantages and disadvantages

This study analyzed the results of treatment of patients with inguinal hernias, with an assessment of the advantages and disadvantages of endovideosurgical hernioplasty techniques. The clinical study used the data of 1317 patients with inguinal hernias. The results revealed that the totally extraperitoneal inguinal hernia repair had some advantages over laparoscopic hernioplasty, such as a shorter duration of surgery (43 15 min), mild pain on a visual analog scale, and an average bed-day after surgery. Complications were diagnosed in 16 (1.2%) patients, and most had ClavienDindo grade II complications. Relapses were detected in 7 (0.5%) cases. Thus, endoscopic hernioplasty (laparoscopic and totally extraperitoneal inguinal hernioplasty) was the preferred surgery for patients with bilateral inguinal hernia, recurrent hernia after traditional hernioplasty, and metabolic syndrome and young people of working age. The use of a modified technique of totally extraperitoneal inguinal hernioplasty with a clear understanding of the multifascial structure of the anterior abdominal wall may reduce the risks of both intraoperative and postoperative complications and increase the cost-effectiveness of treatment of patients with inguinal hernias, allowing us to obtain good results.

P053 COMPARISON OF CLINICAL OUTCOMES BETWEEN INTRAPERITONEAL ONLAY MESH REPAIR (IPOM PLUS) AND ENHANCED-VIEW TOTALLY EXTRAPERITONEAL REPAIR (ETEP) FOR VENTRAL HERNIAS

Aim We have been performing intraperitoneal on lay mesh repair (IPOM plus) as the standard laparoscopic procedure for ventral hernia in our department. We introduced enhanced-view totally extraperitoneal repair (eTEP) for ventral hernia repair in 2018, and have performed 31 cases so far. We compared the outcomes of IPOM Plus and eTEP at our institution. Material and Methods Ventral hernia cases who underwent surgery at our department between 2018 and 2020 were included in the study. The postoperative outcomes and complications of the IPOM Plus and eTEP groups were evaluated retrospectively. Results There were 12 cases of IPOM plus, and all were incisional hernias. There were 31 cases of eTEP, including 7 cases of primary hernias and 24 cases of incisional hernias. Transversus abdominis muscle release (TAR) was added in 24 cases. The mean hernia size was 6.6 x 7.9 cm with IPOM Plus and 8.0 x 10.1 cm with eTEP, and the average meshes size was 15.5 x 22.0 cm and 20.3 x 23.6 cm, respectively. The mean postoperative hospital stay was 7.8 days and 5 days. Postoperative complications included 1 case of mesh bulging and 1 case of recurrence in the IPOM Plus group, 1 case of seroma and 1 case of intestinal obstruction in the eTEP. Conclusions The surgical outcomes for ventral hernias up to 8 cm wide were similar for IPOM Plus and eTEP. The eTEP can insert a larger mesh and may be useful for wider hernias (>8cm).