Phẫu thuật nội soi TAPP điều trị thoát vị bẹn

TÓM TẮT Đặt vấn đề: Thoát vị bẹn là một bệnh lý ngoại khoa thường gặp và có nhiều tác giả đưa ra nhiều kỹ thuật mổ khác nhau. Phẫu thuật xuyên phúc mạc tiếp cận khoang trước phúc mạc (TAPP) với nhiều ưu điểm như tiếp cận phẫu trường nội soi rộng rãi, các mốc giải phẫu rõ ràng, có thể quan sát, đánh giá và xử trí tạng thoát vị khá dễ dàng, có thể phát hiện thoát vị bẹn đối diện và xử trí những bệnh lý kèm theo trong ổ phúc mạc. Phương pháp: Nghiên cứu mô tả có theo dõi 125 bệnh nhân được chẩn đoán thoát vị bẹn tại Bệnh viện Trung Ương Huế và Bệnh viện trường Đại học Y - Dược Huế từ tháng 6/2016 đến tháng 3/2019. Kết quả: Tuổi trung bình 56,25 ± 19,06. Nam chiếm 97,6%. Thoát vị bẹn có triệu chứng 76,8%, có biến chứng 23,2%. Thoát vị bẹn 1 bên 92%, 2 bên 8%. Thoát vị bẹn ẩn đối bên phát hiện trong mổ 2,4%. TAPP 1 bên 92,8%, TAPP 2 bên 7,2%, TAPP kèm phẫu thuật khác 2,4%. Thời gian mổ trung bình 1 bên là 48,62 ± 13,05 phút, 2 bên là 66,11 ± 12,19 phút. Không có tai biến trong mổ. VAS sau mổ 24 giờ: 3,53 ± 0,56. Tụ dịch vùng bẹn sau mổ 11,2%. Thời gian nằm viện sau mổ 4,41 ± 1,25 ngày. Kết luận: Phẫu thuật TAPP là một phẫu thuật an toàn, có thể thực hiện được. Phẫu thuật TAPP có thể phát hiện và xử trí những tổn thương trong ổ phúc mạc cũng như các bệnh lý đi kèm. ABSTRACT LAPAROSCOPIC TRANS - ABDOMINAL PRE - PERITONEAL (TAPP) REPAIR FOR TREATMENT INGUINAL HERNIA DISEASE 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. Methods: A prospective study was carried in 125 cases with inguinal hernia that have been treated by laparoscopic trans - abdominal pre-peritoneal (TAPP) repair. Results: The mean age was 56.25 ± 19.06 years old. 96.7% were male. 76,8% of hernia were symptomatic, and 23.3% were complicated. 92% of hernia were unilateral, 8% were bilateral, 2.4% were occult. 92.8% would perfom an unilateral TAPP repair, 7.2% bilateral TAPP repair, 2.4% simultaneous TAPP and cholecystectomy. The mean operative time was 48.62 ± 13.05 minutes for unilateral TAPP, 66.11 ± 12.19 minutes for bilateral TAPP. The mean VAS 24h post - op was 3.53 ± 0.56. Regarding postoperative complications, inguinal seroma was detected in 11,2% of cases. The mean postoperative hospital stay was 4.41 ± 1.25 days. Conclusion: TAPP is a safe and feasible procedure, allows evaluation of opposite side and resolve combined peritoneal diseases. Keywords: Inguinal hernia, laparoscopic, trans - abdominal pre - peritoneal (tapp)

VP028 TAPP REPAIR FOR INCISIONAL LUMBAR HERNIA

Aim “Incisional hernias are very common and can present even after minimally invasive surgery for other pathologies. Laparoscopic ventral hernia repair first described by LeBlanc in 1992, gained great popularity, because of its known advantages over the open techniques. In the last decade because of increasing concerns about the future risks of using an intra-peritoneal mesh, several minimally invasive techniques using a mesh outside abdominal cavity have been described. We report the use of a TAPP technique.” Material and Methods “48 yo female patient, that underwent a laparoscopic right adrenalectomy, for myelolipoma, in 2015, with subsequent incisional lumbar hernia (L4W1) in the extraction incision.” Results “The patient was submitted to a laparoscopic TAPP repair in ambulatory surgery with extended recovery. The hernia defect was closed with a barbed suture and it was used a 15x15cm medium weight polypropylene mesh without traumatic fixation. For pain control it was done a TAP block guided by laparoscopy. The duration of surgery was 90 minutes. The patient had no complications. No recurrence on follow-up (4 months).” Conclusions “New minimally invasive procedures for the repair of incisional hernias avoid the intraperitoneal mesh position and maintain all the advantages of the minimally invasive approach. Some of these techniques may be complex and have a long learning curve. TAPP seems reproducible and a good option if a good extra-peritoneal dissection is possible. Larger series are needed, to accurately compare these new techniques with IPOM, open sublay and to select the best technique for each patient.”

P115 LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL (TAPP) HERNIA REPAIR IN DECOMPENSATED CIRRHOSIS

Aim To evaluate the possibilities, benefits and safety of laparoscopic treatment of inguinal hernias in patients with cirrhosis of the liver and ascites, in particular to evaluate the TAPP approach for the treatment of inguinal hernias in patients with cirrhosis of the liver and ascites. Material and Methods Group I - TAPP repair in 16 patients with liver cirrhosis and ascites. Group II - Lichtenstein type hernioplasty in 15 patients with liver cirrhosis and ascites. All patients underwent planned surgery after dosing preoperative laparocentesis and correction of liver function indices. Results In the first group of patients no complications developed, no suppurative complications were observed, no edema, no leakage of ascites fluid. Postoperatively, all patients recovered well, noticed less pain. Only 25 percent of patients required analgesics. Patients were discharged at home 3-5 days postoperatively. In group II - minor complications were observed: 1 local hematoma, 1 seroma. Postoperative pain syndrome was more pronounced. All patients required analgesics. Duration of hospitalization 4-6 days. During a 10-month follow-up, no patients had recurrence and chronic pain. Conclusions TAPP repair provided the opportunity to assess macroscopic changes in the liver and possibly to perform liver biopsies, if necessary. TAPP repair reduces days of hospitalization and postoperative recovery by reducing pain syndrome with a low percentage of analgesics. TAPP repair can be a useful treatment option for patients with liver cirrhosis accompanied by ascites.

Total extraperitoneal (TEP) versus laparoscopic transabdominal preperitoneal (TAPP) hernioplasty: systematic review and trial sequential analysis of randomized controlled trials

Purpose To examine the updated evidence on safety, effectiveness, and outcomes of the totally extraperitoneal (TEP) versus the laparoscopic transabdominal preperitoneal (TAPP) repair and to explore the timely tendency variations favoring one treatment over another. Methods Systematic review and trial sequential analysis (TSA) of randomized controlled trials (RCTs). MEDLINE, Scopus, Web of Science, Cochrane Central Library, and ClinicalTrials.gov were consulted. Risk Ratio (RR), weighted mean difference (WMD), and 95% confidence intervals (CI) were used as pooled effect size measures. Results Fifteen RCTs were included (1359 patients). Of these, 702 (51.6%) underwent TAPP and 657 (48.4%) TEP repair. The age of the patients ranged from 18 to 92 years and 87.9% were males. The estimated pooled RR for hernia recurrence (RR = 0.83; 95% CI 0.35–1.96) and chronic pain (RR = 1.51; 95% CI 0.54–4.22) were similar for TEP vs. TAPP. The TSA shows a cumulative z-curve without crossing the monitoring boundaries line (Z = 1.96), thus supporting true negative results while the information size was calculated as adequate for both outcomes. No significant differences were found in term of early postoperative pain, operative time, wound-related complications, hospital length of stay, return to work/daily activities, and costs. Conclusions TEP and TAPP repair seems comparable in terms of postoperative hernia recurrence and chronic pain. The cumulative evidence and information size are sufficient to provide a conclusive evidence on recurrence and chronic pain. Similar trials or meta-analyses seem unlikely to show diverse results and should be discouraged.

TRANS-ABDOMINAL PRE-PERITONEAL (TAPP) REPAIR FOR INGUINAL HERNIAS: A FIVE YEARS EXPERIENCE IN A TERTIARY CARE HOSPITAL

Objective To evaluate the efficacy of Transabdominal pre-peritoneal repair in the treatment of inguinal hernias Materials and Methods: This retrospective study was conducted in Surgical A Unit, Khyber Teaching Hospital from January 2015 to December 2019. A total 114 patients were included in the study. All of the patients underwent Laparoscopic Trans-abdominal pre-peritoneal(TAPP) repair. After six months follow up, their outcome variables were analysed. Results: Mean age of the study population was 41±7.8(SD) years(range 21-67 years). 104 patients had unilateral while 10 patients had bilateral hernias. 89(78.07%) patients had primary hernia while 25(21.92%) patients had recurrent hernia. Mean postoperative hospital stay was 1.21±0.3(SD) days. Umbilical port infection was noted in 2(1.75%) patients while no case of deep/ mesh infection was noted. Recurrence was noted in one case only. Chronic groin pain was noted in 5(4.38%) cases. Conclusion: TAPP is a safe and effective treatment modality for the treatment of primary and recurrent inguinal hernias.

If laparoscopic technique can be used for treatment of acutely incarcerated/strangulated inguinal hernia?

Purpose Laparoscopic treatment for acutely incarcerated/strangulated inguinal hernias is uncommon and controversial. In the present study, we assessed the safety and feasibility of transabdominal preperitoneal (TAPP) repair for the treatment of acutely incarcerated/strangulated inguinal hernias. Methods Patients with acutely incarcerated/strangulated inguinal hernias who underwent TAPP repair at the Department of Hernia and Abdominal Wall Surgery (Beijing Chaoyang Hospital) from January 2017 to December 2019 were retrospectively reviewed. Patients’ characteristics, operation details, and postoperative complications were retrospectively analyzed. Results In total, 94 patients with acutely incarcerated/strangulated inguinal hernias underwent TAPP repair. The patients comprised 85 men and 9 women (mean age, 54.3 ± 13.6 years; mean operating time, 61.6 ± 17.7 min; mean hospital stay, 3.9 ± 2.2 days). No patients were converted to open surgery. Hernia reduction was successfully performed in all patients. The morbidity of complications was 20.2% (19/94). Two bowel resections were performed endoscopically. Nine (9.6%) patients avoided unnecessary bowel resections during laparoscopic procedures. All patients recovered well without severe complications. No recurrence or infection was recorded during a mean follow-up period of 26.8 ± 9.8 months. Conclusions TAPP appears to be safe and feasible for treatment of patients with acutely incarcerated/strangulated inguinal hernias. However, it requires performed by experienced surgeons in laparoscopic techniques.

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

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.