Comparison of post-operative pain after laparoscopic total extraperitoneal mesh repair of indirect inguinal hernia with tacker

Objectives: To compare the post-operative pain after laparoscopic total extraperitoneal mesh repair of indirect inguinal hernia with tacker and without tacker fixation. Materials & Methods: This comparative study was done at Surgical Department of Bahawal Victoria Hospital, Bahawalpur from May 2020 to November 2020 over the period of 6 months. Total 182 patients with indirect inguinal hernia, having age range from 20 to 60 either male or female were selected. In group A patients, laparoscopic TEP mesh repair of inguinal hernia without tacker fixation was done while in group B patients, laparoscopic TEP mesh repair of inguinal hernia with tacker fixation was done. Patients were assessed for post-operative pain and outcome (satisfactory/unsatisfactory) at 1 month follow up. Results: Average of patients was 41.33 ± 12.37 years and 40.83 ± 12.04 years in group A and group B. Out of 182 patients, 170 (93.41%) were males and 12 (6.59%) were females. Mean post-operative pain in Group A was 1.46 ± 1.50 while in Group B was 1.77 ± 2.08 (p-value=0.2505). Satisfactory outcome was noted in 84 (92.31%) patients and 67 (73.63%) patients of group A and B and the difference was significant (P = 0.001). Conclusion: Results of this study showed that there is a significant difference of satisfactory outcome (less post-operative pain) between the non-fixation and fixation group. Difference of satisfactory outcome was also significant between male patients, diabetics and obese patients of both groups. Keywords: Inguinal hernia, laparoscopic, mesh, tacker fixation

Modified Laparoscopic Sugarbaker Repair of Parastomal Hernia With a Totally Extraperitoneal Technique

Purpose: Many patients develop a parastomal hernia within the first 2 years of stoma formation, and even surgical repair is associated with high recurrence rates. An intraperitoneal approach is typically used for the laparoscopic repair of parastomal hernia; it is unknown whether a totally extraperitoneal technique (TEP) is feasible. Here we describe a laparoscopic TEP approach using a modified Sugarbaker method for the repair of parastomal hernia.Methods: Seven patients underwent parastomal hernia repair. The retrograde puncture technique was used to create the extrapneumoperitoneum, and the peritoneum was separated with a laparoscopic TEP approach; the mesh was placed using a modified Sugarbaker technique.Results: All patients had an oncologic etiology for stoma creation. The mean (±SD) size of the hernia defect was 3.1 ± 2.7 cm and the mesh size was 303.4 ± 96.8 cm2. The mean operative time was 195.5 ± 20.7 min and average length of hospital stay after surgery was 4.8 ± 2.1 days. One patient had intraoperative subcutaneous emphysema. The average follow-up time was 8.5 ± 2.7 months; mild pain occurred in 2 patients, 3 experienced seroma formation (with no special treatment required), and 1 had early intestinal obstruction (which was treated with conservative care). There was no hernia recurrence, wound complications, or infections of the surgical site or mesh during follow-up.Conclusion: A laparoscopic TEP technique is technically challenging but feasible. Modified laparoscopic Sugarbaker repair of a parastomal hernia with the TEP technique is safe and effective, although the recurrence rate and late complications require confirmation in more cases with long-term follow-up.

Assessment of early outcome in laparoscopic totally extraperitoneal inguinal hernia repair using lightweight mesh

Background: Laparoscopic surgery is dominating in the field of hernia. The search for the ideal prosthetic biomaterial has been a longstanding issue with debate over simple versus composite biomaterial and lightweight versus heavyweight meshes. This study was done to evaluate the early outcome of lightweight mesh in laparoscopic totally extraperitoneal (TEP) repair.Methods: This prospective observational study was done for a period of 16 months. On the basis of selection criteria patient underwent laparoscopic TEP repair using light weight mesh, early outcomes were evaluated in terms of immediate postoperative pain (analysed via visual analog scale) and chronic groin pain (analysed by visual analogue scale and graded according to Cunningham), patients were also evaluated for operation time, intraoperative bleeding, seroma, stiffness or numbness around groin, or any other complications.Results: There was no intraoperative bleeding among any of the patients. Immediate post-operative pain assessed by visual analogue scale 20% scored one in the visual analogue scale in post-operative day 1. None of the patients were having any complications (like stiffness or numbness in groin or thigh and any other complication) during post-surgery follow up. Only one patient reported mild chronic groin pain at the end of 3 months after surgery.Conclusions: The short term results of laparoscopic TEP repair for inguinal hernia using light weight mesh are quite encouraging. We can conclude that light weigh mesh is fulfilling important role in successful hernia repair as it is associated with very less morbidity.

Outcomes of 207 totally extraperitoneal hernia repairs using self-fixation mesh

Inguinal hernia (IH) repair is one of the most common procedures in general surgery around the world. Minimizing postoperative acute and chronic pain without increasing recurrence has been a critical point, giving place to different strategies like self-fixation mesh. The current study aimed to describe a group of patients who underwent IH repair by Totally Extraperitoneal (TEP) technique with self-gripping mesh at a fourth level hospital between 2012 and 2019. Retrospective review of a prospectively collected database including patients who underwent laparoscopic TEP approach with self-fixation mesh for IH repair. Follow up data was obtained at 12, 24, 36, 48, and 60 months post surgical intervention. 207 hernia repairs were performed in 142 patients, with a total of 66 patients with bilateral IH. 10.6% required hospitalization due to either concomitant procedure performed or cardiovascular comorbidities, with a mean hospital stay of 1.6 days. Median and late follow up was up to 5 years. 88.9% of patients complete a year, 86% two years, and 36.7% with a 5 year follow-up. IH repair using the TEP technique and self-fixation mesh showed to be an excellent approach, demonstrating satisfactory results in follow up and complications.

O38: TACKING VERSUS NO TACKING IN LAPAROSCOPIC TOTALLY EXTRAPERITONEAL REPAIR OF PRIMARY INGUINAL HERNIA - A SYSTEMATIC REVIEW AND META-ANALYSIS

Introduction The necessity of mesh fixation in laparoscopic totally extraperitoneal (TEP) inguinal hernia repair remains controversial. We performed a systematic review and meta-analysis to compare the effectiveness of mesh tacking versus no tacking in laparoscopic TEP repair for primary inguinal hernia. Materials and Methods PubMed, EMBASE and Cochrane databases were searched for relevant articles from inception until November 2019. All studies that compared tacking versus no tacking in TEP repairs for inguinal herniae were included. Recurrent and femoral herniae were excluded from the current analysis. The primary outcome measure was recurrence, while secondary outcomes included postoperative pain scores at discharge and at 1 month, mean operative time, length of stay and seroma rates. Random effects models were used to calculate pooled effect size estimates. Result Eight randomised controlled trials were included capturing 557 patients and 715 inguinal herniae. On random effects analysis, there were no significant differences between tacking and no tacking in terms of recurrence (OR 0.94, 95% CI=0.10 to 9.28, p=0.96), postoperative pain scores on discharge (Mean difference 0.82, 95% CI=-0.35 to 2.00, p=0.17) or at 1 month (Mean difference 0.53, 95% CI=-0.75 to 1.82, p=0.41), mean operative time (Mean difference 1.58 mins, 95% CI=-0.22 to 3.37, p=0.09), seroma (OR=0.70, 95% CI=0.28 to 1.74, p=0.44) or length of stay (Mean difference 0.11 days, 95% CI=-0.04 to 0.25, p=0.14). Conclusion Mesh tacking in laparoscopic TEP repair for primary inguinal herniae does not translate into improved postoperative outcomes and may be omitted. Take-home message Mesh tacking in laparoscopic TEP repair for primary inguinal herniae does not translate into improved postoperative outcomes and may be omitted.

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.

Laparoscopic total extraperioneal mesh hernioplasty is a novel approach for inguinal hernia: our experience over 7 years

Background: Inguinal hernia surgery is the most common performed surgery all over the world. Among them laparoscopic totally extra-peritoneal (TEP) mesh repair fulfils all the requirements with better clinical outcomes than other procedures.Methods: Data was collected from the inpatient and out-patient records of 60 patients who underwent laparoscopic TEP for unilateral or bilateral inguinal hernia in a single unit in the Department of General Surgery during May 2012-June 2019 including the two years of follow-up. 3D mesh was used for application and was fixed with tackers. Then patients were followed up in outpatient department after 1 week, 2 week, and 3 months, 6 months and yearly up to two years. In every visit post-operative pain (assessed by visual analogue scale), local wound complication (hematoma, seroma, wound infection) and recurrence were noted. The data was collected and evaluated and the results shown.Results: All patients were men, with average age of 36.5 years (range 32-58). On categorization 53 (88.3%) of them had unilateral inguinal hernia and 7 (11.6%) of them had bilateral inguinal hernia. Intra operatively 12 (20%) of them had direct inguinal hernia and 48 (80%) of them had indirect inguinal hernia. Haematoma was seen in 1 patients, surgical emphysema in 3, seroma in 5 and recurrence in 2 patients.Conclusions: Laparoscopic TEP mesh repair was effective and safe tool for hernia repair, in terms of lesser postoperative painless number of hospital days, early recovery and lesser wound complications. However recurrence rates are comparable with other methods of hernia repair.