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.

EP.TH.652Use of the Proceed Ventral Patch (PVP) Mesh for Small to Medium sized defects in Ventral Hernia Repair over 10 years – Simple, Safe and Secure

Aims The Proceed Ventral Patch (PVP) has been in use since the late 2000s and is a self-expanding lightweight mesh patch comprised of multiple layers of absorbable and non-absorbable materials including polypropylene and polydioxanone. It is intended for use in all ventral hernias. We report our single-centre experience of using the mesh with primary outcomes being recurrence and reoperation for recurrence, readmission within 21 days for post-operative complications and discharge as day-case. Methods Retrospective review of case notes from 54 patients who were operated between October 2010 and November 2020 was undertaken. Patient characteristics were of a 2.1: 1 Male:Female ratio with a median age of 56 years old. 3 epigastric hernias and 51 paraumbilical hernias were repaired using either a 4.3cm or 6.4cm Proceed Ventral Patch. The size of the hernia defect ranged from 0.5cm to 4cm with a median defect size of 2cm for the 54 patients. Results There were no intraoperative complications. Two patients (0.04%) underwent laparoscopic reoperation for recurrence. Only one (0.02%) patient was readmitted within 21 days for a wound abscess which was drained and treated with a VAC dressing with satisfactory healing. The operations were split between nine different surgeons of varying expertise from ST5 level to Consultant level. Conclusions Ventral hernia repair with PVP is intuitive to learn and has low recurrence/complication rates.

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.

Suture and Fixation of the Transversalis Fascia during Robotic-Assisted Transabdominal Preperitoneal Hernia Repair to Prevent Seroma Formation after Direct Inguinal Hernia Repair

Background. Seroma formation after videoendoscopic repair of inguinal hernias, known as “pseudorecurrence”, may vary from an asymptomatic, self-limiting occurrence to a painful, chronic problem. The aim of this study was to investigate the incidence of postoperative seroma in robotic-assisted transabdominal preperitoneal hernia repair (R-TAPP), modified by suturing and fixating the transversalis fascia to the Cooper ligament. Methods. The study was approved by the local ethics committee (2019-01132 CE-3495). Patients undergoing R-TAPP for direct inguinal hernia from October 2017 to December 2019 were included. In all patients, a barbed running suture of the transversalis fascia was performed to close the cavity resulting from the direct hernia reduction and to fix it to the Cooper ligament, then a lightweight mesh was placed. Demographic and clinical data were collected and analysed. Results. Over the study period, 67 R-TAPP in 51 patients were identified. All patients were male, with a mean age of 63.1 ± 12.7 years. There was 1 case of conversion to open surgery due to adhesions of the caecum to the groin as a result of perforated appendicitis. The mean length of the hospital stay was 1.8 ± .6 days. After discharge, no cases of seroma or recurrence at 30 days nor chronic pain at a mean follow-up of 10.3 ± 6.8 months was detected. Conclusions. In the treatment of direct inguinal hernia with R-TAPP, suturing and anchoring the transversalis fascia to the Cooper ligament are safe, feasible and recommendable in order to prevent postoperative seromas.

Outcomes of Single Incision Anchored Anterior Vaginal Mesh Repair for Recurrent Vaginal Prolapse

Objective: To report the safety and efficacy of single incision anchored anterior vaginal mesh repair for women with recurrent anterior vaginal prolapse.Methods: Retrospective study of women with recurrent anterior vaginal prolapse, Stage 2 or beyond, who underwent single incision anchored vaginal mesh repair with Anterior Elevate (American Medical Systems, Minnetonka, USA) between June 2012 and October 2016. Pre-operatively, the Prolapse Quality-of-Life questionnaire (P-QOL) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire-12 (PISQ-12) were completed. Post-operatively, women completed the P-QOL, PISQ-12 and the global impression of improvement questionnaire (PGI-I). Preoperative POP-Q and post operative POP-Q examination at up to 24 months follow up were recorded. At average follow up of 36 months, participants were interviewed via telephone using questions from the P-QOL, PISQ and PGI-I.Results: 45 women had single incision anterior vaginal mesh kit repair for recurrent prolapse. Postoperatively, 85% of women reported cure of their prolapse symptoms. At 24 months, 80.0% had POP-Q stage 0 or 1 in the anterior compartment, and 93.8% achieved anatomical cure of apical prolapse (point C above 0). During structured telephone interview at mean follow up of 36 months, on PGI-I, 70% reported feeling ‘much better’ or ‘very much better’.Conclusion: Vaginal surgery using single incision lightweight mesh kits can be an effective approach for women with recurrent anterior vaginal prolapse, resulting in subjective and objective cure rates of over 80% with reasonable safety profile up to 60 months postoperatively.