Page 17 - WJOLS - Laparoscopic Journal

WJOLS

Efficacy and Safety of Laparoscopic Inguinal Hernia Repair
to repair the following 24 cases. Meshes were fixed with the authors in 2,559 patients. The TAPP technique was
titanium spiral tacks (Protack, Auto Suture, Tyco Health­ performed 1,944 times (60%), the totally preperitoneal
care). There were no noted intraoperative complications technique was performed 578 times (18%) and the IPOM
and no conversion was necessary. There were five minor repair was performed 345 times (11%). The plug-and-
postoperative complications (5.5%): Two seromas and patch technique was used 286 times (9%) while simple

three transient paresthesias. Analgesics were needed in closure of the hernia defect without mesh was performed
four patients (7.1%) after the first 24 hours. Mean hospital stay 76 times (2%). There were a total 336 complications
was 36 hours with a minimum of 24 and a maximum of 48. (10%): 17 major (0.5%) and 265 minor (8%). A total of 54
Resumption of normal activity was within a mean of recurrences (1.6%) were noted, within a mean follow-up
8 days with return to work in 2 weeks. Three recurrences of 22 months. The TAPP technique had 19 recurrences
were recorded (3.3%) within an average of 18 months of (1%) and 141 (7%) complications including four bowel
follow­up. obstructions due to herniation of small bowel through
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Fitzgibbons et al conducted a multicenter trial to the peritoneal closure and trocar sites. The totally pre­
determine if laparoscopic inguinal herniorrhaphy repre­ peritoneal technique had no noted recurrences and 60
sented a viable alternative to the conventional repair complications (10%). Those who underwent IPOM had
and to assess whether a prospective randomized con­ seven recurrences (2%) and 47 complications (14%).
trolled trial comparing both procedures is warranted. Patients who underwent the plug­and­patch technique
Three types of laparoscopic inguinal herniorrhaphies had 26 recurrences (9%) and 24 complications (8%).
TAPP, IPOM and TEP (EXTRA) were studied in a phase Simple closure of the internal ring had two recurrences
II design. A total of 21 investigators from 19 institutions (3%) and 10 complications (13%).
participated. There were 686 patients with 869 hernias; Rasim et al conducted a study to evaluate the inci­
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366 (42.1%) were direct, 414 (47.6%) were indirect, 22 (2.5%) dence of adhesion formation and the tensile properties of
were femoral, and 67 (7.7%) were combination hernias. the various techniques of laparoscopic inguinal hernio r-
Five hundred and sixty-two hernias underwent TAPP, rhaphy. The techniques evaluated included laparoscopic
217 hernias underwent IPOM, and 87 hernias underwent extraperitoneal mesh repair (EXTRA), TAPP mesh repair
EXTRA. The overall recurrence rate was 4.5%, with a and IPOM repair. Young male pigs underwent mesh
minimum follow­up of 15 months. Complications were placement using the above techniques and had a follow-
divided into the following three groups: (1) those related up for 6 weeks. No trocar site adhesions were observed.
to laparoscopy, (2) those related to the patient and (3) In the group that underwent EXTRA technique, no
those related to the herniorrhaphy. Laparoscopy related intraperitoneal adhesions were noted. One case of filmy
complications were noted in 5.4% of patients; there were
31 cases of bleeding or abdominal wall hematomas with omental adhesions was noted with the TAPP technique.
two patients requiring transfusions; there was one case of Two cases of adhesions were noted with the IPOM tech­
bowel perforation, which was sutured laparos copically; nique, one was minimal while the other was a case of
one bladder injury was managed with open surgery. dense adhesions to the bladder. Mesh tensile strength was
Patient complications occurred in 6.7% with 5.8% invol- compared for the three techniques and measured using a
ving the urinary tract. Secondary abdominal procedures tensio meter. Both the EXTRA and TAPP were comparable
had to be performed on two patients for adhesions, one and significantly stronger (p < 0.05), with tensiometric
for pain in the right lower quadrant and the other for values of 0.69 ± 0.03 and 0.60 ± 0.02 Kg respectively. The
adhesive small bowel obstruction. The sole mortality IPOM technique resulted in the weakest tensile strength
(0.1%) was due to a myocardial infarction on postopera­ of 0.53 ± 0.01 Kg (mean ± SEM).
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tive day 5. Complications related to the herniorrhaphy Sarli et al conducted a study to evaluate the safety
itself were noted in 17.1% of the cases, most of which and efficacy of two techniques of laparoscopic hernia
were minor: transient groin pain (3.5%), seroma (3.5%), repair: the TAPP technique and the IPOM technique.
transient leg pain (3.3%), hematoma (1.5%), or transient From May 1992 to October 1994, 115 patients with 148
cord or testicular problems (0.9%). As surgeons became hernias were included in the trial, 59 of which under­
more familiar with the anatomy of the nerve supply to went TAPP and 56 underwent IPOM. The TAPP took
the groin when viewed laparoscopically, the incidence of significantly longer to perform the IPOM. No intra­
leg pain decreased dramatically. Ninety­three percent of operative complications, conversions to open repair,
patients were discharged within 24 hours postoperatively. nor postoperative deaths were noted in either group.
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A study by Phillips et al reported on the complica­ There were 10 postoperative complications in the
tions of 3,229 laparoscopic hernia repairs performed by TAPP group (16.9% of patients) and 14 postoperative

World Journal of Laparoscopic Surgery, September-December 2015;8(3):81-84 83