Page 23 - Journal of Laparoscopic Surgery

WJOLS

A Comparative Randomized Parallel Group Study between the Classical TAPP Repair and Modified TAPP
while most advocates anchoring the mesh to prevent migra- technique, it gave superior result regarding operating
tion, many others suggest it unnecessary; 20,21 moreover, time and incidences of chronic pain. Cost of surgery was
injudicious application of tack or staple below iliopubic signifi cantly less while giving compatible result regarding
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tract carries an inherent risk of nerve damage. very high analgesic requirement, time for return to work and hospital
proportional incidence of chronic pain in patients on whom stay. For ethical reason, direct evidence of effectiveness
helical tack was used for mesh fixation and peritoneal closure of this technique in providing peritoneal cover for the
in this study needs due attention as a potential cause of such pros thesis was not collected during the trial, it provided
pain of somatic and neural origin. Intraoperative complica- enough indirect and limited direct evidence in support of the
tions though rare, are serious in nature, mostly in the form alternate hypothesis of peritoneal cover, as proposed in the
of visceral injury. 18,23,24 Trials have shown reduction of study which did not assess and compared intra-abdominal
complications and operating time with increased experience. adhesions in real time but it closely monitored the expected
Postoperative gastrointestinal complications are port-site clinically significant effects of adhesion and found the end
hernia, internal herniation from improper peritoneal closure result extremely satisfactory and answered the research
and adhesion leading to intestinal obstruction and occasional question comprehensively by providing a more physiological
fistulisation when bowel is involved. 4, 25-27 Bowel obstruc- alternative way of proving a peritoneal cover for prosthesis
tion by herniation through trocar site or imperfect closure and provokes the need for further studies to see if the study
3
of peritoneum occur earlier (8 days) than obstruction from outcome can be reproduced.
adhesion which commonly happens after a month (mean
2
onset 25 days), just as majority of hernia recurrences follow- RefeRenCeS
6
ing LIHR develops within a year. Both these statistics fall 1. Davis CJ, Arregui ME. Laparoscopic repair for groin hernias.
within purview of follow-up done in this study. Surg Clin North Am 2003;83(5):1141-1161.
With preoperative and major postoperative complica- 2. Liem MS, van der Graaf Y, van Steensel CJ, Boelhouwer RU,
tion like recurrence brought down to acceptable level in Clevers GJ, Meijer WS, Stassen LP, Vente JP, Weidema WF,
LIHR, the focus now have shifted to other parameters like Schrijvers AJ, et al. Comparison of conventional anterior surgery
chronic pain, analgesic requirement, return to work and most and laparoscopic surgery for inguinal-hernia repair. N Engl J
Med 1997;336(22):1541-1547.
importantly the cost of surgery which is so important that 3. Laparoscopic versus open repair of groin hernia: a randomised
advantages of LIHR with shorter convalescence and early comparison. The MRC laparoscopic groin hernia trial group.
return to work when weighed against cost, it leaves only Lancet 1999 Jul 17;354(9174):185-190.
bilateral and recurrent hernias following anterior approach 4. Krähenbühl L, Schäfer M, Schilling M, Kuzinkovas V, Büchler
MW. Simultaneous repair of bilateral groin hernias: open or lapa-
the undisputed indications of LIHR. 28 roscopic approach? Surg Laparosc Endosc 1998;8(4):313-318.
Seroma developed early (within 1 month) though 5. Tsang S, Normand R, Karlin R. Small bowel obstruction: a
spontaneously resolved relatively quickly and occurred morbid complication after laparoscopic herniorrhaphy. Am Surg
almost exclusively following repair of direct hernia in this 1994;60(5):332-334.
study. This fact highlights the importance of inversion of 6. McKay R. Preperitoneal herniation and bowel obstruction post
laparoscopic inguinal hernia repair: case report and review of
fascia transversalis either by fixing it to pubic bone or by the literature. Hernia 2008;12(5):535-537.
application of endoloop at the base of inverted fascia and 7. Phillips EH, Arregui M, Carroll BJ, Corbitt J, Crafton WB,
amputating the redundant portion, 29,30 neither of which Fallas MJ, Filipi C, et al. Incidence of complications following
was performed in this study. Chronic pain developed late laparoscopic hernioplasty. Urology 2010 Nov;76(5):1078-1082.
(by 6 months) and carried a rather protracted course, but 8. McCormack K, Wake B, Perez J, Fraser C, Cook J, McIntosh E,
vale L, Grant A. Laparoscopic surgery for inguinal hernia repair:
resolved with counseling, analgesics and neuromodulating systematic review of effectiveness and economic evaluation.
drugs like amitriptyline in vast majority of cases. As reported Health Technol Assess 2005;9(14):1-203.
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in an earlier study , postoperative hydrocele developed late, 9. Lowham AS, Filipi CJ, Fitzgibbons RJ Jr, Stoppa R, Wantz GE,
progressed with time and required surgery as they did not Felix EL, Crafton WB. Mechanisms of hernia recurrence after
resolve spontaneously. They developed in larger indirect preperitoneal mesh repair. Traditional and laparoscopic. Ann
Surg 1997;225(4):422-431.
hernias where complete dissection of sac was not possible. 10. Tetik C, Arregui ME, Dulucq JL, Fitzgibbons RJ, Franklin ME,
Regarding cost advantage, each procedure of modified McKernan JB, Rosin RD, Schultz LS, Toy FK. Complications
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TAP saved $ 130 by avoiding use of hernia tack, over and and recurrences associated with laparoscopic repair of groin
above the savings from shorter operating time. hernias. A multi-institutional retrospective analysis. Ann Surg
1994;8(11):1316-1323.
The study concludes that, while offering equality of 11. Soltés M, Pazinka P, Radonak J. Laparoscopic hernioplasty TAPP
clinical outcome regarding gastrointestinal complications in treatment of groin hernia—10 years experience. Rozhl Chir
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World Journal of Laparoscopic Surgery, January-April 2014;7(1):16-22 21