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RESEARCH ARTICLE
Laparoscopic Totally Extraperitoneal Repair Using

Three-dimension Mesh to Treat Bilateral Inguinal Hernia

in Adults

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Phuoc Van Nguyen , Minh Quang Dao , Quyet Van Ha , Thuong Van Pham , Truong Van Nguyen , Thang Quyet Tran , Anh
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Thuy Tran , Son Ngoc Vu , Hien Van Nguyen 9
AbstrAct
Aim: This study is aimed to examine the effectiveness of laparoscopic totally extraperitoneal (TEP) repair using three-dimension (3D) mesh to
treat bilateral inguinal hernia in adults.
Materials and methods: We conducted case series on 50 patients with bilateral inguinal hernias undergoing laparoscopic TEP surgery using
3D mesh at Thanh Nhan Hospital from January 2017 to June 2019.
Results: Of 50 patients, 66.0% of patients had a direct inguinal hernia and 34.0% of patients had an indirect inguinal hernia. The diameter of the
herniated hole was mainly from 1.5 to 3 cm in 84.0% of patients. There were 82% of patients using small 3D mesh (8.5 × 13.7 cm) and one case required
mesh fixation (2.0%). Seven patients (14.0%) had complications during surgery. The average postoperative pain time was 2.2 ± 1.5 days (1–15 days).
Pain degree decreased gradually from day 1 to day 3. By day 3 after surgery, 94% of patients had only slight pain, two patients (4.0%) had mild pain,
and one patient (2.0%) had moderate pain. All patients were followed for a mean of 21.4 ± 11.8 months (minimum 1 month, maximum 40 months).
At 1 month postoperative, there was one patient with chronic pain in the groin (2.1%). After 6, 12, and 24 months, no recurrence was recorded.
Conclusion: TEP laparoscopic surgery using 3D mesh is a safe, feasible, and effective method in bilateral inguinal hernia in adults, with low
rates of complications and recurrence.
Keywords: Bilateral inguinal hernia, Laparoscopic totally extraperitoneal, Three-dimension mesh.
World Journal of Laparoscopic Surgery (2021): 10.5005/jp-journals-10033-1471

IntroductIon 1,3,5 Department of General Surgery, Thanh Nhan Hospital, Hanoi,
An inguinal hernia is a phenomenon where organs or tissues in Vietnam
the abdomen protrude through the groin or a weak spot of the 2,4 Department of Surgery, Hai Phong University of Medicine and
abdominal muscles, on the inguinal ligament under the skin or Pharmacy, Hanoi, Vietnam
down the scrotum. This is a common medical condition occurring 6 Department of Obstetrics and Gynecology, Thanh Nhan Hospital,
in 1–5% of the general population, of which 15–20% are bilateral Hanoi, Vietnam
1,2
inguinal hernias. Annually, in the United States, more than 800,000 7 Department of Functional Test, National Hospital of Traditional
inguinal herniation surgeries are performed, and about 15% of Medical, Hanoi, Vietnam
which are bilateral inguinal hernias. 2 8,9 Department of Colorectal Surgery, Military Central Hospital 108,
Laparoscopic surgery for inguinal hernia was first reported Hanoi, Vietnam
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by Ger. Since then, inguinal hernia treatment has undergone * Equally contributed to this manuscript
revolutionary technical advances. Among the surgical methods of
laparoscopic inguinal hernia, laparoscopic totally extraperitoneal Corresponding Author: Phuoc Van Nguyen, Department of General
Surgery, Thanh Nhan Hospital, Hanoi, Vietnam, e-mail: dr.phuocnv@
(TEP) and the transabdominal preperitoneal (TAPP) approaches are gmail.com
the widely accepted alternatives with superiority over open surgery
such as pain relief, reduction of postoperative complications, short How to cite this article: Nguyen PV, Dao MQ, Ha QV, et al. Laparoscopic
Totally Extraperitoneal Repair Using Three-dimension Mesh to Treat
hospital stays, and early return to normal activities. 4–6 Bilateral Inguinal Hernia in Adults. World J Lap Surg 2021;14(3):195–200.
In addition to technical innovations, the advent and the Source of support: Nil
development of artificial mesh revolutionarily change the inguinal
hernia treatment. In 1950, Francis Usher used a flat polypropylene Conflict of interest: None
mesh for the first time to treat inguinal hernia and surgical herniation.
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Since then, the artificial mesh has been widely used to reduce the area in laparoscopic surgery for the treatment of inguinal hernia.
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rate of recurrent inguinal hernia. However, a disadvantage of the flat Since then, many studies around the world have shown that the use
artificial mesh is that it is easy to roll and move from the placement of 3D mesh in the treatment of inguinal hernia is safe and effective as
or increase the postoperative pain by 4–6% due to the use of fixed well as causes low postoperative pain rate and low recurrence rate. 4,7,9
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tools or sutures. To minimize this drawback, in 1999, Bell was one For bilateral inguinal hernia, until now, there is still much
of the first surgeons to use a three-dimension (3D) mesh with the debate about the choice of treatment strategy (simultaneous
bending shape according to the anatomical structure of the groin or unilateral repair), approaches (open surgery, TEP, or TAPP), or

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