Page 87 - World Journal of Laparoscopic Surgery

A Prospective Observational Study on Single-incision or Conventional Three-port Laparoscopic TEP Inguinal Hernia Repair

Figs 17A and B: Postoperative scar at (A) 1 week; (B) 2 months

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Wijerathne et al. reported that postoperative seroma was the VAS score at 6 hours in CTEP was 2.6 ± 1.3 and in the SILS TEP group
most common complication in both methods. All patients with 2.1 ± 1.5. VAS score at 24 hours was 2.1 ± 1.5 in the CTEP group and
seroma were managed conservatively without any intervention. SILS TEP group 1.5 ± 1.5. At 6 hours, p-value = 0.146 and 0.067 at
Postoperative seroma developed in 17% of cases undergoing CTEP 24 hours after surgery; hence the difference between CTEP and
and 8% of cases undergoing SILS TEP. SILS TEP was not statistically significant.
Thus our results are consistent with the above-given studies. The observation made in our study favored SILS TEP to be less
painful than CTEP, however, statistically insignificant. The findings
Hospital Stay were consistent with the observation made by Wijerathne et al.
Orals were started as soon as postoperative nausea was over and when VAS is compared at 6 and 24 hours.
the patient felt hungry. Patients in both groups were advised early
ambulation. As the patients became ambulant, tolerated orals, Cosmesis
and voided urine, they were discharged. The mean postoperative The cosmetic outcome of the patients was compared after 1 month
hospital stay in CTEP repair was 19.2 hours and in SILS TEP repair of surgery. Cosmetic results were graded subjectively 1 month
21.8 hours; (p-value of 0.97—statistically insignificant). postoperatively using the following range of choices: 5 (very
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Wijerathne et al. reported the mean hospital stay of 19.7 hours satisfied), 4 (satisfied), 3 (acceptable), 2 (dissatisfied), and 1 (very
in CTEP group and in SILS TEP group, it was 20.5 hours. dissatisfied) (Fig. 17). The mean cosmetic result was 3.9 ± 0.8 in the
Lomanto et al. reported in their study that the mean hospital CTEP group and 4.1 ± 0.9 in the SILS TEP group. The p-value = 0.14
stay for CTEP was 19.7 hours and for SILS TEP, it was 22.1 hours. which is statistically insignificant.
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Time Until Return to Normal Daily Work Tai et al. observe that the cosmetic outcome graded
In our study, the average time to resume normal nonstrenuous objectively by the patient was 3.9 ± 0.7 and 4.1 ± 0.8 in CTEP and
SILS TEP groups, respectively. The p-value = 0.14 which is statistically
work was 3.7 ± 0.8 days in CTEP repair and 3.3 ± 1.2 days in SILS insignificant.
TEP repair. Thus CTEP group had the almost same time to resume Thus concerning cosmetic outcomes, our results are consistent
normal work as the SILS TEP group. with the above study.
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Tai et al. observed that patients operated by CTEP repair
and SILS TEP repair return to normal work after a mean of 3.8 and Conversion to Open
3.4 days which was statistically nonsignificant. In our study of 30 patients with inguinal hernia undergoing CTEP/
Thus our observations were consistent with the results of other SILS TEP, there was no conversion to open technique.
studies. Choi et al. in his study “Single-port versus conventional three-
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port laparoscopic totally extraperitoneal inguinal hernia repair:
Postoperative Pain a randomized controlled trial” had no conversion to the open
The postoperative pain was calculated using a VAS score. VAS technique.
score was almost the same in CTEP and SILS TEP procedures.
VAS score was calculated at 6 and 24 hours after surgery. The Cost
mean VAS score at 6 hours in the CTEP group was 3.1 ± 2.8 and In our study, the cost in the SILS TEP group, using routine
in the SILS TEP group 2.8 ± 0.8. VAS score at 24 hours was 2 ± 1 laparoscopic instruments was not statistically different from the
and 1.2 ± 1.1 for CTEP group and SILS TEP group, respectively. At CTEP group without compromising patient safety. However,
6 hours, p-value = 0.5 and 0.32 at 24 hours after surgery. the actual cost for SILS TEP when using specialized articulating
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Wijerathne et al. concluded that pain score (VAS) at 6 hours, instruments is significantly higher.
24 hours, 1 week, 4 weeks, 3 months, and 6 months after surgery Observation made in our study was consistent with the
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was slightly higher in the CTEP group compared to SILS TEP group. study by Rajapandian et al., who in their study “single incision
World Journal of Laparoscopic Surgery, Volume 15 Issue 1 (January–April 2022) 85