Page 89 - World Journal of Laparoscopic Surgery

CLINICAL TECHNIQUE
Laparoscopic Mesh Hernioplasty: A Novel Method of

Extraperitoneal Space Creation

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Manash Ranjan Sahoo , Leesa Misra , Sibabrata Kar , Jyotirmaya Nayak , Soumya Bharati Rout , Amiya Ranjan Parida ,
Pradeep Kumar Pradhan 7
AbstrAct
Introduction: In the era of laparoscopic surgery, total extraperitoneal (TEP) hernia repair has become the standard procedure for treatment of
inguinal hernias. While balloon is used to create extraperitoneal space in most Western countries, the financial burden of buying a balloon in
a developing country like India is overwhelming. So, we present a case series of extraperitoneal space creation using a zero-degree telescope
to reduce the cost of the surgery to a few thousand rupees (less than 100 dollars).
Context: Laparoscopic total extraperitoneal inguinal hernia repair.
Aims: To study the feasibility of creation of extraperitoneal space using a zero-degree telescope in laparoscopic total extraperitoneal hernia repair.
Materials and methods: It is a case series of 500 patients from June 2011 to July 2021. Furthermore, it is a single-surgeon experience.
Results: A Total of 500 laparoscopic TEP hernia surgeries were performed over a period of 10 years. Out of these, 485 patients were male and 15
patients were female. The age of patients ranged from 5 years to 85 years. Out of these, 50 patients (10%) were converted to transabdominal
preperitoneal (TAPP) hernia repair. During the follow-up period, no hernia recurrence was found. No major complication was noted in any
patients during this period. Seroma formation was noted in 25 patients (5%). Retention of urine was noted in 25 patients (5%). All patients
returned to normal routine work within 2 weeks.
Conclusion: Zero-degree telescope is a feasible method of creating extraperitoneal space in laparoscopic total extraperitoneal repair.
Key messages: Slight changes in advanced laparoscopic methods can make these costly procedures accessible to a vast population of poor
people in the world.
Keywords: Extraperitoneal space creation, Laparoscopic, Laparoscopic hernioplasty, Mesh hernioplasty, Total extraperitoneal repair.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1516

IntroductIon
1 Department of General Surgery, All India Institute of Medical Sciences,
Inguinal hernioplasty has progressed from tissue-based repair Bhubaneswar, Odisha, India
of Bassini and mesh repair of Lichtenstein to laparoscopic hernia 2–7 Department of General Surgery, SCB Medical College and Hospital,
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repair today which was reportedly first performed by Ger. Initially, Cuttack, Odisha, India
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surgeons used the TAPP method for hernia repair. But it was soon
found out that entering peritoneal cavity for hernia repair has its Corresponding Author: Jyotirmaya Nayak, Department of Surgery,
SCB Medical College and Hospital, Cuttack, Odisha, India, Phone: +91
own disadvantages such as inadequate closure of the peritoneum 9438037714, e-mail: drjmnayak@gmail.com
and injury to viscera from trocars and needles. To overcome these How to cite this article: Sahoo MR, Misra L, Kar S, et al. Laparoscopic
complications, total extraperitoneal (TEP) approach was developed. Mesh Hernioplasty: A Novel Method of Extraperitoneal Space Creation.
Total extraperitoneal approach eliminates complications related World J Lap Surg 2022;15(2):185–187.
to entry into the peritoneal cavity and reduces operative time in Source of support: Nil
bilateral hernias. 2,3
Extraperitoneal space creation is most commonly done by Conflict of interest: None
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balloon dissector as it simplifies the process. The space creation can
also be done without using balloon dissector. In this case, a zero- experience which has been done in a premiere Government
degree telescope (10 mm) is used to create the space by sweeping Institute in Eastern India.
down fibrofatty tissues to the sides. But this may be difficult All patients had to undergo pre-anesthesia checkup and fit
and time-consuming for inexperienced surgeons. Moreover, patients were taken up for surgery. All patients were catheterized
the surgeon may tear the peritoneum inadvertently leading to during the procedure, and the catheter was removed within few
conversion of TEP to TAPP. So here we present a case series of TEP hours after surgery. A 10 mm incision was given just below the
approach of laparoscopic hernia repair in which extraperitoneal umbilicus. Anterior rectus sheath was identified and incised to
space creation is done using a zero-degree telescope, thus reducing expose rectus muscle. Two right-angled retractors were used to
the cost of hernia surgery. retract rectus muscle laterally to expose the posterior rectus sheath.
A 10 mm trocar is pushed through the posterior rectus sheath to
enter the extraperitoneal space. A zero-degree telescope is then
MAterIAls And Methods introduced, and the space creation is done with gentle vertical
This is a case series of 500 patients from June 2011 to July 2021 with and horizontal motion and plane achieved by identification of
a follow-up period of atleast 1 year. This study is a single surgeon Cooper’s ligament. Two 5 mm ports are created under vision, one

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