Page 90 - World Journal of Laparoscopic Surgery

Laparoscopic Mesh Hernioplasty: A Novel Method of Extraperitoneal Space Creation

Fig. 1: 10 mm trocar being placed behind the rectus muscle Fig. 3: Extraperitoneal space creation being done with zero-degree
telescope

Fig. 2: Zero-degree telescope being used Fig. 4: Mesh being sutured to Cooper’s ligament

4–5 cm above the pubis and another in the middle. Hernial sac is laparoscopically with no conversion. Out of these, 50 patients (10%)
identified, separated from cord structures, and pushed cephalad. were converted to TAPP due to either the inability to create a space
The edge of the peritoneum is freed from vas deferens and testicular due to previous surgery or due to inadvertent creation of bigger-
vessels and pushed downward. Now, a 15 × 15 cm prolene mesh is size rent in the peritoneum. During the follow-up period, no hernia
introduced through the 10 mm port and is positioned medially to recurrence was found. No major complication was noted in any
overlap the pubic bone and laterally 2 cm beyond the deep ring. patients during this period. Few minor complications were noted.
The mesh is fixed using prolene suture to the Cooper’s ligament Seroma formation was noted in 25 patients (5%), which got resolved
using single intracorporeal prolene suture. The abdomen is deflated within 6 months with conservative treatment. Retention of urine
under vision, so as to ensure no wrinkling of the mesh. All ports was noted in 25 patients (5%). In these patients, recatheterization
are closed and pressure bandage is given over the deep ring. All was done. No other complications were noted. All patients returned
patients were given intravenous antibiotics for 1 day and analgesics to normal routine work within 2 weeks.
for 2 days. Patients were discharged on the third day and follow-up
was done after 1 month. Subsequent follow-up was done on yearly dIscussIon
basis (Figs 1 to 4).
This single-surgeon experience supports extraperitoneal space
creation using a zero-degree telescope to reduce the cost of
results laparoscopic hernia surgery in developing countries like India.
A total of 500 laparoscopic TEP hernia surgeries were performed Most commonly, balloons are used to create the extraperitoneal
over a period of 10 years. The follow-up period was minimum of space. The cost of a balloon in India is around 20,000 rupees (~300
1 year. Out of these, 485 patients (97%) were male and 15 patients dollars), which is almost five times the total cost of hernia surgery.
(3%) were female. All patients had undergone pre-anesthetic Also, intracorporeal suturing eliminates the need of tacker, which
checkup, and only fit patients were included in the study. Age of saves another 25,000 rupees (~400 dollars). The incidence of
5
patients ranged from 5 years to 85 years. All patients were operated seroma formation in TEP is reported to be around 7% in other

186 World Journal of Laparoscopic Surgery, Volume 15 Issue 2 (May–August 2022)