Page 18 - World Journal of Laparoscopic Surgery

Study of Selection of Method of Laparoscopic Inguinal Hernia Repair
Table 9: Scrotal edema Table 13: Types of hernia
LAP hernia repair Scrotal edema (%) Type of hernia Total Present study (%) Rutkow and Robbins (%)
TAPP 2 Direct 70 70 68
TEP 0 Indirect 30 30 32

Table 10: Shoulder pain Table 14: Types of surgery
Shoulder pain Type of surgery Present study
LAP hernia repair Total Percentage TEP 50
TEP 0 of 50 0 TAPP 50
TAPP 2 of 50 4
26 cases in the 45–64 age group were the highest cases. The age
Table 11: Duration of hospital stay incidence of our study matches the above study. In our study, the
average mean age is 45.40. The mean average age 55.98 ± 12.71
Hospital stay (days) was found in the study by Choi et al. 3
LAP hernia repair 1 2 3 4 Laparoscopic inguinal hernia repair is done under general
TEP 0 45 5 0 anesthesia whereas open inguinal hernia repair is usually done under
TAPP 0 40 8 2 local or spinal anesthesia. So, in elderly patients who are usually
comorbid, the laparoscopic procedure becomes riskier, making it
a disadvantage of the laparoscopic procedure. Laparoscopic hernia
Table 12: Age of the patients at presentation
repair is an ideal procedure in young and in non-comorbid elderly
Age (years) Present study (100 cases) Rutkow and Robbins study patients. In TEP, there is the formation of pneumo-preperitoneal
<15 – 18 (18%) space creation is done while in TAPP pneumoperitoneum is created
15–44 44 (44%) 26 (26%) so in conditions in which pneumoperitonem is contraindicated we
45–64 52 (52%) 30 (30%) can still go for TEP.
>65 4 (4%) 26 (26%) Types of Hernia
In our study, the average percentage of incidence of direct hernia
• Surgical emphysema: Incidence of surgical emphysema was was 58% while for indirect hernia it was 42%, and the mean age
reported in 24% of cases of TEP repair and 0 in TAPP (Table 8). group in our study was 45.40 years. That is because older patients
• Scrotal edema: Incidence of surgical scrotal edema was reported have more chance to develop direct hernia rather than indirect
in 2% of cases in TAPP in an indirect hernia. Reason being we are hernia. The incidence of different types of hernia in our study is
able to dissect the indirect hernial sac easily in TEP as compared consistent with the analysis of the hernia centers 8-year series of
to TAPP according to our experience (Table 9). 2,861 primary hernias (Table 13).
• Shoulder pain: Incidence of shoulder pain was reported in 4%
of cases in TAPP due to abdominal distention by the creation of Types of Surgery
pneumoperitoneum while in TEP, there was no shoulder pain In this study, 50 cases underwent TEP repair and 50 cases underwent
reported as there was no need for pneumoperitoneum creation TAPP (Table 14). The patients were randomly chosen for the different
(Table 10). surgeries.
• Urinary retention: No incidence of urinary retention was reported Laparoscopic TEP repair is technically more difficult than
as all cases were catheterized preoperatively. laparoscopic TAPP repair. In TAPP pneumoperitoneum is created
• Recurrence: Incidence of recurrence was not reported in and later peritoneal flap dissection is done. It is the lucid procedure
laparoscopic inguinal hernia repair cases. as compared to the dissection of preperitoneal space by balloon
• Duration of hospital stay: The mean duration of the hospital stay inflation in TEP. According to the basic principles of laparoscopic
was found to be 2.17 days for the laparoscopic inguinal hernia surgery, in the TEP procedure, there is no triangulation of ports,
repair. Since ours is a teaching institution the minimum time which makes it a challenging procedure.
taken from admission to surgery is 1 day hence making the It is advisable to repair a recurrent hernia previously operated
duration of the hospital stay apparently longer (Table 11). by open repair, by the laparoscopic method as a smaller number
of adhesions are encountered and a smaller number of additional
defects are missed. One of our patients, who was operated by an
dIscussIon open Lichtenstein repair method 3 years ago, developed recurrence.
Age He was easily managed for recurrent hernia by TAPP procedure.
In our study, the maximum age of the patients at the time of
operation was 68 years and the minimum age was 16 years. The Duration of Surgery
highest age group was between 45 and 64 years. In a study by In our study, the time for laparoscopic inguinal hernia repair (TEP/
2
Rutkow and Robbins, the age at presentation is discussed as TAPP) was 90 minutes compared to the Udwadia Tehemton study
4
follows. It is compared with this study (Table 12). which was taking around 67.5 minutes. In the medical research
In the study of Rutkow and Robbins, the highest incidence was council (MRC) trial, the operating time was 58.4 minutes for the
in the age group 45–64 years, which was in 30 cases. In our study, laparoscopic inguinal hernia repair group (Table 15).

World Journal of Laparoscopic Surgery, Volume 16 Issue 1 (January–April 2023) 17