Page 16 - WJOLS - World Journal of Laparoscopic Surgery

RESEARCH ARTICLE
Factors Guarantee Competence of Laparoscopic Repair of

Inguinal Hernia

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Amr Elheny , Khaled Mahran , Abdel F Saleh 3
AbstrAct
Aim: To evaluate the impact of age, type of hernia, size of the mesh used, and fixation of the mesh on the competence of laparoscopic repair
of inguinal hernia.
Materials and methods: Randomized controlled clinical study carried out from November 2016 to July 2017 in 98 patients with inguinal hernias
admitted to surgery Department of Minia University Hospital. Patients were divided into two groups randomly. Group I includes 49 patients
who underwent laparoscopic transabdominal preperitoneal (TAPP) hernioplasty and group II includes 49 patients who underwent laparoscopic
totally extra peritoneal (TEP) hernioplasty with and without fixation of the mesh.
Results: Operative time in group I ranges between 40 minutes and 110 minutes with mean time of about 66.85 minutes, while in group II ranges
between 20 minutes and 105 minutes with mean time of about 52.65 minutes. This difference was statistically significant. Pain was 8.2% in
group I and 10.2% in group II. Scrotal edema was 0% in all patients in both groups. Urinary retention was 2% in group I and 4.1% in group II.
Seroma was the same (6.1%) in both groups. Recurrence after 6-month follow-up was 2% in both groups. All recurrent cases are nonfixed.
Conclusion: There is no difference between TEP and TAPP, but TAPP technique appears to be superior to the TEP repair in patients undergoing
unilateral inguinal hernia repair.
Clinical significance: The TEP approach can be offered to patients with bilateral and recurrent hernias. TEP procedure was associated with
more adverse events during surgery but less postoperative pain, faster recovery of daily activities, quicker return to work, and less impairment
of sensibility after 1 year.
Keywords: Inguinal hernia, Laparoscopic, Minia.
World Journal of Laparoscopic Surgery (2018): 10.5005/jp-journals-10033-1353

IntroductIon 1–3 Department of General Surgery, Minia University, Minia, Egypt
Inguinal hernias comprise approximately 7% of all surgical Corresponding Author: Amr Elheny, Department of General Surgery,
outpatient visits. Male-to-female ratio is 8:1. They affect 1–3% of Minia University, Minia, Egypt, Phone: +20 1277340340, e-mail: amr_
young children. In men, the incidence rises from 11 per 10,000 elheny@yahoo.com
person-years, aged 16–24 years, to 200 per 10,000 person-years, How to cite this article: Elheny A, Mahran K, et al. Factors Guarantee
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aged 75 years or above. Competence of Laparoscopic Repair of Inguinal Hernia. World J Lap
Conventionally, there are two types of inguinal hernia: Surg 2018;11(3):124–127.
Indirect—a protrusion through the internal inguinal ring passes Source of support: Nil

along the inguinal canal through the abdominal wall, running Conflict of interest: None

laterally to the inferior epigastric vessels. This is the more common
form accounting for 80% of inguinal hernias, especially in children. It
is associated with failure of the inguinal canal to close properly after technique. The three techniques are based on the principles of
passage of the testis in utero or during the neonatal period. Direct— using mesh prosthesis to cover the defect of the abdominal wall
the hernia protrudes directly through a weakness in the posterior from inside. 7–9
wall of the inguinal canal, running medially to the inferior epigastric The advantages over conventional surgery are primarily pain
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vessels. It is more common in the elderly and rare in children. reduction, shorter length of hospital stay, and faster resumption of
Inguinal hernia repair is the most frequently performed usual activities. In addition, many studies also show lower morbidity
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operation in general surgery. The standard method for inguinal rates and less impairment of the immune system.
hernia repair had changed little over a hundred years until the Disadvantages of the laparoscopic technique compared with
introduction of synthetic mesh. This mesh can be placed by either conventional surgery include the higher operating room costs, time
using an open approach or by using a minimal access laparoscopic consuming specially in the early learning curve of the surgeons, and
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technique. the need for general anesthesia.
Although open mesh-based tension-free repair remains the
standard operation, laparoscopic hernioplasty in the hands of
adequately trained surgeons produces excellent results comparable objectIve
to those of open repair. 4–6 The purpose of this study was to evaluate the impact of age, type
The techniques of laparoscopic hernioplasty include of hernia, size of the mesh used, and fixation of the mesh on the
TAPP, TEP approach, and intraperitoneal onlay mesh (IPOM) competence of laparoscopic repair of inguinal hernia.

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