Page 17 - WJOLS - World Journal of Laparoscopic Surgery

Laparoscopic Inguinal Hernia

MAterIAls And Methods after laparoscopic hernia repair. To avoid anxiety in patients, they
2
This is a randomized controlled clinical study carried out from should be forewarned about the possibility of CO trapped in the
scrotum, seroma formation, and discoloration of the scrotum and
November 2016 to July 2017 in 98 patients with inguinal hernias penis developing a few days after the operation.
admitted to surgery department of Minia University hospital. Patients are discharged either on the day of operation or on
Informed consent was taken. All patients were operated upon the following day, others occasionally having to remain in hospital
laparoscopically using prolene mesh. Patients were divided into because of previous medical conditions. All repairs are reviewed in the
two groups randomly. Group I includes 49 patients who underwent clinic two weeks postoperatively and any early complications noted.
laparoscopic TAPP hernioplasty with fixation and without fixation
of the mesh, and group II includes 49 patients who underwent
laparoscopic TEP hernioplasty with and without fixation of the ethIcAl ApprovAl
mesh. The mesh was in a size of 7.5 × 11 cm; doubling of mesh had The title, aim, and plan of the study were discussed and approved
been done in some cases, others tailoring of the mesh. Tailored regarding ethics of research in General Surgical Department, Minia
corner of mesh was positioned infero-medially over the Cooper’s Faculty of Medicine. Full written, informed consent was obtained
ligament and pubic bone fixed using a secure strap, while the from all participants. Manuscript was ethically conducted in
superior border of the mesh was fixed to posterior rectus and fascia accordance with Declaration of Helsinki.
transversalis in TAPP.
Demographic and clinical data were analyzed (age, type of results
hernia, operating time, size of the mesh, fixation of the mesh, This study was conducted on 98 patients with inguinal hernia. All
length of hospital stay, recurrence, intraoperative and postoperative patients had laparoscopic surgical repair with prolene mesh. One
complications). Rules for preoperative correction of general diseases female and 97 males suffering from inguinal hernia were included
and precipitating factors of hernia recurrence were followed. in the study with a mean age of 42.87 ± 15.02 years old (range
Patients were hospitalized the day before surgery and 18–73 years) in group I, 36.3 ± 15.18 years old (range 18–77 years)
underwent routine preoperative evaluation including chest X-ray, in group II.
ECG, laboratory studies, and abdominal ultrasound. The side of hernia in group I was right in 28.6% of patients, left
Prophylactic broad spectrum antibiotic (amoxicillin + clavulanic in 61.2% of them, and bilateral in 10.2%, while in group II 34.7%
acid) was administered at the induction of anesthesia. Some were right, 61.2% were left, and bilateral in 4.1%. The type of hernia
patients were operated upon under general anesthesia others in group I was direct in 31.5% of patients, indirect incomplete
under spinal anesthesia (then converted to general anesthesia (pubonocele or funicular) in 59.2% of them, and indirect complete
due to accidental opening of the peritoneum) with Foley catheter in 10.2%, while in group II 25.5% were direct, 64.7% were indirect
inserted in some cases of TAPP. incomplete (pubonocele or funicular), and indirect complete in
The postoperative care of laparoscopic patients immediately 9.8% (Table 1).
after the completion of the surgical procedure is important and Operative time in group I ranges between 40 and 110 minutes
includes appropriate monitoring during the early postoperative with mean time of about 66.85 minutes, while in group II
period usually in the recovery room to ensure a smooth transition ranges between 20 and 105 minutes with mean time of about
from the anesthetic. Most patients require only routine assessment 52.65 minutes. This difference was statistically significant (Table 2).
of vital signs. Acutely ill patients or those with significant cardiac We used single mesh, doubled mesh, and tailoring of the mesh
or pulmonary disease will require invasive monitoring in an done in some cases. In group I, fixation of the mesh was done in
intensive care unit. Appropriate fluids should be administered with 46.9% of the cases, while in group II fixation was done in 42.9%
consideration to the extent of the dissection, unless there is a specific (Table 3).
reason to leave the Foley catheter in place they should be removed.
Pain management following laparoscopy is generally easier Table 1: Patient’s demographics
than following other more invasive surgical procedures. Pain Group I (TAPP) Group II (TEP)
is generally much less with laparoscopy, one of the primary (n = 49) (n = 49) p value

advantages of this approach. Postoperative analgesia may consist Age: (years)
solely of oral medication. Advanced or lengthy procedures may be Range (18–73) (18–77) 0.034*
accompanied by more pain than simple procedures. Diaphragmatic
irritation is an important source of postoperative pain and may lead Mean ± SD 42.87 ± 15.02 36.3 ± 15.18
to complains of shoulder or neck discomfort. By the postoperative Sex
first day, intensity of the surgical pain generally decreases Male 49 (100%) 48 (98%) 0.315
significantly and at this point, patients can be maintained on oral Female 0 (0%) 1 (2%)
pain medication exclusively. Side of the hernia
Depending on the procedure, resumption of oral intake RT 14 (28.6%) 17 (34.7%) 0.455
can begin sooner than with other types of surgery. Following LT 30 (61.2%) 30 (61.2%)
laparoscopic hernioplasty liquids can be provided as soon as Bilateral 5 (10.2%) 2 (4.1%)
the patient awakens from the anesthesia or shortly thereafter,
patients are advanced to a normal diet and prepared for discharge. Types of hernia
Patients can generally return to work 48 hours after a laparoscopic Direct 17 (31.5%) 13 (25.5%) 0.793
hernia repair if they are not required to perform heavy lifting or Indirect incomplete 32 (59.2%) 33 (64.7%)
straining. If the patient is doing well without complications, they Indirect complete 5 (9.3%) 5 (9.8%)
may resume any heavy lifting, straining, or exercise two weeks *Statistically significant

World Journal of Laparoscopic Surgery, Volume 11 Issue 3 (September–December 2018) 125