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          Utpal De, Pronoy Kabiraj                                              10.5005/jp-journals-10033-1326
          ORIGINAL ARTICLE


          Preoperative Infraumbilical Anthropometry: A Selective

          Guide to Endoscopic Hernia Repair—A Pilot Study

                   2
          1 Utpal De,  Pronoy Kabiraj

          ABSTRACT                                                     Table 1: Indications for TAPP and TEP 1
          Introduction: Specific preoperative indications for endoscopic   TEP         TAPP
          hernia repair are nonexistent. The study was aimed to examine   Primary hernia: Unilateral or   Incarceration or strangulation
          the feasibility of preoperative infraumbilical anthropometry (PIA)   bilateral
          as a guide to define endoscopic repair.             Recurrent hernia following   Scrotal hernias
                                                              open hernia repair
          Materials and methods: Forty-five patients were recruited for
          the study based on predefined inclusion and exclusion criteria.   Prior abdominal surgical   Inguinodynia
                                                              history—even involving midline
          Preoperative anthropometric measurements (fixed bony points
          of pelvis and umbilicus) were done. All patients were subjected   Open prostatectomy  Recurrence after TAPP or TEP
          to total extraperitoneal repair (TEP). Failure of TEP was con-               Patients with previous
          verted  to  transabdominal  preperitoneal  repair  (TAPP)  and               Pfannenstiel incision
          reasons for conversion were noted and statistically analyzed.
                                                                                                   3
          Results: A total of 33 patients underwent TEP (73.3%) and 12  TEP as the available working space is more.  But TEP has
          (26.7%) patients had to be converted to TAPP. Raised body   the advantages of less postoperative pain, early ambu-
          mass index (BMI) [mean 22.53, standard deviation (SD) 0.35,   lation, and lower recurrence rate.  Lack of peritoneal
                                                                                            2-4
          p < 0.001], increased infraumbilical fat pad thickness (mean
          2.77 cm, SD 0.27, p < 0.00), and pelvic anthropometric param-  breach and nonfixation of mesh has led to cost-effective
          eters were found to be significant (p < 0.001).     outcome. Though several factors have been postulated
                                                                                                              2
          Conclusion: Preoperative pelvic anthropometry could be a   as contraindications for TEP and indications for TAPP,
          selective guide to endoscopic hernia repair.        none of the reports have taken into consideration PIA as
          Keywords: Anthropometry, Endoscopy, Hernia, Treatment.  a guide to endoscopic hernia repair.
                                                                 Our study was aimed to explore this gray area to
          How to cite this article: De U, Kabiraj P. Preoperative Infra-
          umbilical Anthropometry: A Selective Guide to Endoscopic   deduce if PIA could guide endoscopic herniologist to
          Hernia Repair—A Pilot Study. World J Lap Surg 2018;11(1):8-11.  choose specific (TEP/TAPP) surgery for defined patients
          Source of support: Nil                              with inguinal hernia.
          Conflict of interest: None
                                                              MATERIAlS AND METHODS
                                                              The study was performed in the Department of Surgery
          INTRODUCTION
                                                              from March 2014 to February 2015. Forty-five patients
          A quarter of a century has passed since minimally inva-  with inguinal hernia were included in the study. All
          sive hernia surgery assumed a place in the pantheon of  the patients were admitted through the outpatient
          hernia repair. Since then, numerous studies have been  department. After proper history taking and thorough
          published focusing primarily on intraoperative con-  clinical examination, patients were recruited based on
                                        1
          strains and postoperative outcome.  During the same time  specific inclusion and exclusion criteria. Inclusion crite-
          frame, certain individualistic indications do seem to cry  ria included patients of any sex, age more than 18 years,
                                                  2
          out for a hernia-specific endoscopic approach  (Table 1).  primary, unilateral, uncomplicated, incomplete, reduc-
             Specific preoperative patient selection criteria for a  ible, direct or indirect, inguinal hernias.
          particular endoscopic technique is yet to be evolved.   Exclusion criteria included patients with bilateral
          Transabdominal preperitoneal is considered superior to  hernia, previous lower abdominal surgery (open prosta-
                                                              tectomy, lower segment cesarean section, appendectomy
                                                              scar, and midline laparotomy scar), soft tissue tumors in
                    2
           1 Professor,  Postgraduate Trainee                 the inguinal region on abdominal sonography, patients
           1,2 Department of General Surgery, Bankura Sammilani Medical   with concomitant varicocele, undescended testes, ingui-
           College, Bankura, West Bengal, India               nal lymphadenopathy, general contraindications for

           Corresponding Author: Utpal De, Professor, Department of   laparoscopic surgery, and unwilling patients.
           General Surgery, Bankura Sammilani Medical College, Bankura   History taking included duration, straining factors
           West Bengal, India, e-mail: utpalde@vsnl.net
                                                              (chronic  cough,  lower  urinary  tract  symptoms,  and
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