Page 23 - World Journal of Laparoscopic Surgeons
P. 23

Utpal De, Pronoy Kabiraj
                                Table 2: Multivariate analysis of anthropometric parameters of the patients
                           Type of surgery     No.        Mean             SD               “t”/M-W-U test (p-value)
           BMI             TEP                 33         19.400909        0.7792960          0.000* (<0.001)
                           TAPP                12         22.530000        0.3529615
           ASIS–ASIS       TEP                 33         24.221           0.7897             23.000* (<0.001)
                           TAPP                12         22.875           0.2379
           U–ASIS          TEP                 33         15.463636        0.7175558          14.000* (<0.001)
                           TAPP                12         14.000000        0.1705606
           U–SP            TEP                 33         15.684848        0.3977446          8.983 (<0.001)
                           TAPP                12         14.508333        0.3604501
           SP–ASIS         TEP                 33         14.982           0.6989             63.500* (0.001)
                           TAPP                12         14.158           0.3288
           FAT PAD         TEP                 33         1.791            0.1974           −13.371 (<0.001)
                           TAPP                12         2.775            0.2701
           *Mann–Whitney U test done; M-W-U: Mann–Whitney U test; FAT PAD: fat pad thickness


             Endoscopic hernia repair is another armamentarium  working space, better visualization, and greater freedom
          in this gallery of hernia repair. Though the technical  of movement.
                                                    2,5
          procedure is the same, the approach is different.  More-  The other outcome from our study was that TEP
          over, the anatomy, working space, surgeon’s capability,  should be the initial procedure to start with as failure
          learning curve, cost-effectiveness, complications, recur-  still does not preclude the patient from TAPP, whereas
          rence, and overall patients’ demand, satisfaction and  failure in TAPP leaves the patients with the only option
          acceptability 1-6,8  have placed hernia surgeons in peculiar  for open hernia repair.
          dilemma never seen before. General surgeons perform-   Our results are also consistent with other studies as
          ing hernia surgery in an attempt to master endoscopic  regards intraoperative complications, cost effectiveness,
          repair grope hard to adhere to one or the other procedure  postoperative outcome, and patient satisfaction. 1-8
          based purely on evidences laid by surgeons practicing a   To conclude, we can say that PIA could be helpful for
          particular procedure rather than appreciating the techni-  defining patients undergoing endoscopic hernia repair,
          cal details which would suit them. As endoscopic hernia  though a larger series with more number of patients is
          surgery is ergonomically driven, a particular procedure  warranted. There should be no graduation parameters
          suitable and comfortable to one surgeon might not be   of adapting from one procedure to another and it is up
          compatible with the other. As such, the issue of learn-  to the operating surgeon to decide which procedure is
                  3-6
          ing curve  for a particular procedure before promoting   ergonomically beneficial to him or her.
          oneself to another procedure does not hold true. Rather,
          mastering one technique which ergonomically suits a   REFERENCES
          particular surgeon through constant practice should be     1.  Köckerling F, Bittner R, Jacob DA, Seidelmann L, Keller T,
          the order of the day.                                   Adolf D, Kraft B, Kuthe A. TEP versus TAPP: comparison of
             Currently, there are no specific preoperative indica-  the perioperative outcome in 17,587 patients with a primary
          tions for endoscopic TEP or TAPP barring some anatomi-  unilateral inguinal hernia. Surg Endosc 2015 Dec;29(12):
                                                                  3750-3760.
                        2-5
          cal hindrances.  Endoscopic hernia surgeons tend to     2.  McCormack K, Wake BL, Fraser C, Vale L, Perez J, Grant A.
          promote and propagate the repair in which an individual   Transabdominal pre-peritoneal (TAPP) versus totally
          surgeon has garnered strength. These are mainly based   extraperitoneal (TEP) laparoscopic techniques for inguinal
          on their individual technical difficulties faced during   hernia repair: a systematic review. Hernia 2005 May;9(2):
          operation and postoperative outcome. Keeping in view of   109-114.
          the above consideration, our study aimed to define some     3.  Bracale U, Melillo P, Pignata G, Di Salvo E, Rovani M,
          predefined anthropometric parameters 9,10  which could   Merola G, Pecchia L Which is the best laparoscopic approach
                                                                  for inguinal hernia repair: TEP or TAPP? A systematic review
          guide surgeons to perform a particular endoscopic repair   of the literature with a network meta-analysis. Surg Endosc
          for each individual hernia. In other words, endoscopic   2012 Dec;26(12):3355-3366.
          repair should be individualistic rather than a general-    4.  Cohen RV, Alvarez G, Roll S, Garcia ME, Kawahara N,
          ized approach.                                          Schiavon CA, Schaffa TD, Pereira PR, Margarido NF,
             Our study statistically proved that patients with high   Rodrigues AJ. Transabdominal or totally extraperitoneal
          BMI, increased infraumbilical fat pad, and patients with   laparoscopic hernia repair. Surg Laparosc Endosc 1998
                                                                  Aug;8(4):264-268.
          a narrow pelvis were more likely to benefit from TAPP     5.  Belyansky I, Tsirline VB, Klima DA, Walters AL, Lincourt AE,
          rather than TEP. This was due to availability of more   Heniford TB. Prospective, comparative study of postoperative
          10
   18   19   20   21   22   23   24   25   26   27   28