Page 2 - WJOLS - Journal of Laparoscopic Surgery

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WJOLS
WJOL

10.5005/jp-journals-10033-1311
Short-term Results of Laparoscopic TAPP Inguinal Hernioplasty
ORIGINAL ARTICLE

Short-term Results of Laparoscopic Transabdominal

Preperitoneal Inguinal Hernioplasty in a Developing
Country

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1 Tanweer Karim, Vivek K Katiyar, Rabishankar Singh, Subhajeet Dey
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ABSTRACT How to cite this article: Karim T, Katiyar VK, Singh R, Dey S.
Short-term Results of Laparoscopic Transabdominal Preperi-
Introduction: Inguinal hernias have plagued mankind for its toneal Inguinal Hernioplasty in a Developing Country. World J
upright gait since evolution. Around 16% of the patients pre- Lap Surg 2017;10(3):83-86.
senting to surgery outpatient department have inguinal hernias.
Various procedures like the use of patients’ own tissues or Source of support: Nil
prosthetic meshes have been used in the past to repair inguinal Conflict of interest: None
hernia with varying degrees of success. Laparoscopic her-
nioplasty is the latest technique with several advantages over
open procedures like reduced postoperative pain and shorter INTRODUCTION
recovery period. However, steeper learning curve and cost of
the procedure have been cited as limiting factor. Inguinal hernia repair is the most frequently performed
operation in general surgery. The standard method for
Aim: To study the outcome of laparoscopic transabdomi-
nal preperitoneal (TAPP) inguinal hernia repair in terms of inguinal hernia repair had changed until the introduc-
operating time, postoperative pain, wound complications, and tion of mesh and minimal access laparoscopic technique.
recurrence. The concept of hernia repair underwent evolution from
Bassini’s repair to Lichtenstein tension-free repair with
Materials and methods: This is an analysis of patients that
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underwent TAPP inguinal hernia repair, from January 2013 to the introduction of polyethylene mesh. Prosthetic bio-
May 2015. Case records of 90 patients between 18 and 60 years materials have been combined to form composite mesh
that underwent TAPP by a single surgical team were followed in order to minimize the undesirable side effects. Mesh
prospectively. Data regarding operative time, complications, placement can be achieved by both open and laparoscopic
immediate postoperative pain, chronic groin pain, recurrence, 2
and sensory disturbance were recorded and evaluated. techniques. There are two main approaches for the lapa-
roscopic repair of inguinal hernia. 3
Results: All the patients were males aged from 18 to 60 years. Transabdominal preperitoneal repair involves access
Mean operative time was 60 minutes (40–120 minutes). Postop-
erative pain as assessed by visual analog scale (VAS) 6 hours to the hernia through the peritoneal cavity. Mesh is placed
after has been low (mean: 2). Chronic pain occurred in 2 patients in the preperitoneal space, after incising and dissecting
(2.22%), but that has not affected routine work or mobility. parietal peritoneum. Total extraperitoneal (TEP) repair
Conclusion: Short-term results of TAPP hernia repair using is the newer laparoscopic technique, in which preperi-
mesh demonstrated to be an effective and safe procedure with toneal is created without entering the peritoneal cavity.
low prevalence of chronic pain that was generally of a mild, This TEP repair is technically more difficult than the
infrequent nature. Intraoperative bleeding and use of postopera- TAPP technique, but it may reduce the risk of damage to
tive analgesia were considerably less. There was no incidence intraabdominal organs.
of early recurrence. Learning curve is not so steep as claimed, The potential benefits of using a laparoscopic approach
and considering advantages, the cost of the procedure should
not be a limiting factor even in a developing country. include reduced postoperative pain, earlier return to
normal activities, and a reduction in long-term pain and
Keywords: Laparoscopic hernia repair, Lichtenstein hernio-
plasty, Stoppa repair, Total extraperitoneal hernioplasty, Trans- numbness. The repair of bilateral hernias (including
abdominal preperitoneal hernioplasty. occult hernias detected during contralateral inspection at
the time of a unilateral repair) may be undertaken during
the same operation. Laparoscopic surgery is associated
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1,4 Professor, Resident, Senior Resident with additional costs, for the endoscopy system (video
1-4 Department of Surgery, ESIC Postgraduate Institute of unit, monitor, endoscope, and CO insufflator) and instru-
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Medical Sciences and Research, New Delhi, India ments (staplers, diathermy scissors, or ports), although
Corresponding Author: Tanweer Karim, Professor, Department these may be reusable.
of Surgery, ESIC Postgraduate Institute of Medical Sciences Today, inguinal hernia repair is one of the most com-
and Research, New Delhi, India, Phone: +918447241237 monly performed general surgical procedures in the
e-mail: karimtanweer@yahoo.co.in
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USA, accounting for 10 to 15% of all operations. These
World Journal of Laparoscopic Surgery, September-December 2017;10(3):83-86 83